The relationship between preventive health care and physical examination

Physical examination is the most practical pre-screening tool in the preventive health care system and is the core node connecting "risk prediction" and "active intervention". However, it is by no means the whole of preventive health care - the two are complementary to "point-in-time snapshot" and "full-cycle maintenance", rather than identical or mutually exclusive.

Last week when I was doing health education in the community, I met Aunt Zhang. She came to me with the normal physical examination reports for three consecutive years. She said that she had stomach bloating and acid reflux every day and couldn't eat. She asked why nothing was found in the physical examination. The result was atrophic gastritis with mild intestinal metaplasia after a gastroscopy. If it were two to three years later, the risk of cancer would have increased several times. My aunt still can’t figure it out: “I go for a physical examination every year as required by my work unit, why do I still have problems? ”

In fact, this is also a typical misunderstanding that most people have about the relationship between the two: they either regard the physical examination as the "end point" of preventive care, and think that the absence of an arrow after the examination means that there is no problem with the body, but it doesn't matter if the condition is not good.； Either they feel that physical examinations are just an afterthought, and only minor illnesses are detected, and major illnesses cannot be cured, so soaking wolfberry at home and walking 10,000 steps are not as useful.

Interestingly, different medical systems do have different positions on the two. In the tertiary prevention framework of Western medicine, physical examination clearly belongs to the core of secondary prevention, which is what we often call the "three mornings": early detection, early diagnosis, and early treatment. For example, the 42-year-old programmer I treated last year has a 20-year history of smoking. He was advised to undergo low-dose CT every year. This year, an 8mm ground-glass nodule was detected. After minimally invasive surgery, he was diagnosed with adenocarcinoma in situ. He did not even need radiotherapy and chemotherapy. Now he has returned to work normally. This value from "discovering risks" to "blocking the course of the disease" is the irreplaceable role of physical examination in preventive health care. In the TCM system of "preventing disease," it prefers to put daily care at a higher level. In many cases, there are no abnormalities in physical examination indicators, but changes in tongue coating, pulse, and sleep and bowel movements have already pointed to imbalances in qi, blood, and internal organs. At this time, moxibustion, diet therapy, and adjustment of work and rest fall into the category of preventive health care. This school of thought also just makes up for the blind spot of Western medicine physical examination: after all, waiting for the red light to turn on before intervening is often half a beat too late.

The "physical examination IQ tax" theory that is currently very controversial on the Internet actually fails to understand the linkage between the two. Some people think that spending thousands of dollars for a full physical examination is equivalent to buying "health insurance." When they get the report, they don't even read the summary and recommendations, and just stay up late eating skewers and drinking cold beer. This actually magnifies the role of the physical examination infinitely. If you think about it, a physical examination is just a slice of your physical condition during the dozen or so hours of the examination. Your blood pressure may have been a little higher because you stayed up late the day before, and your uric acid may have drifted up because you ate seafood the day before. Even if all indicators are normal, you will still develop chronic diseases after three to five years due to your habit of being high in oil, salt and sedentary. On the other hand, some people say that "physical examination is useless, and the cancer will be in the advanced stage once diagnosed." This is even more extreme. Take lung cancer, gastric cancer, and colon cancer that are highly prevalent in my country, for example, the 5-year survival rate of the first stage is more than 90%. When you wait until obvious symptoms are detected, most of them have already reached the third stage and the fourth stage, and the 5-year survival rate has dropped directly to less than 30%. This difference between life and death is caused by physical examination.

I always make an analogy with patients: Just think of your body as a family car that you have driven for five or six years. A physical examination is an annual car inspection. If you pass the hard indicators such as lights, brakes, and exhaust, it does not mean that you can build the car casually. Change the engine oil on time, add oil that meets the label, and drive slowly when passing potholes. These daily maintenance are preventive health care. A car inspection can help you find hidden problems that you usually don't notice, such as thin brake pads and carbon deposits in the engine, but you can't expect a car inspection to help you maintain your car, right? Not to mention that many people insist on having PET-CT every year in order to "get all the tests", even though they have no family history of cancer and no high-risk habits. Instead, they consume unnecessary radiation. This is a typical example of blindly choosing physical examination items regardless of the need for preventive health care. It is a waste of money and harm to the body.

In fact, in the final analysis, whether it is choosing the right items for regular physical examinations, or staying up less late at night, eating more vegetables, and taking time to exercise, we are essentially responsible for our own bodies. There is no need to separate the two too much, and there is no need to praise one over the other. Choose appropriate screening items based on your own living habits and family medical history. When you get the report, don’t just look at the arrows. Ask the doctor where you need to adjust your living habits. Don’t rely on your youth to make blind decisions. It is more effective than any health care prescription.