The difference and connection between preventive health care and physical examination

Physical examination is the core component of secondary prevention in the preventive health care system and is the basis for decision-making for all subsequent intervention measures. Preventive health care is the final path to realize the value of physical examination. The two together form the core service closed loop for early prevention and control of chronic diseases. This is the most intuitive conclusion I have drawn after working in community public health services for 4 years and after reviewing the health files of nearly 2,000 residents.

To be honest, most ordinary people have a completely vague understanding of the two, or even confuse them. Last month, I met Aunt Zhang from the community. She is 62 years old. She has participated in free community physical examinations for three consecutive years and her fasting blood sugar was found to be between 6.2-6.7mmol/L, which is a critical state of abnormal glucose tolerance. Every time we chase her to provide her with dietary guidance and regular blood sugar monitoring, she always waves her hands and says, "It's not up to the standard of diabetes, so why are you messing around?" As a result, she was diagnosed with type 2 diabetes at the end of last year, and now she needs to take insulin every day. Every time I see her, I regret not listening to her advice. You see, this is a typical example of equating "having a physical examination" with "taking preventive care", and ultimately suffered a big loss.

In fact, to use an inappropriate analogy, a physical examination is like the annual inspection you do for your private car every year. It tests the brakes, tires, and exhaust gas online, and finally gives you a report listing which items are unqualified. Its mission ends here, and it will not actively help you replace brake pads or repair tires. Preventive care is a complete set of follow-up maintenance. It not only fixes the problems discovered during the annual inspection, but also tells you how to drive to reduce wear and tear, how many kilometers you need to check again, and even customizes a special maintenance plan for you if the car has been in an accident. In essence, physical examination only cares about "do you have any problems now", while preventive care cares about "how can you avoid having problems all the time, and how can small problems not turn into big problems?"

Of course, this boundary is not completely absolute. There is actually a lot of controversy in the industry over the division of powers and responsibilities between the two. Most scholars in the public health system advocate that physical examinations should be fully integrated into the preventive health service chain. For example, some pilot communities in Shanghai have directly tied residents' annual free physical examinations to subsequent health follow-up and chronic disease management. After screening for abnormalities, residents do not need to go out on their own. Family doctors take the initiative to intervene. Last year's pilot data showed that the hypertension control rate in pilot communities was 17% higher than that in non-pilot communities, and the effect is indeed visible to the naked eye. However, some experts in the field of clinical testing hold objections. They feel that the independence of physical examination must be guaranteed. If it is deeply tied to follow-up health care services, it is easy to cause the problem of "deliberately exaggerating abnormal indicators in order to promote intervention projects." In particular, commercial physical examination institutions have a tendency to over-screen. If it is further tied to health care products, it will only increase the burden on consumers. This worry is not unreasonable. I met a young man before who was found to be "strongly positive for Helicobacter pylori antibodies" at a private physical examination institution. He was sold a stomach nourishing package worth tens of thousands. However, when he came to our community for a carbon 14 re-examination, he was negative at all, which was a waste of half a month.

After talking about the differences, let’s look at the connections. In fact, many times the two cannot be separated at all. My personal physical examination last year showed that my blood uric acid reached 460 μmol/L, which is more than 30% higher than the normal upper limit. If I just took a look at the report and threw it aside, saying "it is not enough to require medication", I might have had a gout attack in two years. But I knew that this was a sign of metabolic abnormality, which was a high-risk factor for secondary prevention. Later, I cut the seafood hotpot from three times a week to once a month, forced myself to drink 2 liters of weakly alkaline water every day, and added night running three times a week. After three months, the reexamination dropped to the normal range of 380 μmol/L. You see, without a physical examination, I would not have known that I had high uric acid, and there would be no direction for intervention; without follow-up preventive health care adjustments, the value of the hundreds of dollars I spent on a physical examination would be nothing more than a useless report. Without either, it would not work.

Of course there are exceptions, such as vaccinating newborns with hepatitis B vaccine, which is the core content of primary prevention. There is no need to undergo a physical examination to screen for infection. Direct vaccination can have a preventive effect. This is why we say that the two have a cross-relationship and are not completely inclusive or parallel.

The longer I do this, the more I feel that there is no need to explain overly complicated academic definitions to ordinary people. For ordinary people, just remember the simplest logic: choose a suitable physical examination package every year based on your age and family history. Don’t just choose the most expensive one, and don’t think that you don’t need to check because you are young. When you get the report, don’t just look at the red text for “malignant lesions.” If there is any abnormality, ask a professional doctor. Adjust your diet and diet, and do additional reexaminations when you should. Don’t turn a minor problem into a serious illness. In the final analysis, physical examination is to help you find small flaws in your body, and preventive health care is to help you fix these flaws. If you do both, you can really reduce the number of trips to the hospital. This is the greatest significance of the existence of these two things.