July 26, 2009

Is An Executive Physical Worth The Bother?

A normal medical examination identifies normal medical issues. Specialized tests may identify other problems while minor and manageable.

Multiphasic Screening
Pretend you're an employer. An employee who goes for a medical test costs your company hours of productive work and you may also pay through group medical benefits. What if that employee needs more tests? The costs add up. And you've got other employees.

Sometimes a medical problem isn't discovered until the condition has progressed. It's now too late for prevention and treatment gets costly (time, money, productivity).

Imagine if a tractor trailer filled equipped for diagnostic medical tests came to your building. Employees could get a battery of tests quickly and inexpensively. They would appreciate your concern for their well-being. Solving medical problems early could save lives and save money too. Right?

During the summer of 1982, I investigated the costs/benefits of onsite medical tests at Crown Life --- my first actuarial job. In those pre-Internet days, gathering information took more than a quick web search. Here's what I discovered. In the United States, group medical insurance cost about $1,000 per employee per year. Would investing another $70 a year in multiphasic testing save employers money?

No. Here's why.
  1. the tests missed low probability/high severity conditions (too expensive or invasive)
  2. if problems were found, employees were reluctant to get treatment (just as we're reluctant to eat better and exercise more)
  3. if employees got treatment, the employer's current medical expenses went up
Medical science keeps improving. To explore the state of diagnostic testing, I went for an executive physical examination. I've wanted to go to a concierge medical clinic for years to detect potential medical issues early.

The Process
After booking an appointment over the phone, I received an email giving the address and instructions to fast for 12 hours. There was a link to an online stress questionnaire which took about 20 minutes to complete. The results print in a miniscule blue font (say 6 pt). Not only do you strain your eyes reading the tiny words, you waste colour ink. If you said you wanted to spend more time with your family, you'd get a recommendation saying you should spend more time with your family. Obvious stuff. I brought the results with me but no one even mentioned them.

The clinic is in a nice office tower in downtown Toronto. After changing into exercise clothing, I signed a disclaimer and authorized the release of results to my own doctor.

Here are the steps.
  1. sign a disclaimer
  2. measure height/weight/waist
  3. collect blood/urine
  4. snack (end of fasting)
  5. test vision, colour blindness and glaucoma
  6. measure lung capacity (you expell air from your lungs through a tube for as long as you can)
  7. discuss results with a doctor
  8. more testing by the doctor (blood pressure, thyroid, etc)
  9. brief discussion with the doctor
  10. measure resting heart rate (you lie down and have probes attached to your arms, chest and legs)
  11. complete feedback form, change and leave
The whole process took 2.5 hours. There's soooo much waiting, which reduces the benefits of having everything-under-one-roof. Maybe waiting leads to better test results. Maybe the length helps you feel like you got value for the money.

To my surprise and dismay, there were no other tests. Not even a treadmill, which is what I wanted most. There wasn't even an option to purchase that test or any other. I also wanted to know how my body's biological age compares with my chronological age. Am I closer to the body of 40 year old or 60 year old?

There was plenty of time to talk to the doctor but not much to discuss. He was pleasant but I had no way of gauging his skills and I doubt we'll ever meet again. Last summer, a common toe ailment caused me months of agony. Treatment took visits to six doctors (including three specialists). That shattered my faith in the medical profession. Best to stay healthy. I listened politely but am more likely to believe a Google search than a doctor. Dilbert fans may in interested in the ordeal Scott Adams endured while struggling to regain his voice.

There was no report or handout of any kind. Maybe that comes later. I didn't think to ask, but no one told me.

No medical problems were found. I was advised to exercise more (aerobic and strength) and consider a personal trainer. My snugger-than-ever pants tell me that already. I've been walking 45-60 minutes most evenings for several weeks and am starting strength training tomorrow.

Worth The Bother?
Visiting the clinic was certainly more pleasant than going to my family doctor with the crowded waiting room and noise. The tests were similar to those your regular doctor performs or orders.

There was no "wow" moment that made the experience memorable. The clinic felt like an expensive hotel. You're well treated and in pleasant surroundings. But you expect that. You paid for that.

Nothing bad happened but not nothing was exceptional either. These days average is not enough. I don't know if I'd bother going back. I prefer my regular doctor over strangers doing similar tests in a fancy clinic.

Podcast (7:21)

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