The difference between preventive care and physical examination

Physical examination is a phased process of "checking for existing diseases and looking for hidden dangers". The core is to screen out health problems that have undergone pathological changes and meet the diagnostic standards.； Preventive health care is a full-cycle "preventing disease and regulating status". The core is to intervene in imbalances that have not yet reached disease diagnosis standards and reduce the risk of future illness. The two are completely complementary and no one can replace the other.

To be honest, when I was doing science popularization at a community health center, I met too many people who confused the two. The one who impressed me the most was 62-year-old Aunt Zhang. All the indicators in her physical examination for three consecutive years were within the normal range. However, she was tired all day long, had difficulty falling asleep, and her shoulders and neck were too stiff to lift. She took the report to the internal medicine department, and the doctor said she was not serious enough to take medicine, so she could only go back and rest more. Later, with the mentality of giving it a try, she went to a doctor in the preventive health department. After identifying her physical condition as qi deficiency and blood stasis, she was prescribed moxibustion twice a week, combined with Baduanjin for 15 minutes a day, and adjusted her eating habit of eating porridge every time. In less than 3 months, she said she was sleeping soundly and could not even breathe when climbing the third floor.

Interestingly, the controversy between the two has never stopped, and has even divided into two quite extreme schools: one is the "physical examination is useless", which believes that even if the physical examination indicators are normal, you will still feel uncomfortable, so it is better to spend money on daily health care. Some people even dare to say that health care can replace cancer screening.； The other school is the "health IQ tax theory", which believes that all interventions that do not see clear changes in indicators are deception. It is enough to have a physical examination every year, and there is no need to waste money on anything else.

If we speak objectively, both views are a bit extreme. First, let’s talk about the irreplaceability of physical examination. All its indicators are thresholds that have been clinically verified in large samples. For example, abnormalities will be marked only if fasting blood sugar exceeds 6.1mmol/L, and follow-up will be required only if ground-glass nodules are seen on lung CT. These standardized judgments can accurately identify diseases with clear pathological changes such as early cancer, hypertension, and diabetes, especially early cancer screening, such as using low-dose spiral CT to detect lung cancer and gastrointestinal endoscopy to detect digestive tract cancer. This cannot be replaced by any health care method. But its shortcomings are also obvious: it is essentially an "annual snapshot" of your health status, which can only reflect your physical condition on the days when you were examined. And as long as the indicators have not reached the abnormal threshold, even if you are already in a sub-healthy state with impaired sugar regulation and high blood pressure, the physical examination report will only give you a stamp of "no abnormality" and will not give you any intervention plan.

I have encountered a more extreme example before. A 28-year-old Internet programmer went to the emergency room with acute pancreatitis the next day after receiving a normal physical examination report. He danced and drank all night with his friends. Do you think this weird physical examination is useless? No, he just didn't understand. A normal physical examination just means that you haven't been diagnosed with a disease at that time. It doesn't mean that you are issued a health pass for the whole year.

And formal preventive health care just fills the gap that physical examination cannot cover. When you hear preventive health care, don’t think of massages in beauty salons or scammers selling health care products. Nowadays, the preventive health departments of community hospitals and the health management centers of tertiary-level hospitals are doing serious things: for example, Western medicine will conduct health risk assessments based on your family history and daily routine, and prescribe personalized exercise prescriptions and nutrition plans for you. Traditional Chinese medicine will do nine types of physical identification and use gentle methods such as moxibustion, cupping, and tea to adjust your imbalance. Just like the person with a fasting blood sugar of 5.9mmol/L mentioned just now, a physical examination will only tell you that it is normal. A preventive health doctor will tell you not to eat more than 2 taels of carbohydrates a day, ensure 150 minutes of moderate-intensity aerobic exercise every week, and test your blood sugar once a month to nip the risk of developing diabetes at the earliest stage. Of course, there are indeed many informal organizations in the industry now that are boasting about their effectiveness, and they dare to say things like "cure all diseases" and "replace physical examinations". Everyone has stepped in several pitfalls, and it is normal to have biases against health care. This is why many doctors from the evidence-based medicine school emphasize the value of physical examinations. After all, the effects of health care interventions are long-term, and it may not be possible to get immediate feedback on indicators, which is not as intuitive as the results of physical examinations.

Last year I gave health education to an Internet company, and nearly 300 of their employees had physical examinations every year. Last year alone, 12 of them were found to have grade 3 thyroid nodules, and the physical examination center only gave the recommendation of "six-month follow-up." Later, we conducted preventive health care intervention for these 12 people for half a year: they were required to stay up late no more than twice a week, adjust their intake of iodized salt, and do 10 minutes of breathing relaxation exercises every day to regulate their emotions. During the physical examination this year, 7 nodules had been reduced to level 2, and the remaining 5 nodules had not progressed. This is that health care has filled the gap in the follow-up intervention of the physical examination.

To put it bluntly, saving health is the same as saving money. Physical examination is to check the accounts at the end of the year to see if there are any shortfalls or debts. If there is a big problem, make up for it as soon as possible.； Preventive health care should be taken care of in peacetime. Don’t wait until the end of the year to calculate the accounts only to find that the hole is too big to be filled. Combining the two things together is the most stable health account. There is really no need to argue over which one is more useful than the other.