The difference between preventive care and physical examination

Physical examination is a preliminary tool in the preventive health care system. The two are subordinate but completely different concepts - physical examination is a single-point health screening action with the goal of "finding problems."」； Preventive health care is a health management system covering the entire cycle, with the goal of "solving problems and preventing them from happening."

When I assisted in the elderly public health project at the community health service center in the past two years, I met no less than twenty elderly people like Aunt Zhang. They actively participated in free physical examinations every year. When they got the report and saw that there were not many arrows, they stuffed them into drawers. They ate pickled vegetables when they should eat pickled vegetables. They danced square dances for three hours without stopping. They only thought of seeing a doctor when they got really dizzy and had chest tightness. When asked, "My physical examination last year was fine."

In fact, this is the most common misunderstanding. Many people think that a physical examination is preventive care. Many people even think that health care projects that are more expensive than a physical examination are IQ taxes. I have to mention here that there are indeed two schools of thought in the industry: one is the pragmatic school, which believes that for most ordinary people, if they can insist on regular physical examinations every year, they have completed 80% of preventive health care, and there is no need to engage in overly complicated displays. ； The other group is the professional group in the public health system. They feel that only doing physical examinations without follow-up intervention is essentially a waste of the value of physical examinations and cannot be regarded as real prevention.

If you really want to make an analogy, you can understand if you think of your body as a family car that has been driven for more than ten years: the physical examination is an online test conducted by the vehicle management office once a year. It checks whether your brakes are effective enough, whether the exhaust gas meets the standards, and whether there are any problems with the lights. After more than a dozen inspections, you will be stamped and tell you whether you have passed or failed. That's it. And what is preventive care? You should be careful not to slam on the accelerator when driving, change the engine oil regularly, actively check the tire pressure after long distance driving, drive less on non-paved roads when your car is old, even change the antifreeze glass water in advance in winter, and try to avoid the sun when parking in summer. These miscellaneous small actions add up to complete maintenance.

You see, the standards for physical examinations are uniform. Whether you are a 20-year-old programmer or a 60-year-old hypertensive patient, the items in the basic physical examination package are not much different. It is nothing more than adding a tumor marker screening when you are older. It is a universal screening, and it only matters whether there are any organic abnormalities in your body at the time of your examination. I have a friend who works as a developer. His physical examinations for three consecutive years were all normal. However, last summer he had a stiff neck and was so painful that he could not lift his arms. When he went to the rehabilitation department, he found that the curvature of the cervical spine had straightened. He was still wondering why the physical examination did not detect it. In fact, the anteroposterior and lateral radiographs of the cervical spine in ordinary physical examinations can only detect bone hyperplasia, intervertebral disc herniation, early muscle strain, and curvature changes. They are not within the scope of routine screening at all. This kind of problem is originally for preventive health care to intervene in advance.

Unlike standardized physical exams, preventive care is completely personalized. For example, if you have a family history of lung cancer, your preventive health care plan will definitely require you to have a low-dose spiral CT every year instead of a regular chest X-ray. You will also be asked to smoke less cigarettes, turn on the range hood when cooking in the kitchen, wear a mask when going out in hazy weather, and even clearly outline how to moisturize your lungs during the change of seasons. ； If you have a constitution with high uric acid, in addition to checking your uric acid regularly every year, you will also be reminded to drink less soup and seafood, and how to take medication to relieve the symptoms during the attack. These small and long-term interventions are beyond the control of physical examinations.

Nowadays, many high-end physical examination centers are promoting "post-examination management", which actually connects physical examination and preventive care. On the day you finish the report, a health manager will give you an intervention plan, and you will be followed up regularly. This is a good thing, but don't be fooled by the merchants and think that this is an "upgraded physical examination". In essence, the two links are put together, and the core logic is still separate.

In fact, for us ordinary people, there is no need to get too hung up on the academic definition. To understand the difference between the two, the most practical meaning is not to regard the annual physical examination as a "gold medal" for health, and don't start staying up late eating and drinking after getting a completely normal report. After all, the physical examination just takes a "snapshot" of your body, but to keep this machine running smoothly, it still depends on daily maintenance, right?