The difference and connection between preventive health care and physical examination

Physical examination is the most important entry-level means of preventive health care. Preventive health care is an extension of the value of physical examination. The ultimate goal is to reduce disease risks and improve long-term quality of life.

Two years ago, when I was working as a public health volunteer at a community health service center, I came across a particularly typical example: Aunt Zhang from the community had a full set of physical examinations with her unit every year, and every report showed "no obvious abnormalities." As a result, she was suddenly hospitalized last winter because of transient cerebral ischemia. The doctor said that she might have suffered a cerebral infarction if she had been here a few days later. Aunt Zhang was lying in the hospital bed and still wondering: My physical examinations are normal every year, how come something happens when I say something is wrong?

In fact, this is the misunderstanding that many people have about physical examinations and preventive health care: they think that doing a physical examination is equivalent to doing health management, confusing two related but completely different things.

To put it bluntly, a physical examination is more like taking an "instant snapshot" of your body. All indicators reflect your physical condition during the days of the examination - if you stayed up late the day before the physical examination and drank half a catty of liquor, there is a high probability that the transaminase will be high. After taking a rest for three to five days and then checking again, it may return to the normal range. Nowadays, the passing thresholds for routine physical examinations are based on clinical diagnosis standards. For example, only fasting blood sugar ≥ 6.1mmol/L will be marked as abnormal, and blood pressure ≥ 140/90mmHg will be judged as high blood pressure. As long as this threshold is not reached, even if your blood sugar is stuck at a high level of 5.8-5.9 for three consecutive years, the report will only give you a "normal" rating. There have been different voices in the industry regarding this threshold setting: The clinical school believes that if the threshold is lowered, it will increase a lot of "health anxiety" out of thin air, which will be detrimental to the public's mental state. ； Public health advocates believe that the existing thresholds for routine physical examinations are too loose and can easily miss a large number of high-risk groups in the early stages of the disease. This is equivalent to drawing the early warning line at the node of "already sick" and wasting the early screening value of physical examinations.

The logic of preventive health care is just the opposite. It will not wait for you to reach a critical point before taking action. Let’s talk about Aunt Zhang. Her physical examination reports over the years have actually buried signals: her body mass index has been above 28 (obese) for four consecutive years, her fasting blood sugar has increased year by year, and she has a family history of hypertension. If this information was included in the preventive health care system, the family doctor in the community would have followed up early and asked her to control her sugar, lose weight, and monitor her blood pressure every day. She would not have suffered from cerebral ischemia. When I used to go to the clinic with general practitioners, I often heard them say a joke: "A physical examination is an X-ray of health. It can see whether you are growing anything and whether your indicators are up to the passing mark." ； Preventive care is daily maintenance of health. You can’t wait until the annual vehicle inspection to think of changing the oil, right? ”To put it bluntly, preventive health care covers the 364 days beyond the physical examination: how much salt you eat every day, how many hours you sleep, whether you exercise for 150 minutes a week, and whether you are emotionally stressed for a long time. These details that are not written on the physical examination report are precisely the core intervention content of preventive health care.

Of course, the two are not antagonistic at all, but can be said to be bound. After Aunt Zhang's accident, the community piloted a "post-examination closed-loop" model: after a resident has a physical examination at the center, the system will automatically pull his physical examination data for the past five years for comparison. As long as he is at risk of chronic diseases, the data will be directly synchronized to the corresponding family doctor. Someone will follow up to provide guidance on diet and exercise, and will be reminded to review relevant indicators every three months. After more than a year of operation, the new incidence rates of hypertension and diabetes in the community have been directly reduced by 12%. There are now two different operating ideas in the industry: Most commercial physical examination institutions still follow the "examination is over" model, and they sell the physical examination package itself. ； More and more public medical systems are trying to connect physical examinations with follow-up preventive care. To put it bluntly, they are turning one-time screening into long-term health maintenance. The latter is actually the direction that the public health system wants to see most.

Let me tell you a little story about myself. During my physical examination last year, my uric acid was measured at 412 μmol/L, which is only a little lower than the critical value for men of 420. The physical examination report is of course "normal", but I know that this is a red light warning. During that time, I happened to work overtime, drink soup and eat seafood every day. I quickly adjusted my diet for two months and increased the frequency of weekly exercise. When I checked again, it dropped to 357. If I had only looked at whether there were arrows on the report, I wouldn't have taken it seriously at all, and I might have had a gout attack in two years and was so painful that I couldn't get out of bed.

In fact, there is really no need to draw too close the boundary between the two, and we ordinary people don’t need to worry about conceptual differences: just do the annual routine physical examination, don’t find it troublesome or useless. When you get the report, don’t just turn to the end to see if there is any “abnormality”. Pull out last year’s report and compare it to see which indicators are quietly rising. If you really don’t understand something, just ask a community doctor. Stay up less late at night, eat less heavy takeaways, and walk two more steps. These seemingly inconspicuous little things are the most practical preventive health care.