Executive physicals 'bad medicine,' journal article claims

Executive physical examinations, in which patients pay doctors a fee for an on-demand physical are "bad medicine," says an article in this week'sNew England Journal of Medicine.

Such physicals, which often cost thousands of dollars and are not covered by health insurance, take a day or two and involve an extensive series of medical tests and evaluations. They arecommonly marketed as a yearly event to save time for busy executives, writes author Dr. Brian Rank, medical director of HealthPartners,a Minnesota-based, non-profit HMO (health maintenance organization).

Rank laments the rise of the executive physical as a heavily marketed but questionable service offered by many of the most prestigious U.S. medical institutions, such as the Mayo Clinic and the Cleveland Clinic.

"Many of the centres that provide them tout an environment of exclusivity, personal attention and luxury of the type one might expect to see at a four-star hotel or high-end resort," thearticle says. Those who undergo these physicals clearly appreciate the indulgent touches, such as complementary bathrobes and slippers or the performance of the whole process in a so-called VIP area."

"As an example of progressive medicine, the executive physical fails on three important counts: efficacy, cost and equity," Rank writes.

'As an example of progressive medicine, the executive physical fails on three important counts: efficacy, cost and equity.' Dr. Brian Rank

Having more tests during an exam or having it take longer does not mean better medicine for the patient, Rank argues. One example of a test often includedin such physicals but "rarely meaningful as a predictor of disease" is a computed tomographic, or CT, scan of the heart. Some tests like a CT heart scan are included in executive physicals "with little regard to medical evidence" to justify them, Rank writes.

The high cost of executive physicals also reinforces a perception " that costlier is better,"he says, calling the idea indefensible. It runs counter to most other efforts in insured health care, Rankargues.

"The executive physical is almost a parody of the high-cost, low-return procedures that prudent companies rightly want clinicians to eliminate for other employees."

Such exams are also inequitable, Rank argues, allowing only patients with the ability to pay access to personalized treatment.

Executive physicals are also marketed in Canada, but the practice may be less prevalent than in the United States.

An Ottawa clinic called La Vie Executive Health Centre, run by Dr. Hassan Sannoufi, opened in December and provides medical services that it says the public system doesn't cover. One of the services is a five-hour physical exam that includes electrocardiograms, eye and hearing tests and a diet assessment. It costs $1,200.

The Dominion Health Centres of Canada clinicin Edmonton offers a bevy of procedures for senior company employees including a complete physical, blood tests, an electrocardiogram and a CT scan of the arteries. It costs $1,050.

Dr. Trevor Theman, registrar of the College of Physicians and Surgeons of Alberta, said clients of the Edmonton clinic may be jumping the queue for health service because they can afford to pay and raised the same doubt as Rank's articleon the question of whether patients actually need all the tests they receive.

Theman also questionedwhether there was anydifference between tests given during an executive physical and those given during a normal insured physical examination.