Every journey has a starting point. Every story has a sequence that must be followed in order for it to make sense. As the Red King said to Alice, “Begin at the beginning, proceed through the middle and then, when you come to the end, stop.” The executive’s journey toward wellness is not excepted from this rule. This month’s installment is the first of two parts about taking your first steps along the wellness path.
Most people who achieve executive status (including entrepreneurs, law partners, small- and medium-sized business owners, corporate and financial consultants) are usually well into or past their mid-30s. In fact, most are over 40, and some are surging into their 50s and 60s. With that much mileage on the odometer, regardless of your general level of physical fitness (just finished another triathlon, did you?)—and in some cases because of your high level of physical fitness—you may have accumulated more wear and tear, bumps, bruises and road rash (physical, mental, emotional, spiritual, internal and external) than you care to admit or, in many cases, tend to avoid thinking about.
OK, denial is a widely practiced coping mechanism, though not a very good one. And it breaks down sooner or later. Problems have to be faced. So, before pounding on down the Wellness Road in search of optimal performance, you must first make sure you’ve taken care of the basics. And the prime basic here is to do something about what may be ailing you. That’s to say, if you are carrying a disease or are merely afflicted with imbalances that can lead to illness, then it’s not realistic to be thinking about wellness as your next destination—first things first.
Executive health and screening programs are popping up all over the country like mushrooms after a rain. Total body scanning centers are being advertised in the newspapers. Executive health and wellness programs are being launched at university medical centers. Private clinics, spas and retreat centers offer various versions of “comprehensive” health and wellness assessment programs. Many alternative healing programs and practitioners offer their own versions of health and wellness assessment. For do-it-yourselfers, there are self-assessment tools on the Internet. And more and more mainstream primary care physicians are interested, knowledgeable and capable enough to provide important health assessment services. Where, oh where, should a humble executive from the country begin to choose from such a potpourri of programs?
Total body scans
Total body scanning services cater to the popular fantasy (and our good old American love of technology) that health assessment can quickly, easily and reliably provide tangible results told with pictures. Employing an x-ray device (mostly specialized CT scanners), these programs claim to provide a comprehensive look at your body’s major organ systems to show the presence of certain risk factors and perhaps even to spot certain kinds of diseases before you become symptomatic. They’re promoted on the notion that life can be prolonged via radiological detection of diseases in early stages. They claim to assess your current risk for developing several treatable conditions, including heart attack, osteoporosis, gallstones, kidney stones and aortic aneurysms. They also promote the idea of finding lung, kidney or other cancers in the earliest stages before you develop symptoms.
Max Rosen, M.D. and associate professor of radiology at Harvard Medical School, says, “The best uses [of total body CT scan screening] are to give patients intelligent information about their health status that they can use to make decisions about future medical care or lifestyle choices.” The cost of such scanning ranges from several hundred dollars up to more than $1,000 and is almost never covered by insurance. Besides cost, the downside of total body scanning is there’s little scientific evidence that it’s effective enough to be relied upon or to be widely employed—though there are occasional dramatic anecdotal reports of successful disease detection and treatment.
Many scans only obtain “false positive” results (the false detection of an abnormality later shown not to be present). There’s also the risk of “false negatives” (when a disease is present but not detected). The former can lead to unnecessary anxiety and the costs of additional testing or unneeded medical services. The latter can leave you with an unwarranted reassurance of good health, even if you might be in the early stages of a serious disease. The biggest overall risk may be the temptation to take a body scan result out of context, such that the advice and services of a regular medical and/or complementary health-care providers advice and services are relegated to lesser importance.
University and private programs
University-based and similar high-profile private executive health programs (such as the Mayo Clinic and Scripps) are another option for your health assessment. They tend to market their status as “centers of medical excellence,” and most offer a more or less comprehensive array of medical screening services aimed at detecting the presence of disease or incipient health problems. Many also offer a selection of services by repackaging the offerings of existing specialty departments that are, sometimes, bundled with the fees for an overall health maintenance or wellness program. Others provide screening services only, and any medical or allied health services that are subsequently required revert to a standard fee-for-service arrangement.
Most of these programs are careful to highlight “special attention” for the busy executive, and usually include some form of appointment streamlining, same-day services, customized screening programs, even valet parking and/or limousine service, all of these being important conveniences to anyone who has had to deal with the intrinsic inefficiencies of large urban medical school campuses. However, these perks arguably only bring the time-efficiency factor a little closer to that of seeing a local medical provider in our own rural-urban environment.
A typical medical school-based executive health program will offer some combination, or all, of the following:
• Comprehensive laboratory testing
• Cardiac exercise tolerance test
• Nutrition assessment
• Lifestyle and fitness assessment
• Stress management evaluation with a psychologist
• Various risk assessment tests, x-rays and/or scans for coronary artery disease, stroke, diabetes, hearing, eyes, skin conditions, colon cancer, pancreatic disease, abdominal illness, prostate cancer, breast cancer, osteoporosis, body fat assessment, lung disease and other test batteries determined by family history and personal risk profile (most often at additional cost to the basic program fee)
• Referral within the medical school system to expert specialists as needed
• A written report, copies of all test results, possibly including all of same on a take- home CD-ROM
Additional, optional features may include:
• Exit interview with a program physician
• Interview with a health-care coach
• One or more periodic follow-ups
• Storage of your results and records for “future reference,” which some may regard with skepticism in an era when private personal information is so subject to invasion and disclosure.
Deluxe private assessments
The unquestioned deluxe version of executive health screening is the private multifaceted clinic and private spa/resort setting for what might be called a “total immersion” health assessment. An industry-leading prototype of these is Canyon Ranch and its two campuses in Arizona and Massachusetts. In these programs, a very well-designed, comprehensive screening and subsequent wellness program is provided in a dedicated and custom luxury environment that supports and facilitates the entire experience.
In these programs, there is more emphasis on taking the time required and maximizing the discovery process and self-awareness benefits. In addition to what the university-based programs offer, there is typically emphasis on detailed fitness assessment, healthy nutrition and psychological assessment and education—the latter a feature most often neglected among the majority of body-focused assessment programs.
During the several days you’re undergoing a comprehensive assessment, you can take full advantage of the complete luxury spa and resort accommodations and facilities. In these high-end programs, the net program usually equals the medical scope provided at the best university programs. The best private programs exceed the university programs in terms of helping you integrate and understand the results. They also provide a road map regarding how next to proceed using more holistic resources than basic mainstream medical care services.
Following the initial assessment, these health resort complexes entice your return business by offering any number of health and wellness-promoting vacation packages. The packages focus on things like weight control, smoking cessation, stress management, physical conditioning and preventive strategies for your personal needs. All this combined convenience and customized care is obtained at a cost. And, at this level of service, the cost of health screening alone can range from $3,000 to $5,000. The concurrent hotel/spa services and accommodations for 4 to 10 days will be an additional $3,500 to $15,000.
So now you have an idea of the types of assessment tools that are available to you. In next month’s column, I’ll dig a little deeper into choosing the one that might best suit your needs.
Allen Gruber, M.D., is an anesthesiologist and pain management specialist. He’s been living along the Russian River and practicing medicine in Sonoma County for 15+ years.
You can reach him at agruber@northbaybiz.com.
