Taking responsibility for your own health is a well-worn mantra for aging Baby Boomers and now even for post-Boom generations. But will a typical physical examination provide enough information to truly get a handle on one’s well-being?
The average adult requires some 24 preventive services, or tests, according to a study based on recommendations by the U.S. Preventive Services Task Force, appointed by the U.S. Public Health Service. But some important preventive measures, such as screening for vision impairments, colorectal cancer and chlamydial infection, are administered to less than 50 percent of appropriate patients, according to a study published in the American Journal of Preventive Medicine.
Bottom line: People may get a snapshot of their health, but they won’t get the big picture.
Squeezed by the financial pressures of managed care and a plethora of time and resource demands, some physicians find it virtually impossible to administer needed preventive services in a single patient visit.
But consumers now have options. Though insurance companies vary in their level of reimbursement for preventive services and the medical community debates the efficacy of these measures, a flourishing industry offering a variety of screening services has emerged.
“There certainly are more preventive tests and screening exams available than ever before,” said Dr. Mary Jo Welker of Columbus, Ohio, a member of the board of directors at the American Association of Family Physicians. “Although insurance pays for some of these, many people who have the money are now starting to pay for these services themselves. And, even though there might not be long-term medical outcomes to prove the efficacy of some of these tests, to get the tests done sometimes just offers peace of mind to people.”
Supersized exam
Executive health physicals are an increasingly popular preventive health option.
Though the comprehensive exams originated decades ago as a means for corporations to keep top executives healthy, individuals increasingly are paying for the exams without corporate or insurance reimbursement, said Dr. Robert Noven, medical director of Northwestern Memorial Corporate Health in Chicago, which provides health services to businesses.
In the six years that Northwestern has been administering the exams, Noven has seen the number of individuals who pay for the check-ups out of their own pockets rise from virtually none to about a third of patients.
Though there is no formula for executive physicals, the exams go far beyond the average physical. The comprehensive tests can last anywhere from three hours to two days. The typical executive physical begins with a detailed medical history, followed by a battery of blood chemistry tests and a thorough hands-on exam.
Other commonly included components include a chest X-ray, body-fat percentage test, hearing and vision screen, pulmonary (lung) function test, electrocardiogram, bone-density test, coronary-risk profile, kidney-function screen, exercise stress test, urinalysis screen and nutritional and lifestyle consultations.
For men, executive health exams may include some form of colon cancer and prostate screening. Women often receive a gynecological exam, Pap smear and mammogram.
The exams usually conclude in a private consultation with the physician as well as a detailed written report offering health and lifestyle recommendations. Prices for the exams range from $450 to a few thousand dollars.
Chris Pucel, 52, a finance professional from the Joliet area, recently underwent an executive physical at Executive Health Exams International in Chicago.
“As you get older, things start to deteriorate,” said Pucell, whose company picked up the tab for the physical. “They were able to see where my deficiencies are and, best of all, they took the time to discuss what I could do. They don’t rush you in and out of there.”
Dr. Erik Kooyer, who maintains a private practice on the South Side and administers executive physicals at Executive Health Exams International, believes the money is well spent.
“None of us would ever argue about the costs of an oil change, and we realize the peril of not doing so,” he said. “We seem to be slower about accepting the costs of taking our own preventive health measures.”
Though a comprehensive physical serves as a good starting point to assess health, some people are looking to go a step further by undergoing–and often paying for–imaging tests that may reveal the beginnings of heart disease, lung disease or cancer.
Though the efficacy of the cancer testing has been under fire of late, Robert Jackway of Rosemont, now 49, is convinced that the heart scan he paid to undergo in 1998 was a lifesaver.
One case
He had started experiencing breathing problems that initially were thought to be related to asthma. Even though Jackway’s family had a history of heart disease, two internists told him that there was no need for a heart scan.
Jackway nevertheless underwent a CT scan, or computerized X-ray, at the University of Illinois Physicians Group, a Heart Check America facility in Arlington Heights. The results revealed an 80 percent blockage in one of his arteries, which was verified by an angiogram. He underwent angioplasty to open the artery.
“The internists were telling me that I am fine because I was in such good physical condition that I was passing the stress tests. So it basically fooled the doctors into believing that there were no problems,” Jackway said. “If I didn’t undergo the screen, I might have never found the blockage and could have had a heart attack and dropped dead without any warning signs.”
Though Jackway embraces heart screening, the medical community is divided. Long-term studies to prove their effectiveness have yet to be published, and many doctors question if the benefit actually outweighs the risk of radiation exposure.
Dr. George Kondos, associate chief of cardiology at the University of Illinois at Chicago, however, believes that the CT scanning can pick up on heart disease early. Kondos, who is working on a number of studies involving early detection of heart disease, said that the CT tests are a good idea for men past age 40 with at least one other risk factor such as hypertension, high cholesterol or family history of heart disease and for women past age 50 with at least one other risk factor.
“You can just drop dead if you don’t have any pain,” Kondos said. “The key to treating heart disease is early detection.”
The debate and a sampling of costs
Some doctors contend that the battery of new imaging tests is a good way for people who face some type of risk to get a glimpse of their actual health status, while other physicians contend that the tests have yet to prove themselves.
“Remember, cholesterol-screening tests were not paid for by insurance companies just 10 years ago. So these tests might become more accepted as time goes on as well,” said Dr. George Kondos, associate chief of cardiology at the University of Illinois at Chicago.
“But sometimes medications look really good when they first come out and then you find there are side effects after using them in long-term clinical trials. Or you just find out that over the long haul they don’t really do anything,” added Dr. Mary Jo Welker of the American Association of Family Physicians.
As the medical community further debates the merits of each of these tests, consumers, for now, will have to decide if the following procedures are worth it (All prices are from Heart Check America.):
Coronary artery scan: Detects and measures coronary calcium, the marker for atherosclerosis ($395).
Lung scan: Detects lung cancer and other abnormalities in the lungs ($395).
Body scan: Includes the functions of the two earlier scans plus detects cancer and other abnormalities in the kidneys, liver, pancreas, gallbladder, abdominal aorta, adrenal glands, lymph nodes, spleen and in the bladder, prostate, ovaries and uterus ($800).
QCT bone-density scan: Detects osteoporosis (a silent disease characterized by low bone mass and structural deterioration of bone tissue) before a fracture occurs ($195).
Virtual colonoscopy: Detects cancer and polyps (small growths that may become cancerous) in the colon. More than 95 percent of all colon cancers start as benign polyps that gradually transform to a malignant state during 10 to 15 years ($1,450).
— J. M.
