Executive physicals, just say no

A great perspective piece in the NEJM (via the WSJ Health Blog), saying that executive physicians symbolizes all that is wrong with the mindset of the American patient.

The central tenet that “more is better” is thoroughly debunked, as it should be:

Executive physicals also reinforce a related misperception “” that costlier is better, that a $3,000 examination must be worth more than one that costs 1/10 of that amount. This is an indefensible idea that should not be promoted by the health care industry. Even as individual hospitals sell these services for exorbitant fees, gratuitously overusing our health care resources, our system as a whole is appropriately straining in precisely the opposite direction, toward cost-effectiveness, transparency, competition, and accountability. With its outrageous cost and unproven efficacy, 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.

When it comes to health care, “more”, “costly”, and “new” are not necessarily better for the patient.

Everyone needs to understand that if there is hope to control health care spending.

Comments are moderated before they are published. Please read the comment policy.

  • Kyle Janek, M.D.

    Kevin, Kevin, Kevin…you completely and uncharacteristically, took your eye off the ball on this one.

    I have never participated in an executive physical, yet I have read about them and witnessed their growing popularity among folks who are tired of being rushed in and out of the more typical office encounters. Dr. Rank seems to be very bothered by the fact that someone gets a pair of slippers when they sign up for these things. In fact, the sneering tone of the entire article is unmistakable. I find it amusing that a physician would be put off by the thought of a patient encounter being pleasant for the guy on the cold end of the stethoscope.
    Full disclosure here: after 22 years in a hospital-based private practice and 13 of those years as a member of Texas’ part-time legislature, I recently joined a company whose goal is to bring evidence-based biomarker blood screening directly to patients, which we think is superior to the kind of executive physical described. In fact, we could be seen as competitors. This may or may not qualify for the disdain of Dr. Rank; I don’t particularly care one way or the other. We do care, though, that more patients are not satisfied with the patronizing attitude of physicians like Dr. Rank who seem to think that they should be the gatekeepers to healthcare, and patients who want to actually participate should be patted on the head and told to sit down.

    Let me take on directly the three areas mentioned in the article with a different look. The first is cost: executive physicals are pricey. Fair enough. But one then should ask: “Compared to what?” If the executive’s company decided to give her a year-end bonus or a plasma TV of comparable value, would Dr. Rank think the money be better spent? Would it be better spent on a three-day vacation at a resort with no doctor around? Seriously? And we should not forget that, as with many emerging industries, the folks who pay more, early, are generally paving the way for cheaper costs to be enjoyed by others later. Think cell phones.
    The second attack is on efficacy. Dr. Rank says that “inherent in the provision of this service is the notion that the most health care is the best health care.” It’s an old magician’s trick to make you watch his left hand while the right conceals the handkerchief. Dr. Rank wants the reader to assume that an executive physical represents “the most health care”. Yet if three days getting a thorough physical, extensive testing, even nutrition counseling can forestall heart disease and two weeks of hospitalization – not to mention $90,000-plus – for a heart attack, I would have to argue for the slippers and the salmon salad. I have a friend whose wife gave him a CT scan for Christmas – they found a kidney tumor. Try telling him this was not “efficacious”. Anything that engages patients in their own healthcare is better than the current system where doctors have to play a game of “Mother, May I?” with insurance companies.

    Lastly, Dr. Rank argues that these executive physicals are inequitable because not everyone can afford them. Again, I repeat my argument about high-end consumers helping pave the way for economies for others. We now are beginning to see small businesses recognizing the value of employee wellness. But beyond that, Dr. Rank seems to make the argument that if not everyone can have something, then no one should. Wow.

    As long as we are casting stones here, try this one. The website for Dr. Rank’s company, HealthPartners (where he is the medical director), says “Our receptionists review appointment schedules each day to ensure that each patient receives the right amount of time for his or her needs.” It’s nice to know that a receptionist is going to decide how much time I need with my doctor.

Most Popular