The Ideal Annual Health Check-Up - Less is More
Be very careful about the tests you do as part of an annual health check-up.
Health check-ups have become a huge business, based on the fearmongering premise that early diagnosis of disease saves lives. While this is true of a few conditions, it is not true for most cancers and diseases that are often picked up incidentally and which would have likely caused no problems, if left alone as we have seen with prostate cancer screening.
For example, gallstones are a big circus. If you decide to do an ultrasound of the abdomen as part of a yearly health check-up and it picks up gallstones, you will feel pressurized by the system to get the gallbladder removed, which despite all the advances in surgery, is not without some morbidity and mortality and often just completely unnecessary.
While health check-ups are useful, it is a good idea to follow the adage, “less is more”. One argument that many patients and doctors advance is that the more we know about our body and the more information we have about what is going on inside, the better it is. This is why whole body MRIs and sometimes even PET/CT scans are done to give you assurance that there is nothing wrong inside.
In practice however, since each individual is a unique human being with variations in anatomy and anatomic variants (conditions that look like disease but are not), more often than not these tests throw up “disease-like” features that need further tests and then even more tests, perhaps including biopsies that do nothing but take you down a rabbit-hole with all its attendant issues such as costs, anguish and perhaps even bodily harm from all those tests and examinations. This is further exacerbated by the fact that even if your doctor knows that these variants or incidental findings are irrelevant, given the current medicolegal scenario, even in India, where it is not difficult for patients to sue doctors, most doctors will practice defensive medicine and continue to test until they are 120% sure there is no disease. I wrote about this in my piece on serum PSA for prostate cancer screening, but we see this day in and day out with multiple conditions throughout the body.
An ideal health check-up would involve the following