Essay on the relationship between preventive health care and physical examination

Core conclusion (stated directly at the beginning)

Preventive health care and physical examination are not a one-way subordinate relationship of "including and being included". The two are dynamic linkage systems that support each other throughout the whole life cycle of health management - physical examination is the most practical pre-screening tool for preventive health care, and the goal of preventive health care is the core anchor for the formulation of physical examination plans, interpretation of results, and follow-up intervention. The ultimate goal of pre-control of health risks cannot be achieved without either of them.

Last year, I participated in the physical examination follow-up work for the elderly over 65 years old at a grassroots public health station. The one who impressed me the most was Uncle Li, who lives in Dongyuan Community. His physical examination for three consecutive years showed that he had carotid plaques and high blood lipids. However, he felt that he was doing good health by dancing in the square every day and taking deep-sea fish oil on time. He never adjusted his diet or took statins according to the recommendations of the physical examination report. He suffered a cerebral infarction last winter and was sent to the hospital. Although his life was saved, the left side of his body suffered from hemiplegia. When talking about this case, the old doctor at the station who had worked in public health for 30 years sighed and said that this is a typical example of making health care and physical examination into "two skins". It seems that both things are done, but in fact it has no effect at all.

In fact, the industry has always had different academic views on the weight positioning of the two, and there is no unified standard answer. Most scholars of the traditional school of public health emphasize the basic value of physical examinations and believe that the formulation of all preventive health care measures must be based on accurate physical examination data. The essence of health care without the support of physical examinations is "blind nutrition" - just like supplementing iron casually without doing blood routine, blindly supplementing calcium without checking bone density, which may bring additional metabolic burden to the body. This view is also recognized by many grassroots practitioners. After all, we have encountered too many cases of supplementing indiscriminately following Internet celebrities' health posts, but supplementing problems. The clinical prevention school that has emerged in recent years is more inclined to believe that universal preventive health care behaviors (such as smoking control, alcohol restriction, and 30 minutes of moderate-intensity exercise every day) can be carried out without relying on the results of physical examinations. Overemphasis on the necessity of physical examinations will actually raise the threshold of preventive care and make many People with low incomes and no fixed physical examination benefits directly give up health management. This view is also supported by data: the 2021 National Resident Health Literacy Monitoring Data shows that the proportion of people who believe that “physical examinations are too expensive and unnecessary” has reached 27%, of which rural residents account for more than 40%.

Both views are actually tenable. A cohort study covering 12 provinces published in the magazine "China Public Health" in 2022 showed that people who adhere to daily health care but do not have regular physical examinations have a 42% lower rate of early diagnosis of chronic diseases than those who have annual physical examinations.； There is almost no difference in the risk of chronic disease among people who only undergo physical examinations without follow-up health care intervention and those who do neither type of measures. To put it bluntly, neither one of the two things will work.

I have a friend who works as an Internet operator in 1996. He soaks wolfberry in a thermos cup every day and takes anti-sugar pills and liver-protecting tablets every day. He told him to go for a physical examination every year. He always said, "I usually do such a good job in health care, there is no need to spend that wasted money." As a result, the physical examination for the recruitment in the spring of this year showed moderate fatty liver and uric acid exceeding the standard of nearly 100 μmol/L. He himself was confused and said, "How can I still get fatty liver when I take liver-protecting tablets every day?" ”In fact, his health care measures were completely based on online marketing posts and did not match his lifestyle of staying up late every day and eating takeout every day. If he had had a physical examination a year or two earlier, he would have known that his body fat rate was high and his metabolism was poor. Adjusting his diet would have been more effective than taking any imported supplements.

The problem of “excessive physical examinations” that everyone complains about now is essentially a physical examination that is divorced from the goal of preventive care: people in their twenties and thirties with no family history of cancer are asked to undergo thousands of dollars of PET-CT screening. This not only wastes money, but also causes unnecessary radiation exposure, which completely violates the original intention of preventive care to “reduce health risks.” When our station now provides physical examination packages to residents, we will first spend 10 minutes asking about past medical history, family history, and living habits. If there is a smoking history of more than 10 years, a low-dose spiral CT will be added. If there is a family history of diabetes, a glucose tolerance test will be added. We will never blindly promote expensive items. After all, the core purpose of the physical examination is to provide direction for follow-up health care, not to make more money.

To put it bluntly, preventive health care is like the daily maintenance you do for your car: add regular oil, change the engine oil regularly, and don’t slam on the accelerator or brake. This is the most basic health care.； The physical examination is like an annual car inspection. No matter how well you maintain it, you still have to check whether the brake pads are worn and whether the engine has carbon deposits. Otherwise, if it breaks down halfway while driving, the money and energy spent will be much more than the maintenance and vehicle inspection combined. Some people also say that I usually drive very carefully, can I not have my car inspected? Of course it's possible, but if something goes wrong, you have to bear the risk yourself. That's the truth.

Last month, I went to the countryside with a provincial disease control expert to do science popularization. What he said was particularly spot-on for me: “Preventive health care and physical examination are like two legs of a person. If one of them is missing, you will stumble on the road to health. ”There is no standard answer for who is more important. The best combination is the one that suits you: If you have a regular schedule, eat healthy, and have no family history, a basic physical examination worth a few hundred dollars every year is enough. ； If you have underlying diseases or family medical history, you must appropriately increase the frequency and items of physical examinations, and cooperate with targeted health care measures. This is the correct way to start health management.

References

[1] National Health Commission of the People's Republic of China. Health Examination Management Standards (2023 Edition) [S]. 2023.

[2] Zhang Li, Wang Hao, Li Ming, et al. Cohort study on the risk of chronic diseases among adults in 12 provinces of China based on group examinations and preventive health care behaviors [J]. Chinese Public Health, 2022, 38(11): 1387-1392.

[3] Publicity Department of the National Health Commission. 2021 National Resident Health Literacy Monitoring Results[R]. 2022.