In last month’s column, I discussed the various methods you can use to begin your overall wellness program—from total body scans to clinical evaluations to private resorts. This time around I’ll cover cost considerations as well as what your own personal physician might be able to do for you.
Costs to consider
There are a number of North Bay corporations and industries that will underwrite the costs of the high-end screening programs mentioned in last month’s column—and regard it money well spent. For many self-employed business owners and professionals, however, the cost and time required are unsupportable. Unfortunately, it’s a rare medical insurance plan that covers wellness care or preventive health screening in the absence of a known disease. Also, it’s rare for insurers to recognize or pay adequately for multi-disciplinary health care programs. This is why almost all health screening and wellness programs are a cash-pay enterprise. Even so, they should be considered a good investment for executives because they can take advantage of health screening services that are entirely outside the restrictions of mundane insurance programs. Screening programs are also a boon for some medical providers because they’re one of the few settings where a physician or healer can practice medicine as he or she deems appropriate—without third-party interference and prohibitions.
Results to expect
The end result of a comprehensive screening process may provide a snapshot of your overall physical state, setting aside questions about statistical validity for the moment. Many of the risk indicators of evolving and life-limiting physical malfunctions can be spotted during this kind of multiphasic screening process, subject to subsequent verification.
While sounding good on paper and sometimes very informative to their recipients, the fact remains screening programs are controversial. Remember, today’s medical (and insurance) world tends to critically examine everything in a statistical crucible of accuracy, efficacy and cost-effectiveness for large numbers of people.
But what may serve the medical care and insurance industries in terms of evidence-based benefits relative to expenditure for the mass of people runs counter to what individuals perceive to be their own best interest. It’s one thing to adjudicate what’s “best” for large numbers of other people. After all, we (as the body politic) generally do not want to pay for things that do not provide the greatest good for the greatest number. But when it comes to our individual needs our opinion becomes much more liberal and inclusive about the services we think we need. Total body scans may turn out to be very cost-ineffective when applied to large numbers of people. But that kind of mass policy mentality becomes personally irrelevant to the person whose screening discovered a nearly always fatal kidney cancer that was totally cured following its removal. Was it worth it to him? You bet. Nevertheless, decisions about the appropriateness of medical screening tests are made every day in the halls of academia and government solely based on parameters of statistical efficacy and accuracy.
Rethinking the process
According to Ellen Barnett, MD, UCSF associate clinical professor of family practice and preventive medicine and co-director of the Integrative Medical Clinic (IMC) in Windsor, there are only five or so screening tests that have been scientifically verified to provide substantial predictive value for illness and to make a measurable difference in patients’ longevity. These include blood pressure screening, cholesterol profiling, colon cancer examination, PAP tests and total body skin examination. Mammograms have also been shown to be effective when employed in tandem with intelligent medical management. Dr. Barnett states with authority of long experience and expertise in both mainstream medical practice and with complementary therapies of many types, that mega-evaluations may not be particularly valid or predictive of very much when you compare the very few accurate positive findings of disease compared to the huge number of tests performed in the aggregate.
Anyone with an excellent personal primary care doctor who is well versed in preventive screening can obtain most of the benefits of health screening without resorting to vast batteries of tests. The essential ingredients are medical skill and sound clinical judgment. They are essential for making sense of all the data and deciding what further tests may be worthwhile. It may take decades for the outcome data of whole body scanning and comprehensive testing programs to be verified and ascertained for their actual effectiveness. But, right now, we know this more elegant approach comes very close to the claimed benefits of total body scanning and screening programs.
Therefore, the most likely to be medically effective and cost-effective starting point is to call your personal primary physician (MD or DO) and set up an appointment for a full health and medical screening evaluation. There are also a number of local preventive health programs that can provide formally organized outpatient screening programs as well that feature the same basic ingredients.
A head-to-toe physical exam is just the beginning. A strong emphasis should be placed upon taking a very detailed medical and health history. The next step is to obtain an inventory of health risk factors that are known to have predictive value for long-term health and longevity. The third stage should be a thorough psychological/emotional evaluation (the most often omitted Achilles heel of most executive health programs). From these, your doctor can make an informed selection of indicated laboratory and diagnostic imaging tests. Finally, your evaluation should be wrapped up with a careful explanation and counseling about your screening results and how to make whatever changes are needed in your life.
Beyond this screening process, an incremental personal change program can be implemented beginning, not with the biggest or most dramatic problem on your horizon, but first with the problems you are most likely to be successful at changing. Once you are whipped into shape by this kind of practice-for-success, you’ll be better prepared, with skillful assistance, to go for tackling “the big one,” whatever it may be in your case: smoking, weight loss, regular exercise, chronic back pain and so forth.
Taking it to the next level
Most of this column has focused on detection of bodily disease as a sort-of “clearing of the decks” for achieving wellness. The next step for most wellness seekers is to employ alternative and complementary health care providers. But, as has been pointed out to me by Dawn Present, L.Ac., a Santa Rosa acupuncturist, there is another kind of role to be played in health testing and screening by naturopaths, chiropractors, functional medicine practitioners, traditional Chinese and Aryuvedic medicine practitioners and others. Each healing tradition has its own metaphor of health and illness that serves as a mirror for what we cannot view directly. In Western medicine, it is the rationalist and scientific model of the body. In Chinese medicine, it is the balance of qi gong (chi) energy flowing through the meridians. Such constructs, however useful for the healing artist, do not particularly lend themselves to scientific analysis and may lose validity when attempts are made to translate them into other paradigms.
As I indicated two columns back, it’s very difficult to cross over from one model of health and wellness to another when analyzing a body and a life. But I also think a scientifically trained physician who is well-versed in the arcana of qi gong energetic balance, cranio-sacral energy flows, nutritional states and/or Chinese diagnostic methods may be better qualified than most of the medically focused screening programs to integrate the data obtained from both mainstream and complementary diagnosis. An executive who employs this type of healer during the next phase of a comprehensive screening is one who will realize a more complete understanding of his or her path toward wellness.
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.
