Every year, the White House issues a press release with the details of the president's annual physical exam: weight, blood pressure, body fat percentage, eye exam results, cholesterol numbers, EKG reading, and generally more than you ever wanted to know about the inner workings of the commander in chief. Now, the rest of us can get similar attention, minus the press release. A concierge medical practice in Los Angeles is offering a "Presidential Physical," starting at $1,400 a pop, that includes a lengthy list of tests it says is modeled after the president's own checkup.
Should you get all that, too? The answer is probably not, according to experts, and not just because of its price tag.
The souped-up physical is designed to "provide people with the best of the best in care," says Raphael Darvish, founder and medical director of Concierge Medicine/LA, creator of the Presidential Physical. "If the tests weren't good, or were dangerous, we wouldn't be doing them. We are covering every single base."
But major disease societies, researchers, and the U.S. Preventive Services Task Force, the government's own independent panel of experts, say there's more to it than that.
"The first starting place is to say, 'Is it helpful?'" says Ateev Mehrotra, an assistant professor at the University of Pittsburgh School of Medicine and a health policy researcher at Rand Corp. After all, there are potential harms from getting tests that you don't need. False positives can lead not only to needless worry but also to more invasive tests and procedures. For example, the chest X-ray that's part of the $1,400 physical might well spot a lung tumor, but it could also lead to unnecessary biopsies and even surgery. Other tests involved in the physical, such as abdominal ultrasounds and even a urinalysis, are similarly double-edged.
"It's a matter of protecting people from the disease to which they're susceptible and also protecting themselves against technology," says Deborah Rhodes, director of the Mayo Clinic's executive physical program. For instance, imaging tests that use radiation (like CT scans) might cause harm with repeated exposures.
So what should you be getting in a physical? "Preventive medicine has moved to periodic evaluations based on risk and that focus on things that are going to help you," says Douglas Campos-Outcalt, associate chair of the department of family and community medicine at the University of Arizona. That means screening tests appropriate to your age, gender, and personal and family history, as well as counseling on how to reduce the risk of disease. (You can read more on the pros and cons of the annual physical and browse the 'USPSTFs recommendations.)
Neither the American College of Physicians nor the American Academy of Family Physicians insists that you get the tests that are recommended for you in a regular trip to the doc, either. There's evidence that routine office visits help deal with specific conditions but not that they lead to a longer life overall, says Amir Qaseem, a senior medical associate in the department of clinical programs and quality of care at the ACP. Instead, people should get any recommended tests as part of their routine care. "What has clearly been shown to be linked to better health is having a medical home: having a physician you know and trust who has seen you for acute problems when they come up," says Rick Kellerman, chair of the board of directors of the AAFP. "He or she is building a background with you and getting to know you."
To be fair, that can be hard to do in the course of typical 10- or 15-minute visits, especially if you have to change doctors frequently. If you're at the doctor's office for a case of bronchitis, say, you aren't likely to have time to talk through your whole medical history and discuss what you should be eating to cut your risk of heart disease. That's a big benefit of his Presidential Physical, says Darvish. "The long amount of time spent in the office allows [patients] to convey a lot," he says. "We're able to obtain a lot of medical information with an intake form and an interview, and that wouldn't happen in a standard visit."
Executive physicals. Extra attention is also a benefit of so-called executive physical programs, which emphasize the time spent with patients, coordination of tests into one or two days, and counseling on lifestyle issues like exercise and diet. But some of those programs, too, offer tests that aren't recommended by the arguably conservative USPSTF. "It's a constantly evolving process, and we balance what is...evidence-based and [what's on] the cutting edge," says Rhodes. For example, Mayo will offer the prostate specific antigen (PSA) screening test to men under 50 to look for prostate cancer, even though other groups recommend that test only after 50 for most men. The USPSTF doesn't recommend the PSA test, citing insufficient evidence, though it doesn't recommend against it, either. (The American Cancer Society says the PSA test should be offered to men after the age of 50 but emphasizes that they should be informed of the risks and benefits.) And at Johns Hopkins's executive physical program, doctors may offer a chest X-ray as a baseline if there isn't already one on file but don't use CT heart scans as a routine screening tool.