Even then, some people who sign up for executive physicals ask for more than they need, says Dr. Benjamin Ansell, director of UCLA's Comprehensive Health Program. "We tailor the program for an individual's needs but also based on the results from their last exam," he says. "If I have a 48-year-old man who's been a couch potato for years, I have to assume the worst and look for plaque buildup." But if a man is already on medication to control blood pressure and cholesterol levels, he says, there would be no added benefit of having a coronary CT scan. "There's radiation involved that's not trivial," he says. "We actually end up talking patients out of certain expectations."
A good primary-care physician who knows a patient well can be just as thorough as a VIP exam. But the hospital-based programs carry the advantage of doing it all in one place, in a condensed time period. "The patient comes in, and they don't have to leave till it's all done. This is an ideal way of delivering preventive healthcare," Carstens says. "But unfortunately, the costs involved are not for the masses."
Individuals, and individual companies, however, have far different standards for determining what health is worth. Providing an executive physical for top-tier employees could result in a CEO not having a heart attack, not getting colon cancer, and the company not being forced to replace a key executive. Individuals could make their own calculations on what additional years of quality life are worth. Claudine Williams, 87, for example, just made her second trip in about eight years to Scripps in La Jolla for an exam that she'll pay for herself. She once owned the Silver Slipper and Holiday casinos in Las Vegas. She still serves on corporate boards, but she took time off for a trip to California because her hometown offers nothing as thorough.
"I would have been in 20 different buildings and seen 10 different doctors," she says. "Here they get it all together."
No more office hopping
She was describing just the kind of office-hopping routine that turned Gilmore's 81-year-old father off to preventive care. He recently moved to Los Angeles, and Gilmore wanted to make sure his medical care was under control. "We spent the first four weeks he was here, in and out of hospitals, to get him up to speed," Gilmore says. By then, he says, his father was ready to bag the whole thing. "He just didn't want to go to any more appointments," Gilmore says.
That experience, coupled with his own recent birthday, prodded Gilmore into looking for a better way to get a thorough exam. He'd had one a few years ago, but his doctor spent about five minutes with him, he says, and he waited a couple of weeks for test results. Specifically, what Gilmore wanted was reassurance that 38 years of a vegetarian diet and consistent bike riding offset the damage of several decades of smoking and occasional heavy drinking. "I don't smoke anymore, but I wonder what those years have done," he says.
Those were the same questions that sent McManus to the Mayo Clinic, as a journalist researching his book, in 2003. "I already had excellent health insurance and access to wonderful doctors," he says. "I didn't need the Mayo Clinic exam. But I fell in love with the place as a model for how healthcare should be done."
The process, McManus says, respects a patient's time by providing efficiency. It respects a patient's feelings with thorough discussion. It understands a patient's anxiety about test results and responds with timely answers.
Pinpointing problems, however, doesn't solve them. Patients have to follow medical advice.
McManus was advised to lose 25 pounds. He has, instead, gained a couple of pounds in the four years since his exam. But he also was told to quit smoking, advice that certainly didn't come as a surprise. "I knew that smoking was bad," he says. "From my docs in Chicago, and from about 500 other sources, I knew it was bad." The "don't smoke" message that finally got through was the culmination of everything he already knew, plus a rapport with the cardiologist who told him how bad it was for his heart, all in the context of a hospital with a stellar reputation. "Now I drink less than I did before [the exam], I exercise about the same, but I don't smoke," he says.
The programs want people to return every year, and each year, the tests will be different. People in their 50s, for example, need a colonoscopy every five years, not every year. In the binder full of test results that patients take home are charts. Year after year, they can track the progress, or deterioration, of their blood pressure, cholesterol levels, pulmonary function and other physical measures.