What is the relationship between preventive health care and physical examination?

Physical examination is the core link in the preventive health care system. The two are mutually supportive and indispensable. They are by no means a "subordinate" or "interchangeable" relationship as many people think. To put it bluntly, it's a bit like outpost reconnaissance and follow-up combat deployment on the battlefield. You can't figure out where the enemy is and how many troops there are during reconnaissance. The subsequent deployment is all a fool's errand. But if you just complete the reconnaissance and then leave it alone, then no matter how careful the reconnaissance is, it will not play any role in defending against the enemy.

I have been working in community public health for almost 8 years, and I have seen too many regrettable cases where the two are separated. In the past two years, there was a 43-year-old middle-level employee in a company. Every year, physical examinations organized by his company revealed excessive triglycerides and mild fatty liver disease. He always felt that physical examinations were just a formality. No symptoms meant that there was nothing wrong with him. After get off work, he continued to drink heavily with friends and stay up late to catch up on plans. He also made no health care adjustments to his diet or work schedule. Last winter, he suffered an acute pancreatitis attack and was sent to the emergency room. He stayed in the ICU for a week before he came out. The previous physical examinations were in vain.

Nowadays, there are two extremely controversial views. One is that "physical examinations are useless because they can't find any problems. It's better to eat health products and exercise more." The other group is just the opposite. They think that "a high-end physical examination worth tens of thousands of yuan every year is enough. It doesn't matter how you do it. If you find problems early, you can cure them." I have come across real counter-examples to both of these. There was a 62-year-old aunt in the community who was very particular about her health. She alternated between taking Cordyceps sinensis and fish oil, and she danced squarely every day. She said she was doing a good job in health care, but she refused to do free physical examinations for the elderly. Last year I couldn't persuade my daughter to go for a check-up. A low-dose CT scan revealed a ground-glass nodule. The pathology showed that it was early-stage lung cancer. Fortunately, it was discovered and removed in time and everything was fine. If it had been delayed for another year or two, the consequences would be disastrous. This is the pitfall of pitting health care and physical examination against each other. There is also a building materials business owner who spends RMB 50,000 to 60,000 every year on a full set of high-end physical examinations, including PET-CT and tumor markers. He feels that he has done a solid job in the physical examination. He smokes and drinks regularly and sleeps less than 4 hours a day. The annual physical examination showed that his blood pressure had reached 180/110, and he was also accompanied by carotid artery plaque. He himself was confused and said that I still have problems with my annual physical examination. This is not to regard physical examination as all preventive health care, forgetting that daily intervention is the core.

In fact, when we are doing grassroots preventive health care work, we have already embedded the two together. We will not complete the physical examination first and then slowly think about the follow-up plan. We will first customize the physical examination items based on each person's age, family history, and daily habits. For example, an old man who smokes dry cigarettes all year round will not only arrange a chest X-ray, but directly add a low-dose CT. Young people with a family history of diabetes will also need to do sugar in addition to fasting blood sugar. Tolerance, the corresponding health plan will be customized simultaneously on the day the physical examination report comes out. For example, if fasting blood sugar is found to be impaired, we will directly give you a sample recipe for the week, tell you how long to walk briskly every day, and follow up the weekly follow-up indicators. Last year, there were 37 residents in our jurisdiction who were found to have abnormal fasting blood sugar. After half a year of follow-up, 28 of them returned to normal levels. This is the effect of the linkage between the two.

To put it bluntly, it’s not that complicated. A physical examination is like a safety check you do at home every once in a while to see if there are any hidden dangers of aging wires or leaking water pipes. Preventive care is your habit of turning off unused electrical appliances and draining sewer pipes regularly. If you do not make rectifications, it will be useless no matter how detailed the inspection is. If you only do maintenance, you will not know where the hidden dangers are, and a small problem may turn into a big accident one day.