Executive physicals--bad medicine on three counts.

  • Brian Rank
  • Published 2008 in The New England journal of medicine

Abstract

n engl j med 359;14 www.nejm.org october 2, 2008 1424 I corporate boardrooms throughout the United States, executives are wrestling with the management of health care costs. They are demanding health care services that are effective and evidence-based and that don’t entail excess or unjust costs. They are meticulously assessing insurers and providers on all these counts as never before. And rightly so. There’s some irony, then, in the fact that many of these executives leave these boardrooms for days at a time to take part in one of modern medicine’s most expensive and least proven approaches to care: the executive physical. If you want to have an executive physical (and have the money to pay for one), you won’t have to look far. These services are marketed heavily by many of the country’s largest and most highly regarded health systems and hospitals, including the Mayo Clinic, the Cleveland Clinic, and dozens of others. Although the specific components of these programs vary, certain traits are common. Most involve a dedicated block of time — a day or two — during which the executive undergoes an extensive and comprehensive battery of in-depth medical tests and evaluations, with results made available immediately. Most such physicals are marketed as a yearly event. Most cost thousands of dollars and are not covered by insurance. Many of the centers that provide them tout an environment of exclusivity, personal attention, and luxury of the type one might expect to see at a four-star hotel or high-end resort. Those who undergo these physicals clearly appreciate the indulgent touches, such as complimentary bathrobes and slippers or the performance of the whole process in a so-called VIP area.1 It’s easy to understand the appeal of the executive physical to companies and their executives. With executive compensation high and competition for top talent fierce, it’s not surprising that companies want to do everything they can to protect the investment they make in senior management. Nor is it surprising that the executives themselves, with heavy demands on their time, would be drawn to the convenience of onestop shopping, the pampering, and the peace of mind that the executive physical seems to represent. Like a four-star hotel, the executive physical is, at least outwardly, “the best” — just what executives are accustomed to getting. It’s also easy to understand why the executive physical appeals to the hospitals and systems that offer it. The physical represents an opportunity for the provider to show off its ability to serve high-profile patients with the most advanced testing available. It also represents a new and attractive revenue stream. Nevertheless, in my view, the emergence of executive physicals is not a good thing. It’s not good for the patients who undergo them, it’s not good for the companies that pay for them, and it’s not good for the health care system overall. As an example of progressive medicine, the executive physical fails on three important counts: efficacy, cost, and equity. Inherent in the provision of this service is the notion that the most health care is the best health care. If a standard physical exam entails three tests, the thinking goes, then an exam with a dozen tests must be better. Similarly, an exam that takes 2 days must be better than one that takes an hour. Of course, there is no evidence for either premise, and indeed a growing body of research suggests quite the opposite — that unnecessary testing may cause more harm than good, owing to false positive findings, unwarranted follow-up visits and costs, needless worry, and harmful side effects of the tests themselves. Consider, for example, the inclusion in many executive physicals of a computed tomographic (CT) scan of the heart to determine the executive’s calcium score. Although most patients would probably find information gleaned from this examination interesting, it is rarely meaningful as a predictor of disease. In its current summary of recommendations, the U.S. Preventive Services Task Force concludes that the potential harms of routine screening for coronary heart disease in low-risk adults exceed the potential benefits.2 Executive Physicals — Bad Medicine on Three Counts

DOI: 10.1056/NEJMp0806270

Cite this paper

@article{Rank2008ExecutivePM, title={Executive physicals--bad medicine on three counts.}, author={Brian Rank}, journal={The New England journal of medicine}, year={2008}, volume={359 14}, pages={1424-5} }