Executive Health Assessments: Costly and Ineffective

Dr. Mark Dermer

The power of conventional wisdom can be both a good and a bad thing. When the wisdom is based on facts and truth, it’s good. But it can be a force for bad when it is based on faulty premises or bad information. An example of this is executive health assessments — those private, expensive check-ups designed to make the employers and key employees feel like they can get ahead by detecting lurking health problems early.

But science tells us that this idea is erroneous. A leading study in the British Medical Journal from 2012 concluded that annual examinations and testing don’t reduce death, disease or work absenteeism. That’s why the Canadian Task Force on Preventive Health Care and the Collège des Médecins du Québec, among others, recommend against them. That also means that the money that employers spend on executive health assessments is wasted.

Almost everyone knows a person who had a serious illness unexpectedly diagnosed at an annual checkup. However, research shows that when we calculate the overall benefits and harms of these assessments, there turns out to be no net gain from yearly examinations.

Four Harms Caused by Tests

Any test done in these assessments can potentially cause four types of harm, which can negate testing benefits.

1. Test dangers – some tests are riskier than others. For example, according to a widely-cited and respected academic study, any test that requires “ionizing radiation” (x-rays, CT scans and PET scans) raises the risk of cancer. We estimate that each CT scan of the chest or abdomen causes premature death for one in 2,000 people.

2. The risk of false alarms – a test mistakenly tells us that a healthy person is sick. This leads to two possible harms: the risk of further testing to prove that the first result is incorrect, and the anxiety during the wait to disprove the false alarm.

3. False reassurances – the results say that the patient is well when he has an illness. That’s particularly dangerous for conditions that cause sudden disability or death, such as heart disease.

4. The risk of overdiagnosis – in this case, the test result is correct but the identified problem would be better left alone. For example, recent research suggests that as many as 30% of breast and prostate cancers might pose no threat. And many treatments are equally effective both before and after you develop symptoms, so there is no need to start treating and risk side effects before the disease troubles the patient.

Researchers consider the 2012 British review cited above to be the most authoritative answer to the question of whether or not these annual assessments are effective. The results are clear: yearly physicals do not reduce the rates of overall death, death from cancer or heart disease, disability, hospitalization or work absence. Furthermore, and perhaps most surprising, the review could not find evidence that annual physicals reduce patient worry. For employers, the lack of impact on work absence or disability is particularly important.

What Are the Safe Alternatives to Executive Health Assessments?

So, if costly and invasive annual executive health assessments don’t really accomplish their goal, what should an employer do to maintain the health of their valuable leadership talent?

First, ensure that employees have an ongoing relationship with a primary care health professional and that they see that professional at least once every two years. That visit should focus on assessing risk, arranging proven screening tests and providing preventive advice.

The second thing is to provide quick and easy access to healthcare when a new problem arises. Ideally that would be available from the patient’s regular provider, but many primary care offices don’t offer timely visits or have inconvenient hours or locations. In addition, the new problem might occur while the employee is travelling.

Those limitations on conventional practice are why telemedicine is growing so quickly. New innovations will allow telemedicine to safely manage an ever-larger proportion of new problems while saving the time cost and waits of conventional primary care. Contact us to learn more about why telemedicine is a smart way to invest in employee health.