The difference and connection between preventive health care and physical examination

Physical examination is the "pre-investigation link" in the preventive health care system. The former is a "health snapshot" at a certain point in time, and its core is to screen for disease risks.； The latter is a dynamic health management system covering the entire life cycle, with the core being to reduce the probability of risk occurrence. The two are neither a parallel relationship nor a substitute relationship, but a supporting action that supports each other. Without either one, you cannot truly manage your health.

When I was working as a public health volunteer at a community health service center two years ago, I met 62-year-old Aunt Zhang. She came to her family doctor with the physical examination reports from her work unit for three consecutive years and said that her annual physical examinations showed "roughly normal", but she always felt dry and tired recently. When she checked, her fasting blood sugar had reached 7.2mmol/L, which was just on the diagnostic line for diabetes. I looked through her previous reports and found out that for three consecutive years, her fasting blood sugar had been at the critical value of 6.1-6.9 for abnormal glucose tolerance. At the end of the report, there was only an understatement of "it is recommended to follow up and control your diet." Aunt Zhang said she saw this line and thought she just needed to eat less sugar. She should drink thick millet porridge instead. After eating, she would lie on the sofa and watch TV dramas. No one had ever told her how much impact these habits had on blood sugar.

You see, this is the most intuitive difference between physical examination and preventive care. The logic of the physical examination is to "take photos": draw your blood and take your X-rays that day. All indicators reflect your physical condition during the ten hours or even shorter period during the examination. Its task is to mark out abnormal indicators and tell you "there may be a problem now", but it will not ask you about your daily habits, nor will it give you a tailor-made adjustment plan, nor will it follow up on changes in your indicators for several months. The logic of preventive health care is to "keep your account": starting from the first dose of hepatitis B vaccine when you are born, to scoliosis screening when you are a student, shoulder and neck health guidance for office workers, chronic disease follow-up for middle-aged and elderly people, and even home rehabilitation suggestions for disabled elderly people, it covers all stages of your life. It does not wait for your indicator to turn on the red light before taking action, but starts from every detail of daily eating, drinking, moving and sleeping, and tries to prevent you from even touching the critical value.

There are actually two quite extreme schools of thought in the industry today, which is quite interesting. One type is the "physical examination priority group", most of whom are practitioners from commercial physical examination centers. They believe that as long as they do a comprehensive physical examination package every year and detect problems early and treat them early, they are equivalent to doing a good job in preventive health care. ； The other type is the "health-first group", most of whom are practitioners of grassroots public health or traditional Chinese medicine health care. They feel that physical examinations are an afterthought. As long as they adjust their diet and exercise routine, there is no need to spend so much money on examinations every year. I have met people on both sides, and what they say makes sense, but they all go to extremes: no matter how you adjust your living habits, there is no guarantee that the nodules and potential genetic mutations in your body can be eliminated by nourishing yourself. You still need to check if you need to. ； On the other hand, if you do the most expensive PET-CT every year and then stay up late and drink heavily every day, the problem you find out is just that you knew you were going to be sick a few years ago, which is meaningless.

Speaking of the connection between the two, I have a friend who works as an attending physician at a physical examination center in a public tertiary hospital. He said that they have changed their assessment standards in the past two years. Performance is no longer measured by the number of physical examinations performed in a year or the number of high-end packages sold. Instead, performance is measured by the follow-up rate of users with abnormal physical examinations and the effectiveness of intervention. For example, for users who found pulmonary nodules during physical examination, they used to write "recommended reexamination in 6 months" in the report. Now, the information of these users must be synchronized to the corresponding community public health team. Doctors responsible for preventive health care will take the initiative to call and follow up, asking you whether you smoke, whether you have a family history of lung cancer at home, and whether you can turn on the range hood for cooking. You will be given targeted care guides, and you will be reminded to come back for a reexamination when the time comes. In other words, physical examination provides "accurate navigation" to preventive health care. You don't need to deal with useless content of large-scale popular science for everyone, but directly provide you with personalized plans based on your abnormal indicators. ； Preventive health care provides "pre-screening" for physical examination. For example, if you have never smoked, have no family history, and are under 40 years old, you do not need to have chest CT every year to avoid unnecessary radiation and waste. If you have high-risk factors, you will be directly prescribed targeted examination items, which is much more useful than blindly choosing a large package worth thousands of dollars.

I have stepped into this kind of separation pit myself. In the past two years, the physical examination showed that uric acid has been stuck at around 430 μmol/L, which is less than 10 higher than the upper limit of normal. The report only said "low purine diet". I searched it on Baidu myself and said that it meant drinking less beer and eating seafood. I didn't touch these things in the first place, so I didn't take it seriously. Later, I listened to a preventive health lecture by the Centers for Disease Control and Prevention, and I learned that another important cause of high uric acid is excessive fructose intake. At that time, I had two bottles of iced black tea a day in the summer and a cup of pearl milk tea a day in the winter, both of which were high in fructose. I quit sweet drinks when I went back and went for a follow-up checkup three months later. The uric acid dropped directly to the normal level of 380. To be honest, if there was only a physical examination without follow-up health care guidance, I might still be in the dark until now, and I would not react until gout actually developed.

In fact, to use an inappropriate analogy, a physical examination is like the annual inspection you do for your car every year. It checks whether the brakes are working, whether the engine oil is sufficient, and whether the exhaust gas meets the standards. It can detect hidden diseases that you would not notice when driving, but it cannot help you extend the service life of your car.； Preventive care is your usual car usage habits. Adding oil that meets the label, performing maintenance when the mileage is exceeded, and not slamming on the accelerator and braking, can prevent car problems. But you can't say that if I take care of my car, I will never have to check it last year. I will regret it when the brakes fail one day.

Recently, I have seen a lot of people complaining about "useless physical examinations", saying that last year's physical examination was normal, but late-stage cancer was detected this year, or complaining about "excessive physical examinations" and spending thousands on a bunch of useless projects. In fact, these questions essentially separate physical examinations from preventive care: If you go to a preventive care doctor for a risk assessment in advance, have a gastroscopy every year if you have a family history of gastric cancer, and have a mammogram every year if you have high-risk factors for breast cancer, how could you not be detected? If you didn't blindly buy those "high-end physical examination packages" that cost tens of thousands, and let the doctor choose items for you based on your age, medical history, and family history, how could you waste your money?

To put it bluntly, we ordinary people’s expectations for health have never been “not sick”, but to live comfortably and with less pain. A physical examination can help you figure out where you are now, and preventive health care can help you find the right path to health. Doing both together is the most worry-free way.