Routine physical examination does not check for infectious diseases

The vast majority of ordinary routine physical examination packages do not include systematic infectious disease screening, but only cover basic indicators of a very few specific infectious diseases based on package positioning and industry requirements.

If you were to look through your workplace welfare physical examination report last year, you would most likely not be able to find testing items for infectious diseases such as HIV, hepatitis C, and syphilis, right? I helped compile a package list at the physical examination center before. The most common basic physical examination on the market costs 300-800 yuan. Most of the blood tests focus on routine blood tests, liver and kidney function, blood lipids and blood glucose. At most, a chest X-ray is added to check for active tuberculosis. None of the five items of hepatitis B will be voluntarily included - the state clearly stipulated as early as 2010 that routine physical examinations such as employment and school admissions should not be compulsorily tested for the five items of hepatitis B to avoid employment discrimination against hepatitis B virus carriers. Testing will only be arranged if the subjects take the initiative to sign and request the addition of items.

Of course there are exceptions. I have met a young girl who works in early childhood education. Her physical examination required hepatitis A, hepatitis E, syphilis, and PPD tests. This is clearly required by the Education Bureau. After all, she deals with children with weak immune systems every day and needs to be carefully checked. There are also physical examinations for employees in the food industry and public service industries, which also require screening for infectious diseases transmitted through the digestive tract and respiratory tract. This kind of special routine physical examination that is mandatory for the industry is not the same as the welfare physical examination for work units and the basic package of personal choice that we usually talk about. As for clearly targeted special physical examinations such as pre-pregnancy physical examination and entry-exit physical examination, infectious disease screening itself is a must and is not within the scope of ordinary routine physical examination.

Why don’t ordinary routine physical examinations include screening for infectious diseases? To put it bluntly, it is just a few practical issues that are stuck. The first is the cost. A full set of screenings for eight common infectious diseases costs one thousand less, while an ordinary basic physical examination package only costs two to three hundred. Regardless of whether the unit pays for it or the individual pays for it at their own expense, most people are unwilling to spend several times more money for low-probability events. There is also the problem of false positives. I have seen more than one person who randomly added items and found out that they were weakly positive for syphilis. They were so frightened that they could not sleep for half a month, and the re-examination came back negative. It was a waste of time. The infection rate of the general population is low, and large-scale screening can easily create unnecessary anxiety. Let’s talk about privacy issues. There was news before that a certain company mixed the positive results of employees’ infectious diseases into a unified report and issued it, causing the person involved to die directly. Neither the responsible physical examination center nor the employer can afford this kind of responsibility. Therefore, such sensitive items are applied for and reported separately, and are not included in the general package at all.

There is actually controversy over this matter in the public health field. Some scholars believe that HIV screening should be included in the routine physical examination options for people aged 18-45. After all, the infection rate in this age group has indeed increased in recent years. Early detection and early medication will make the patient's survival period almost the same as that of ordinary people, and it can also reduce invisible transmission. However, some epidemiologists object, saying that the HIV infection rate among the general population is only a few thousandths. If large-scale screening is conducted, it will consume medical resources and cause false positive psychological burden, which is far less efficient than free screening for people with high-risk behaviors. Both statements are reasonable, and there is currently no unified conclusion.

In fact, there is really no need to worry about routine physical examinations. Physical examinations are inherently a matter of "affordability and frugality". Just like when you go to a restaurant and order a set meal, the basic set meal is home-cooked food that is enough to satisfy you. If you want to eat seafood, you have to pay separately. If you have recently engaged in high-risk behaviors, are preparing for pregnancy, or are often exposed to blood or public service work, you can go to the physical examination center to add items. Most of the items are dozens to more than 100. You can also apply for separate reports and anonymous testing. You can completely control your privacy. It is much more reliable than making random guesses based on basic physical examination reports.