How Its works in modern time & who are the real beneficiaries
Opting for preventive health check-ups seems to have become a growing trend among a large section of the middle and elite classes. Many corporate hospitals & corporate laboratory chains across India routinely offer such packages. They often include an array of limited biochemical tests, cardiovascular function tests e.g stress test; imaging studies such as X-ray, ultrasound and sometimes more advanced scans and specific investigations such as mammography, pap smear and bone density testing.
The description of these packages is akin to that of credit cards or frequent flyer programmes in airlines—basic, silver, titanium, gold, platinum and sometimes health card membership, corporate health programme, soon. The idea is to promote the notion that they are tailored to the needs of a particular age, sex and patient groups.
Such check-ups are periodic and many employers offer these packages as job perks. There is a firm belief that preventive checks are necessary and contribute to good health. Of course, there is the issue of costs. But then, it is those who can afford private healthcare that are prime targets of these packages. They assume an expenditure in the range of Rs.5,000 to Rs.15,000 is money well-spent and guarantees better health.
Unfortunately, many assumptions on which preventive health check-ups are based are fallacious. The analogy of a car that needs regular servicing is often used to justify these procedures, a particularly tempting comparison for a class familiar with the need to put their personal vehicles through preventive maintenance every few months. The human body, however, is very different from a car or any other machine and has self-healing powers. Unlike a machine, a periodic abnormality in the body’s functioning is the norm and, in an overwhelming majority of malfunctions, the body uses its healing powers to take care of the problem. Periodic health checks provide a snapshot of the body’s condition at a point of time and tell us little about how the body is actually coping with an abnormality.
An even more problematic aspect of putting a person through a battery of tests is the concept of what is a normal reading of a test for a particular individual. Normal values for the population are determined based on a large number of individual values and are always represented as a range and not a fixed number. If plotted on a graph, normal values take the form of a bell curve, with most people clustered in the middle and a few who lie on either end. This also means there will be people who fall outside the normal range for a particular test but that value is normal for them.
Evidence from meta-analysis done in diverse settings shows that, on an average, there is a one-in-20 chance that an abnormal result is not really so. An absolutely normal person, who is put through a battery of 20 tests, has an even chance that at least one test result will be abnormal. This is when an Rs.15,000-package turns into a much more expensive enterprise, as doctors embark on a wild-goose chase to nail the elusive abnormality. In addition to costs, the patient is put through a range of more invasive and advanced tests that pose a risk to an otherwise healthy body. It also puts a patient through unnecessary anxiety that might adversely affect a person’s life.
The limitations of preventive health check-ups are not merely theoretical. There is a range of evidence that routine health check-ups, unless backed up by sound evidence, just do not help and can actually harm. For example, there are some periodic routine check-ups that are evidence-based such as a pap smear to detect early signs of cervical cancer in women after a certain age but no mean to put through pap smear test for someone with a thyroid disorder. Nothing, however, justifies putting a person without symptoms through a battery of random tests. The blood test is the 1st process in diagnosis or doctor’s evaluation. It’s understandable to have a thyroid test along with your liver or kidney function checked.
Diagnostics of all kinds are powerful tools when used in conjunction with clinical assessment, family medical history and when a person exhibits symptoms. However, If a doctor finds on physical examination and from the patient’s history that a patient has a lump in the abdomen or has periodic episodes of central chest pain, it is entirely justified to prescribe tests specifically designed to ascertain the cause. But a shotgun approach to diagnostics is cowboy medicine, not a part of rational healthcare. Corporate hospitals, corporate laboratory chains and health card issuers are the principal and usually the only beneficiaries of the growing practice of these preventive health check-ups.
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