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10/02/2008

Let’s Get Physical

I agree with The Wall Street Journal Health Blog and NEJM’s Brian Rank, that executive physicals are, as they are currently practiced little more than a sham.

To be more specific, as Rank argues, executive physicals are three things: inefficacious, too costly, and inequitable. More akin to going to a spa than going to the doctor’s office, executive physicals pamper the elite but also provide them with more to worry about, more cost, and also fewer answers.

And this is just plainly unethical.

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It’s one thing to offer those who you know can afford more tests, well, more tests that are effective, but it’s another to offer fat cats tests that are unproven and incredibly expensive because they are, well, incredibly expensive. And that’s Rank’s claim.

Take, for example, full body CT screening which Rank mentions in his article as does WSJ Health Blog. Just one center found as the top hit on a Google search for “full body CT” extols the virtues of a full body CT screen by listing off the 12 diseases it can detect including “diseases of the spine” while never once mentioning that the procedure is still considered experimental by the FDA. Moreover, it “takes only seconds” while you are “fully clothed” and can give you “piece of mind”. What executive who works 100 hours a week wouldn’t want that?

I’m with you Dr. Rank. Executive physicals that push tests and procedures based on unproven methods on unwitting patients are never acceptable. Just because these patients, unlike many others, have the resources to pay for high tech, high cost procedures doesn’t mean they should.

Even if that patient is flying in from one city and back out to another (as some of these executive physical patients do) and that patient will never see the physician again, or if the two never develop a real physician-patient relationship, it doesn’t mean that the physician doesn’t have a responsibility to the person not to rip them off or that the physician can’t do the patient harm.

A doctor always has a responsibility to care for the mental and physical well-being of any person who walks through their door, into their CT machine, or to whom they give results. Period.

Summer Johnson, PhD

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