Health Check Up

Business Gimmick or a Necessity?

BCCI (10-03-2017)

Dr. Hemant Haldavnekar

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Health

Old the state of being free from illness or injury.

New WHO: State of complete physical, mental

and social well-being and not merely an absence of disease or infirmity

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Seven major ingredients for good

health

1. Exercise

2. Diet and nutrition

3. Weight Control

4. No smoking

5. Alcohol in moderation: Abstinence ideal

6. Avoiding injury

7. Disease prevention: Immunization

Periodic check-ups

Health risk appraisals

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An ounce of prevention

is worth

a pound of cure

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Why Health Check-up?

To warn about risks

To diagnose disease early & to prevent/ postpone complications

To objectively determine the efficacy of treatment

Before traveling abroad

To determine fitness for work

For purpose of insurance

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o Basic data for health research and planning

o A legal document describing the care received

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Types of Medical Examinations

Pre-Employment Medical Examination (PEME)

Pre-Placement Medical Examination Noise Forklift /Crane operators Work at height

Periodic Medical Examination (PME) Medical Examination following Over-

exposure Pre-Retirement Medical Examination Food Handlers SHAPE Categorization Executive Health check-up

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Screening

Diabetes

Hypertension

IHD

Cancer – Prostate, Cervix, Breast, Colo-rectal

Osteoporosis

STDs – HIV, Hepatitis B, VDRL

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Investigations included in

Health Checkup

HAEMOGRAM (CBC) CBC

RBC Haemoglobin MCHC MCV MCH PCV

WBC TLC DLC

Platelet count

Peripheral smear

ESR3/15/2017 10

Investigations included in

Health Checkup

BIOCHEMICAL PARAMETERS

Blood sugar Fasting (Plasma<126, Blood<110)

Post Prandial (Plasma<200, Blood<180)

Uric Acid

Lipid Profile Total Cholesterol

HDL

LDL

VLDL

Triglycerides3/15/2017 11

Investigations included in

Health Checkup

KIDNEY ASSESSMENT

Complete urine Analysis

BUN

S. Creatinine

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Investigations included in

Health Checkup

LIVER FUNCTION TESTS SGPT (ALT) SGOT (AST) S.Bilirubin

Total Direct

Alkaline Phosphatase Total protein Albumin Globulin A/G Ratio

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Investigations included in

Health Checkup

GENERAL TESTS

Blood Grouping & Rh Typing

Stool examination

ECG (Resting)

X-Ray (Chest), Spirometry

Ultrasound screening of the whole abdomen

Pap smear

Tumor markers

DEXA Bone densitometry

Cardiac CT-angio3/15/2017 14

Investigations included in

Health Checkup

Clinical examination

Medical Summary

Advice by Senior Physician

Rectal examination by General Surgeon

Genital examination by Gynaecologist

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Investigations included in

Health Checkup

Diabetic

Control – FPG, PPPG, HbA1c

Lipid profile

LFT (Statins, Glitazones)

Renal – Urine R/microalbuminuria, Creatinine

Ophthalmic - Fundoscopy

Cardiac – ECG, 2D Echo

Exercise tolerance test (ETT)

Neuro – NCV

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Investigations included in

Health Checkup

Hypertensive

Ambulatory BP monitoring Chest X-ray – Coarctation, cardiomegaly Lipid profile Sugar – FBS, PPBS Electrolytes Liver function tests (Statins before, 2-3 m, yrly) CPK (Statins, fibrates, Niacin, Ezetimibe) Uric acid (Thiazides) Renal profile Cardiac – ECG, 2D Echo, ETT Ophthalmic – Fundoscopy

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Terms

Sensitivity

person with disease will test positive

Specificity

person without the disease will test negative

True positive / False positive

True negative / False negative

Positive predictive value – Malaria

Negative predictive value – Cardiac CT-angio

Pre-test and Post-test Probability

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IDEAL effective screening program

• Segregate the diseased from the healthy

• High sensitivity and a high specificity

• Treatment applied early should lead to a better

outcome than treatment applied after onset of

symptoms

• Benefits must outweigh the harms

The 5 main reasons for a

diagnostic test

1. Establish a diagnosis in symptomatic patients ECG to diagnose STEMI in patients with chest

pain.

2. Screen for disease in asymptomatic patients PAP smear in sexually active women

3. Provide prognostic information in patients with established disease CD4 count in patients with HIV.

4. Monitor therapy by either benefits or side effects International normalized ratio (INR) in patients

taking warfarin

5. To confirm that a person is free from a disease Pregnancy test to exclude the diagnosis of ectopic

pregnancy.

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Benefits of general screening

Done at person’s convenience

All under one roof

Saves time of busy executives

May detect illnesses very early in apparently healthy persons

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Drawbacks of general screening

Doctor sees you at the end of tests

One size fits all

Unnecessarily subjecting NORMAL people to un-required tests

Cost of test

False positives

? Harmful

Confusion with the results, misdiagnosis, unnecessary treatments

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Drawbacks of general screening

Excess focus on one modality

Pressure to attribute a cause for abnormal reports/ incidental findings

Reluctance to give ‘Negative’ reports

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Diagnostic Process

Patient InterviewComplaintsPast HistoryPersonal HistoryFamily History

Physical ExaminationSigns

Investigations

Diagnosis

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Controversies

Mammography in women between 40 and 50

50% false positive

Anxiety

Disfiguring biopsies

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Controversies

Rectal examination/PSA for screening for Ca

Elevated PSA not diagnostic

Prostatic biopsy

Radical Surgery

Impotence

Incontinence

Diaper dependence

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2/3 become impotent

… 50% rendered incontinent …

BJU 2006: 97: 1234-1241

…… become dependent on diapers …

…… or else on catheter …

and would really live a miserable life thereafter…

Ideal Periodic tests

Attributes

Person’s age

Sex

Family history

Personal risk factors

Symptoms

History of disease

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US Preventive Services Task

Force (USPSTF)

Recommendations BP – All adults Total Cholesterol

Men (35-65), Women (45-65)

Stool for occult Blood (50-75) in USA Mammography – Women (50-74) 2 yrs PAP smear – every 3 years upto 65 yrs Vision tests – Pre-school & elderly Hearing – elderly Intraocular pressure

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US Preventive Services Task

Force (USPSTF)

Does not recommend routinely

Screening for Diabetes (only >45)

Screening for Thyroid disorder

Bone Densitometry in menopausal women (only >65)

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Who and how often

20s and 30s – Once every 2 to 5 years Healthy people do not need

Chest X-ray, ECG or extensive blood tests

Check up should include Physical examination Height Weight Pulse BP Cholesterol PAP smear (in sexually active women) (<65) Screening for breast cancer (50-74)

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Technology

We shall have to refrain from doing

things merely because we know how to

do them

- Sir Theodore Fox. The Lancet, 1965

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Inappropriate use of technology

Excessive use 4D Ultrasound for baby’s first album

Unethical use Sex determination

Wrong use IVF for all infertile couples

Misuse Laser/Endoscopic surgery without enough

training

Defensive use Protection against being sued

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Reasons for inappropriate use

Generation of income

Recover costs

Profitability

Cost effectiveness

Fear of expulsion

Glamour of latest gizmos

Latest and Newest

Pressure from manufacturers

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Ask yourself

How will the test help identify what is wrong?

Will it give us specific or general information?

How sensitive and specific is the test?

Does the benefit far outweigh the risk?

How will this test change my treatment?

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Check the reliability of results

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The state of being free from illness or injury3/15/2017 56

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