Essay on the relationship between preventive health care and physical examination

Physical examination is a cost-effective and highly operable pre-screening link in the preventive health care system. The two are neither subordinate nor interchangeable, but a complementary combination of "single-point precise inspection" and "full-cycle health maintenance" - physical examination provides quantitative decision-making basis for preventive health care, and preventive health care provides a landing intervention path for risks discovered by physical examination. The collaboration between the two is the optimal solution for modern health management.

Let me tell you a true story that I met at a community public health station last year: 62-year-old Aunt Zhang insists on having a physical examination every year, and all indicators are within the normal range. However, she suffers from dizziness and insomnia all year round, and even takes a lot of supplements to no avail. Later, the family doctor team conducted a preventive health assessment on her and discovered that she got up at 5 a.m. every morning to dance square dances. She had been exercising on an empty stomach for three years. In addition, she loved to reheat leftovers and eat them hot. Her nitrite intake exceeded the standard for a long time. After adjusting her exercise time and eating habits, her symptoms basically disappeared in less than two months. This incident also gave me a more practical understanding of the relationship between the two: many times physical examinations can tell you "you are not sick now", but they cannot tell you "whether you will get sick if you continue like this". This gap is exactly what preventive health care should fill.

Interestingly, the discussion on the relationship between the two has never stopped in the field of public health, and the views of scholars in different research directions are quite different. Those who are deeply involved in clinical prevention believe that the value of "early detection, early diagnosis, and early treatment" of physical examinations is irreplaceable. As long as the coverage of standardized physical examinations for age-appropriate people is increased, the 5-year survival rate of high-incidence cancers such as digestive tract cancer and cervical cancer can be increased by at least 40%. This is also the core logic of the country's vigorous promotion of free two-cancer screening and physical examinations for the elderly in recent years. Another group of researchers who are engaged in population health intervention use the follow-up data of the past 10 years to speak: Many people have normal physical examinations every year, but they still suffer from myocardial infarction and stroke. The problem is that the physical examination only takes a snapshot of health at a certain point in time, and does not take into account the usual risk factors such as blood pressure fluctuations, smoking, alcoholism, and prolonged sitting. To put it bluntly, the physical examination is done, but the follow-up preventive care is not kept up, which is equivalent to wasting. There is also a more radical view that many commercialized excessive physical examinations will cause unnecessary anxiety and excessive examinations due to false positives, which in turn violates the original intention of preventive health care.

I have been working at the grassroots level for almost 6 years, and I have seen too many examples of the two being separated, and I have also stepped into many pitfalls. When I first entered the industry, I recommended a physical examination package to residents, always thinking that the more comprehensive the better. Later, I met a 48-year-old sister. The physical examination report showed that the CA125 tumor marker was twice as high as the normal value. She cried with the report for almost a week and could not go to work. In the end, it was found that she had just passed her menstrual period and had chronic pelvic inflammatory disease. After three months of follow-up, the indicators fell back to the normal range. After that, I realized that without pre-evaluation and follow-up support for preventive health care, physical examination may actually add burden to people.

There is also a young man who works in Internet operations. He uses the physical examination package issued by the company every year, and all indicators are normal. He stays up late every day, drinks iced drinks, and takes omeprazole to deal with stomach pain. Last year, we came to do free Helicobacter pylori screening and persuaded him to do a carbon 14 test. He also said, "I have no problem with the physical examination. Why should I check this?" Are you saying he didn't have a physical examination? He did it, but the general package did not include screening items corresponding to his age and eating habits. The essence was that there was no risk assessment of preventive health care in advance, and the physical examination was done blindly.

In fact, to give an inappropriate analogy, a physical examination is like the annual inspection you do for your car every year. It can detect hidden faults such as brake wear and engine carbon deposits. However, preventive care means that you usually add the appropriate grade of oil, perform regular maintenance, and avoid violent driving. You can't say "I have done the annual inspection every year, so I can build a car," right? The same goes the other way around. No matter how well you pay attention to maintenance, you can't guarantee that you won't be able to discover some hidden problems on your own. You still have to rely on professional testing to find them out.

There was a 72-year-old Uncle Wang who always felt that physical examinations were useless. He said that his neighbor still got lung cancer after having physical examinations every year. Later, our family doctor team conducted a risk assessment on him and found out that he had smoked for 50 years and was a high-risk group for lung cancer. We specially applied for free low-dose snail medicine for him. Through rotational CT screening, an 8mm ground glass nodule was detected last year, and minimally invasive surgery was performed in time. Now I am recovering very well. I always say to everyone I meet, "It's not that physical examinations are useless, but that you have to choose the right items that suit you." This is actually a typical example of preventive health care that starts with stratification and then guides physical examinations.

After all, the two are inherently tied together, and there is no need to distinguish who is higher and who is lower. Now when we sign a contract with a family doctor, we first conduct a full set of health risk assessments for the contracted residents, including family history, eating habits, exercise habits, and past medical history, and then customize a personalized physical examination package. After the physical examination, we need to follow up with 6 months of health guidance, control salt when necessary, prescribe exercise when necessary, and keep an eye on reexamination when necessary. This is how preventive health care is truly put into practice.

Someone asked me before, how do ordinary people deal with the relationship between the two? I generally say one thing: Don’t take physical examination as a golden ticket to avoid death, and don’t take health care as a metaphysics. First, find a professional to check your health. Check what needs to be checked, and change what needs to be changed. This is better than anything else. After all, health can never be solved by relying on a certain examination or a certain habit. It requires a combination of punches.