The difference and connection between preventive health care and physical examination

To put it bluntly, the core relationship between the two can be explained in one sentence - physical examination is a standardized pre-screening tool in the preventive health care system, while preventive health care is a collection of all health management actions covering the entire life cycle, including risk intervention, habit adjustment, and disease prevention and control. Many people often equate the two, essentially regarding the tool as the entire package.

A while ago, when I was doing health education in the community, I encountered something like this: 52-year-old Aunt Zhang came to ask with the normal physical examination reports for three consecutive years. She said that she had been dizzy and numb recently. She went to the orthopedic department and found that the physiological curvature of the cervical spine had disappeared, and she also had pre-hypertension problems. She was particularly puzzled, "My work unit organizes physical examinations every year. Isn't this just preventive care? Why are there still problems found?" ”

If you have been exposed to grassroots public health work, you will know that preventive health care is much more complicated than physical examination. Frequent vaccinations for newly born children are preventive health care. The guidance on myopia prevention and control given by schools to students is preventive health care. Banners hung up every day in communities calling for reducing salt and oil, quitting smoking and limiting alcohol are preventive health care. Even fall risk assessments for elderly people living alone and suggestions for aging-friendly home modifications are all within the scope of preventive health care. It is not a one-time deal. It is a dynamic action that can be adjusted at any time according to your age, physical condition, and living environment. In many cases, there is no need to touch medical equipment at all, and it is just a habit adjustment that is incorporated into your daily life. According to the three-level prevention standard of public health, it covers everything from prevention and control of the cause before the onset to rehabilitation intervention after the onset.

The physical examination is more like an annual snapshot of your body, which can only reflect your physical indicators on the days of the examination, and the items are standardized - ordinary employment physical examinations will not specifically add dynamic cervical spine X-rays to you, and regular packages will not ask you what time you stayed up every day or how many grams of salt you eat in one meal. Its core function is to catch abnormal indicators that have emerged. As for how to adjust after the abnormality and how to prevent small problems from developing into diseases, that is not within the scope of physical examination services at all.

There are two very extreme voices in the industry now. In fact, they are both related to the lack of understanding of the boundary between the two. One school of thought is that "physical examinations are useless". Most of them have encountered cases of "cancer was detected six months after a normal physical examination", and they feel that physical examinations are a waste of money - but the coverage of routine physical examinations is inherently limited, and it is impossible to screen out all rare diseases and early-stage diseases that progress quickly. If you have to regard it as all preventive care, there will naturally be a psychological gap. The other school is the theory of "physical examination is everything". They spend tens of thousands every year on a full set of PET-CT and genetic screening, thinking that it is equivalent to having health insurance. However, if you are found to have high blood lipids and still eat hot pot, or if you are found to have pulmonary nodules and still smoke every day, no matter how expensive the physical examination is, it will not stop the disease from coming to your door. On the contrary, you may bear unnecessary radiation risks due to over-screening.

The case of a corporate client I followed up before is very typical: a 38-year-old executive, whose physical examination last year showed high low-density lipoprotein and a tendency for fatty liver disease. If it were anyone else, he would have stuffed it in a drawer after reading the report. Our public health technician followed him and conducted a three-month intervention: he set a 150-minute moderate-intensity exercise plan per week, adjusted his diet when socializing, and equipped him with a home blood lipid monitor. Follow-up changes in indicators every month. After a physical examination this year, both abnormalities returned to the normal range. You see, this is the correct model for the cooperation between the two: physical examination delivers accurate "intelligence" to preventive care, and preventive care uses the information to solve the root problem. The two things are in a line, and it is useless without either one.

After working in public health for almost ten years, my biggest feeling is that many people think that preventive health care is "virtual" and that only the physical examination report in hand is "real". This is really a misunderstanding. If you spend thousands of dollars on physical examinations every year and fail to correct even half of the problems found, then the money spent on physical examinations is really wasted. On the contrary, there are many preventive health care actions that do not cost money: smoking one less cigarette a day, walking ten minutes more, and not drinking cold beer when you stay up late are more effective than the most expensive physical examination you have every year. Next time you get the physical examination report, don’t just focus on whether there are any “abnormalities”. Think more about what adjustments should be made behind these abnormalities. Then your physical examination is really not in vain.