What is the difference and connection between preventive health care and physical examination

To put it simply, physical examination is the core front-end screening method in the preventive health care system, and preventive health care is a complete health intervention logic covering the entire life cycle of a person. The two are in a supporting and inclusive relationship and cannot be equated.

I have been doing health management in the community for almost 7 years, and I have come across this misunderstanding that physical examinations are equal to preventive care too many times. Last week, a 62-year-old resident came to me and said that his annual physical examination at work was normal. However, he recently felt dizzy and went to the hospital for a check-up. He was directly diagnosed with grade 3 hypertension and was also warned of the risk of cerebral infarction. He took the physical examination report and asked me if the previous physical examination was fake. I looked through his reports for the past three years, and I actually had clues: his blood pressure had been at the critical value of 138/89mmHg for two consecutive years, his body mass index had exceeded the standard, and his blood lipids were also at a high level. However, the report only gave four words "recommended follow-up". He turned around and forgot, staying up late to watch chess and drinking white wine without delay, and abruptly turned the critical problem into a confirmed disease.

You see, a physical examination essentially takes a "snapshot" of your body at the moment. All indicators are the status of the dozen or so hours during which you drew blood and did the examination. The core function is to detect pathological changes that have already occurred. Even a high-end physical examination that adds tumor markers and genetic screening is essentially "looking for existing problems." But the scope of preventive health care is much broader. It does not focus on indicators at a certain point in time. Instead, it takes into account your living habits and family history in the past few years, and your risk of disease in the next few years. It not only needs to find problems, but also provides specific plans on how to prevent problems from occurring and how to fix minor problems. It also needs to follow you up. For this old man, if someone had calculated for him when he was first diagnosed with critical blood pressure that he had a 20-year history of smoking, was 15 pounds overweight, and had a risk of developing high blood pressure of more than 60% in the next three years, and had set specific requirements for him to eat no more than 5 grams of salt a day, walk for 30 minutes after meals, and have his blood pressure checked once a month, he would not have been at this point.

The industry now has different views on the weight of the two. Some institutions that conduct high-end physical examinations believe that as long as the accuracy of physical examinations is sufficient and the port of early screening is continuously moved forward, most prevention needs can be covered. For example, millimeter-level early tumors can now be detected through liquid biopsy, which itself is the most effective prevention. But most of us who work in grassroots public health don’t see it this way. After all, no matter how accurate the early screening is, if no one intervenes after the problem is found, and users don’t take it seriously, it will still be a useless effort.

But having said that, the two must not be separated. Just like when an old farmer wants to prevent insects when planting crops, he first has to squat in the ground and peel off the leaves to see if there are insect holes and test whether the soil moisture is sufficient. This step is equivalent to a physical examination. You can’t even figure out what the situation is at the moment. The subsequent watering and insecticide spraying are all a fool’s errand. In the past two years, many physical examination centers have also been changing. In the past, the report was completed. Now, users with critical blood sugar or pulmonary nodules will be directly connected to health managers, and 3-month or half-year review and intervention plans will be established. This is to open up the front-end entrance of physical examination and follow-up services of preventive care. The effect is indeed much better than before.

To be honest, we ordinary people don’t need to dig into the definitions to clearly distinguish between the two. Just remember not to use the annual physical examination as a health "gold medal" to avoid death. Even if the report is full of small arrows and there is no one, you have to keep an eye on whether you have bad habits of staying up late, sitting for too long, or eating too much. If you feel uncomfortable, don't bear it. This is the real prevention.