“Complete” Health Checkups : Are they complete? Are they useful ?
There is a proliferation and plethora of health check up schemes offered by hospitals and clinics.
Conceptually, the expectation is they are very useful for making early detection of diseases and preventing their progression. Glaring examples are high blood pressure and diabetes which have no symptoms and can be only detected when measured as a routine.
However, an analysis of pooled results of nine trials involving 11,940 deaths has revealed the opposite. This recent Cochrane review (ref below and which was in the news recently) by Danish researchers lead by Lasse Krogsbøll has claimed that, “"We think it's unlikely that health checks reduce mortality to a degree where it would be beneficial," because in the analysis it was found that it did not lead to any substantial reduction in the deaths for instance from cancer and heart disease.
The reason for such findings could be that the health checkups are being utilized by the "worried well" segment of population- people who are usually fit and take an interest in their own health while unfortunately those who are at high risk of serious illness shy away from these regular checkups. Or it might be that genuine health problems are spotted at other times - when patients present with symptoms, to the physician. Following which the physicians generally do aggressively manage them and hence the results of regular health checkup do not seem to affect the statistics on deaths. Or it's possible that those getting the checkups were already well cared for by their regular doctor
A downside of general health checks is the problem of false positive and false negative test results.
The former (a test result which is falsely abnormal) may lead to unnecessary further testing or over treatment which may be harmful and anxiety development among the people.
The latter (a test result which is falsely ‘normal’, but actually the person has disease which is missed) may give a false sense of assurance and complacency. An example is a “normal” cardiac stress test and patient developing heart attack a few days or weeks later.
The again, if tests are normal but lifestyle is unhealthy, it could be dangerous. For example, a heavy smoker may get all his test results normal and hence may continue smoking. Sometimes all tests are done except the one relevant for that person. Hence the Cochrane reviewers mention that “public healthcare initiatives that are systematically offering general health checks should be resisted.”. “ The results don't imply that prevention is worthless”, Krogsboll said, “just that offering checkups to the general population of adults doesn't seem to add benefits.”
On the reverse, besides the examples of hypertension and diabetes alluded to above, there are ample examples of early detection of cancer and other diseases which lead to early treatment and prevention of progression of disease. Also, by providing an opportunity to both patients and physicians to contemplate and discuss potential risks, the check ups could also provide a vehicle through which patient worries can be more thoroughly addressed and methods to adopt preventive measures including lifestyle changes promoted.
So what is the way forward ?
As in many things in life, I think the middle way is the best. It helps to be selective.
- Do a general health check if your doctor suggests or your organization requires it or if there is a suspicion that there may be a problem or if there is strong family history of a disease.
- Add some more tests which are more relevant to a person if not included in the plan
- Certain tests like routine & regular measurement of BP, blood sugar and lipid profile should be universally adopted, should start from age of 30 and done periodically in view of the high prevalence of coronary disease in our country especially in the young. Screening for breast cancer and cervical cancer in women and occult blood in stools are other examples. Hence the results of the Cochrane review does not imply that doctors should stop clinically motivated testing and preventive activities.
- Remember the limitations of the tests. They are neither complete (no battery of tests can detect ALL the possible future abnormalities) nor 100% accurate. Don’t rely too heavily on test results or rush for further testing. The test results should be discussed with an independent consultant not related to the check up plans so as to take into consideration false positives and negative possibilities and the likelihood of disease in the person and to decide on the necessity of further testing or treatment
- The most important role of life style should not be over shadowed by “health check ups”. One should remember that the test results could be normal, yet a person may develop disease due to faulty lifestyle or due to not doing important tests relevant to that person (not included in the check up plan). So a so called “complete medical check up” is no substitute to a healthy lifestyle consisting of regular aerobic exercise, prudent diet and avoidance of smoking.
- How frequently should undergo “health checks” ( for example yearly ? every 2 years? every 5 years?)
This depends on the risk profile of the person and the results of first test. Not everyone requires an annual medical check up. For example certain professions like pilots on whom many lives depend, require annual checks even though first check up is entirely normal.
So do you want to go for a general health check up ? Go ahead, but tread slowly, with eyes, ears and mind open.
