It’s time to get rid of routine clinical examinations. They’re a waste of time and money.
Back in the 1950s, senior executives were admitted to hospital for up to five days for health checks, spending one-to-one time with a doctor in a ‘human dry dock’. The problem is that this old-fashioned and elitist model continues to hang over corporate attitudes to healthcare for employees.
In other business areas, like hotels and air travel, we’ve woken up to sharper, more efficient options. We don’t have to stay in a grand old building with chandeliers, plush carpets and a trouser press, we can get a good nights’ sleep in a modern and comfortable room at a fraction of the cost.
The value of an annual clinical examination as a form of luxury – and therefore only available to the top executives – is a myth. As a GP, it’s clear to me that carrying out checks on the chest and stomach of someone without any particular symptoms of an illness isn’t very useful. It’s assumed that these kinds of checks have a fundamental value in terms of an official clinical ‘validity’ and ‘reliability’, and they don’t. We’re just back in the fancy, expensive hotel.
Clinical examinations with a doctor or GP built their reputation as the gold standard over the course of the 20th century at a time when the medical profession was looking to enhance its status, and when organisations wanted to offer the ‘best’ reward packages to their senior staff. There’s also been their growing importance to the insurance industry. A hundred years’ ago this kind of examination was resisted by doctors and the general public wasn’t interested – now its recommended and demanded.
A string of research papers in the 1960s highlighted that routine clinical examinations didn’t help anyone’s health. Now, given the rise of newer technologies and training, doctors are considerably less skilled in the clinical examination than those trained 30 years ago. Rather than being useful for improving health outcomes for people, there’s now even evidence that the opposite is the case. For example, an internal screening examination in women without any symptoms is not only unpleasant and uncomfortable but it won’t pick up ovarian cancer – in fact it might simply provide dangerous false reassurance. The results of the UK ovarian cancer screening trial (published in December 2015) make it clear that improving survival is about access to annual Ca125 testing and ultrasound, not the clinical examination.
We obviously still need health testing as a form of MOT, but it’s all about the form it takes – making sure there’s a real impact on improving health. The hard research evidence over time – major studies in the US and Canada – have pointed to the importance of taking a different approach. We need to discard the old fashioned comprehensive annual health examination and replace it with more focused clinical measurements of, for example, blood pressure, lung function, body mass index and waist/hip circumference – the areas where there is real evidence for the impact of such measurements on patient outcomes and future health.
In the 1990s a number of key papers were published based on the Ebeltoft trial (undertaken in Denmark). 1500 individuals were divided into random groups. One group underwent a health check including measurements of blood pressure, body mass index, lung function testing (with spirometry) together with a variety of simple blood tests: lipids, glucose and biochemistry. After five years of follow-up there was a 4.2% reduction in BMI, 4.9% reduction in systolic blood pressure and a 7.6% reduction in cholesterol. A second group did the same, but also spent time with a GP for an examination and consultation. The results were identical – highlighting exactly which part of the time spent by people was of value.
When it comes to the full-blown clinical examination offered by employers, the Emperor really has no clothes. This is important for benefits provision in organisations – nowadays we can improve impact and outcomes and reduce costs; and can also offer a more efficient form of health screening to more people.
