Annual physicals in Ontario need an update
TheStar.com – opinion/editorialopinion
December 19, 2012. Dr. Elaine Chin
This week, Ontario’s physicians agreed to the province’s demand to cut the time taken for your annual physical from 20 minutes to 10.
Not only does this make an outdated procedure an even more hurried one, it signals just how much our sacred annual ritual needs a massive overhaul.
The checkup I learned to do in medical school 25 years ago has barely changed: using our hands and eyes, we do a head-to-toe inspection of your body’s surfaces and orifices. With the help of a stethoscope, which was invented in 1816, we listen to your lungs and heart. We use a tapping hammer and tuning fork to gauge your muscle strength and nerve function. We then order blood and urine tests to find out your blood count, electrolytes, liver and kidney functions. If you smoke, we may call for a chest X-ray, and if you’re a mid-life woman, you may get a mammogram and bone density test, too.
That’s it. Yet our “free” physical isn’t significantly useful in predicting our big three killers: heart attack, stroke and cancer, nor does it let doctors catch diabetes early. True, if you want to pay out of your own pocket, you can get a PSA test for prostate cancer and a CA125 for ovarian cancer as well as nutrient markers to detect deficiencies (such as for Vitamin D). But these tests are far from perfect predictors of sickness or health.
So why hasn’t our physical changed in a quarter century when medicine itself has been revolutionized?
Maybe the decision-makers think the new generation of tests isn’t useful. If so, they would be tragically wrong, because there are now all kinds of tests to detect dire conditions that are much more effective than what we use now.
Or perhaps they think these new tests would cost the health-care system new dollars. On that point they would be right, although the cost for many tests would plummet if they were performed on millions of patients, rather than on thousands or even just hundreds. And think of how these new tests would keep patients out of the hospital by detecting a heart condition rather than dealing with a heart attack in the ER.
Ontario’s Minister of Health Deb Matthews announced last month that she wants doctors to “personalize your annual checkup.”
But true personalized medicine begins not with a medical history of your family, but with a genetics test — two words that didn’t appear next to each other 25 years ago. With the results of this simple saliva test, we can:
• Provide you with a statistical estimate of your disease risks for everything from deep vein thrombosis and Alzheimer’s disease to celiac disease and macular degeneration.
• Prescribe medications that we know in advance will work for you, so you don’t need to be a drug experiment.
• Identify if you are in danger of colon cancer and soon prostate and breast cancer. You can get a Cologic blood test that will cost you $75, and is almost as effective as a colonoscopy that will cost the health-care system $400. Soon, this type of metabolomics testing will be able to track the development of all medical conditions, including Alzheimer’s disease.
• Identify if you have or will likely get diabetes.
• Chart the progress of plaque in your arteries before it causes a heart attack — without the risk of high radiation doses that come with CT angiograms or physical damage to arteries from traditional angiograms. Today’s MRI imaging can also detect breast cancer tumours that mammograms can often miss.
This isn’t the half of it.
Smartphones can detect irregular heartbeats or high blood pressure, assess the quality and amount of sleep, track our activity levels, the food we eat and much more. Our body’s GPS is available here and now. And given the acceleration of new monitoring technology, in five years our smart devices will give us far more accurate information about hundreds of different disease indicators than a checkup or our doctor possibly can today.
With these astounding advances in genetics and mobile technology, another mega-shift is already happening. When you, our patients, can self-monitor your health better than we doctors can, it won’t be long before you’re challenging your government to pay for tests that are personalized to you and that provide the kind of evidence-based insights that are so absent in our system of antiquated physicals.
So the question isn’t, “But won’t they cost a lot of money?”
It’s, “Won’t they save a lot more money and lives?”
Because the answer is, of course, they’ll do both.
Dr. Elaine Chin is a Toronto physician and founder of the Executive Health Centre.
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