A Five-Hour, $5k “Super Physical” Exam | Hacker News Reader

A Five-Hour, $5k “Super Physical” Exam

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75 pointsRickJWagner55 comments

I've had a similarly priced full day medical in the UK (with Preventicum) although it included (almost) full body MRI (less annoying than I thought it would be!), ultrasounds of abdominal organs, lung capacity tests, and various such things.

I am very glad I did. While people are often warned away from such things due to the risk of finding things that could cause concern but which are not strictly dangerous, it has hugely put my mind at rest given some health problems I was having. It is also amazing to have full body medical grade MRI scans I can navigate on my computer(!)

I can't think of a huge deal to say about the experience, but I am happy to answer questions if anyone has any.

I've often wondered about this - I don't know anyone myself in the UK who gets a 'yearly physical'. Even middle class people like this seems to be aimed at. I didn't even do one when I was in the military.

I sort of assumed it was one of those things that people did in the movies as a plot device. Like normal people having a lawyer on retainer so they can say 'call my lawyer'.

Is this something I should be doing? Why's isn't my surgery inviting me to do it if it's beneficial?

Same in Australia. Here you just go to the doctor when you notice something that’s not right.

Apart from going to the dentist, really the only medical thing that most healthy people would do fairly regularly is a skin check/mole scan every couple of years, since melanoma is such a risk here.

It's not normal in the UK at all to have that kind of check-up, especially not pre-emptive MRIs.

Screen too early and often can lead to too much preventative medicine and procedures, which ironically while preventing specific things aren't without their downsides and can cause an overall lower quality of life.

Sometimes it can feel like the NHS swings the other way and is hesitant to refer for diagnosis even when there is an issue, but in general they try to balance things for everyone. Also, what can be beneficial for an individual may not be beneficial for society as a whole.

That said, if something feels wrong, then please do keep on at your doctor to get a diagnosis. It can be feel like you have to borderline harass doctors to get referrals sometimes in the UK but if there is an issue then don't give up.

I know I was on deaths' door when the hospital finally diagnosed me properly. My GP was still telling me I just had intercostal muscle pain and to take painkillers and come back later even after the hospital had figured it out.

Regular bowel cancer and cervical cancer screenings are provided by the NHS - the former from 50 here in Scotland (possibly because of our atrocious diets).

They were going to lower it to 50 (from 60) in England too[1] but they seem to have opted for 55 instead.

[1] "In August 2018, ministers agreed that in the future bowel cancer screening in England will start at the age of 50." https://www.gov.uk/guidance/bowel-cancer-screening-programme...

Same in the European countries I've lived in: a "check" isn't a thing, except for some specific things like certain cancer screenings. You visit the doctor when you're sick, otherwise you don't. I think it's a reasonable expectation that your body will signal if something needs to be looked after.

There is a trend to require medical checks before doing sport once you are at a "serious amateur" level or above.

Typically my annual physical is blood work (cholesterol, blood sugar, liver enzymes), blood pressure, chest exam (heart/lungs), check for testicular cancer, and soon a finger in the butt to check the rough size of my prostate.

> I don't know anyone myself in the UK who gets a 'yearly physical'

Partner did as part of the life+health insurance package provided by $company. But it was the normal blood work, blood pressure, eyes, hearing, lungs, heart, etc. kind of thing; nothing like the Elitra shebango.

I would have expected the opposite from a country where everyone could get one for free.

Or maybe here in the US it is more common because healthy people want to get something for the exorbitant amount of money they spend on insurance.

I do expect your level of tests/diagnostics for the price mentioned. And the value of finding things to be not concerned about is close to priceless I think. You should try 3d printing one of your own organs just for novelty!

Doctor here. You didn't have a false positive-- of course you feel better off. But, you're not physically better off because nothing came back as positive or treatable. Some will start in your shoes, but be unlucky and have a false positive. They would be mentally and physically worse off as potentially inconclusive tests followed by potentially unnecessary procedures resulted in, say, removing one of your kidneys. Yes, that will only happen very rarely and yes I've seen it happen.

There can be kind of a two prong "test" to determine if screening is harmful. Physically, is it a good idea? Answer is probably no. We're not in a scarcity situation really where the "prestige" demographic isn't getting recommended to get appropriate tests based on their risk factors (on the other hand, some of our poorest aren't getting them but that's not an issue solved here). The other side is mentally. Again, I'd argue that people with a clean unnecessary screening got out lucky. They'd be mentally much worse off had something come back positive.

Bizarrely, there's new data suggesting that even fixing known problems, like coronary artery blockages doesn't improve mortality in a lot of situations you'd think it would. That suggests that we're doing too much screening in that case (I mean, if the treatment is worse than the disease... why screen?), not too little. As another example there is a well-known vascular surgery group going to churches under the pretense of "screening" for leg atherosclerosis, then performing high-margin, high-turnover, and unnecessary procedures on the very high "induced" false-positives.

I also find it utterly bizarre that screening would include lung capacity testing. In an otherwise healthy adult who can say, climb a flight of stairs or something of the sort without getting shortness-of-breath, that test is completely meaningless and expensive from a "disease" perspective. On the other hand, it does give you a number to compare to your peer group, kind of like resting heart rate. On the other hand, resting heart rate is free, can be done yourself, and literally takes 15 seconds to measure.

In the end, I'm not really against having these sort of "prestige" medical services available. Particularly because more choice is generally good-- and it's your body, you should do what you want with it (within reasonable bounds). But, everyone should educate themselves because on balance, I doubt people end up up feeling or being better off considering the ones who will have false positives.

These type of arguments never sit right with me. It's my body, I'd like to know as much about it as possible. It's good to be aware of the risk, but at the end of the day it's my decision to take that risk on.

One reason to screen more is that it provides incentive for better treatments. How many people would be researching new coronary artery treatments if we just started ignoring the disease?

And for that matter how often will statistically motivated reductions in screening cause true positives to be missed?

Much too often for comfort. I’d much rather try filtering false positives myself than guessing at true positives.

The parent agrees with your first paragraph at the end of their comment. I disagree with what you seem to be asserting, which is that anyone who's not getting every atom of their body scanned is "ignoring the disease".

My parents have fallen prey to a quack like this. They think he walks in water, but he has done so many bad procedures on my family. It is sad, but it is hard to convince them how harmful many of the procedures are given that they won’t bother to change their unhealthy lifestyle.

> I also find it utterly bizarre that screening would include lung capacity testing

Until I was 15 I used to play water polo at a reasonably competitive level; I had to get yearly "sport physicals" (not sure what they're called in English). I didn't always go to the same hospital and the procedure changed a bit from one place to another.

One year they tested my lung capacity, and they told me that I had "the lungs of king kong" (I think I was at about 125% the average/median/expected for someone my age and size).

It was the best physical ever, I still cherish that moment.

Opinions like this are dangerous for intelligent people. I was falsely diagnosed by my doctors for 10 years who were gun-ho on not "over testing". They told me my symptoms were just IBS and there was no need for additional testing. I had to find a doctor who would do more tests and immediately they found cancer in my intestines, a softball-sized tumor in my liver, and multiple other tumors. Denying intelligent people knowledge is a mistake; we just also need the information need to process the data provided. But I do agree there is a section of patients who will have trouble using the information they might receive.

Your case is very different from the OP and the post you're responding to though. They are discussing the benefits and drawbacks of screening for a lot of stuff on an otherwise healthy person with no symptoms or complaints. In your case you unfortunately have had something very wrong with you and your symptoms were misdiagnosed.

> Opinions like this are dangerous for intelligent people.

I also want to add this was quite rude and conceited.

> I also want to add this was quite rude and conceited.

Personally, I didn't interpret the poster's opinion as rude or conceited. This is hacker news. It attracts a demographic of intelligent people who are used to seeing the world without blinders on. It makes sense to me that someone who identifies as a "hacker" would be offended by the idea of withholding information.

Tumors are actually a great example of over testing. The key is, you don't know what would have happened in the alternate universe, but when you say the word "tumor", you just assume it's a super dangerous thing that would have inevitably killed you.

The truth is, when we do a careful autopsy of old people who died of non-cancer diseases, we usually find a ton of hidden tumors that have just quietly been lying dormant, not really harming them. In those cases, ignorance is bliss because doing anything to remove the tumors only could have increased their risk of death given that the tumors didn't kill them.

We don't know what bucket of people any one person is in, we can only look at overall statistics.

It seems to me that doctors are the only people with the opinion that testing doesn't help people. Is this taught?

Either I test positive, and this gives me a treatment program or more knowledge about the situation - and how I can manage it physically and emotionally.

Even given a chance of testing false positive, it allows me to do more appropriate research and weigh up the risks and benefits - something I don't have without that test.

or I test negative, and I gain reassurance that I don't need to worry about this risk.

The worst case (in my view) is a false negative - but that's the same position as I was in without a test.

I'm an epidemiologist and I think excessive testing doesn't help people, so it is definitely not just doctors. False positives can do real harm, including killing people if it leads to unnecessary treatment like surgery.

You need to think about a tests Postive Predictive Value and Negative Predictive Value. The PPV is the number of people who get a positive test who have the condition divided by the number of people who get a positive test who do not have the condition. When the PPV is low the test can provide functionally no information. Now the important thing to remember is that the PPV changes based on the prevalence of the disease in the population, so a given test could be good for some people and bad for others, all depending on their base risk.

Yes - you should always think about the risk of a false positive when considering a treatment (or, equivalently, the PPV). That risk hasn't vanished at the point of testing.

If you know the risk of a false positive and the benefit and risk of treatment, then you have the option of reducing risk: choosing an option with increased risk is a mistake, but a mistake in judgement, not a mistake due to the test.

You assume that given a positive result you can gain certainty, but that is not so. Medicine is a statistics game, even for individuals with test results, and even when adding even more tests on top you don't turn it into certainty. What is abnormal for somebody else may be normal for your body, and trying to do something about it may actually be worse. Weighing risks and benefits sounds easy, but it only really works for doctors (looking to optimize their overall success for all their patients) rather than for individuals - for large numbers. Plus, it's always based only on the "known knowns". There is a huge amount of "known unknowns", and the amount of "unknown unknowns" is unfathomable (thanks Rumsfeld, famous American philosopher, for popularizing those terms). What is "normal" is not based on a complete understanding of every individual as a complete system but the parts are compared among individuals after abstracting away the context that they are in. So knowing what is "normal" or not does not give you nearly as much information as you may like.

Sure, your method works for a lot of cases - but it doesn't work or not very well for orders of magnitude more.

I'm not a doctor. I just write software.

Not doing unneeded tests has parallels to not doing unneeded logging. The costs may be low, but they're not zero.

Sure -- if you have a problem, it might have been nice to have screened for it earlier, or to have logged more data for that flow; but if a problem is rare, the costs for doing all the tests or all the logs adds up.

In medicine specifically, we often read about interventions that turn out to have not been the greatest idea. Avoiding or postponing interventions in the absence of symptoms seems more prudent than seeking out more interventions in general. There are some things where widespread screening makes sense, and you shouldn't ignore symptoms or family history, of course.

The parallel here would be running a test, not writing a test.

If the test [likely] takes up more resources to run than the [likely] benefit, then don't run the test, I agree.

I wouldn't count that as a diagnostic test at all, though.

Here's a concrete example from my own life. I've had a very minor and benign heart condition my whole life. Switching doctors after I moved across the country they're like: "We should do an echocardiogram to just check that it hasn't changed."

They do the ECG and find a really crazy high blood pressure in my heart so they think I have pulmonary hypertension. This kicks off:

- A sleep study

- Lung capacity study

- Restricted travel (they didn't want me to fly - which was a problem with my consulting work)

- A full-on cardiac catheter procedure - which is outpatient, but still a procedure where they put you under twilight sedation and insert large metal sheath into your groin (femoral artery)

Easily a dozen doctors visits, thousands of dollars in additional tests, and multiple weeks of time altogether. Also, non-trivial risks of infection and complication from the procedure.

On top of that, it's a mental thing. Every twinge of a muscle in my chest would cause a spike of concern, I'd sit around worrying about my heart inflating and bursting, etc.

All to (thankfully) find out that definitively 100% that the ECG was a false positive and I'm perfectly fine. One kicker to this though is that I was initially rejected for health insurance at a new job (pre ACA) as I'd had this procedure. It took patiently explaining over and over again to insurance people the above before they would accept me.

I'd like to see some data on the rate of false-positives for this type of scenario. I can only assume your situation was an edge case and that were it indeed a serious problem, you would be singing a different tune. Clearly there is some benefit to using ECG as a diagnostic tool to save lives, so your scenario doesn't necessarily negate the ones that are truly cardiovascular problems. Not that you don't have a valid argument (you do and thanks for sharing btw), but it's a matter of weighing the total outcome across the board I think.

I had a hyphema of my retina. Each time I visit a new doctor and they check my pupil dilation, I can tell they are disturbed when they move to that eye and it does not react. I've had doctors express alarm and tell me they were going to run tests on my head.

Now I just tell them before they inspect me and avoid the whole thing altogether.

I had similar experience with crappy ECG suggesting I had some horrid heart condition. After a fraught week, learned it was totally false. Now each time I get the ECG, get the same false positive, I bother about it less.

It's not even just false positives. Real positives can also throw up huge dilemmas.

For example, let's say it had been discovered during my scans (which were taking place for unrelated reasons) that I had a minor aneurysm in my brain that had a roughly annual 0.2% chance of rupture. Let's then say I was given the choice of having an operation with a 10% mortality rate. What do I do?

This sort of decision is really tough, because I could easily live another 50 years with such an aneurysm, but the terror of having something like that in your head might scare you into taking a risky operation you logically shouldn't take. Sometimes ignorance of minor problems is a good thing.

(Note: These stats above are plucked out of thin air to make a point, but I know of real cases where the numbers have fallen this way.)

If you're over 35 then you have at least 0.2% chance or so of death, sorry to say.

Knowing what might kill you might give you the chance to deal with it, or choose how to live with it.

While I agree this is of dubious value medically, it’s also interesting as simple data collection and collecting data does not require actions.

I was looking to getting an MRI every decade as an artistic endeavor. You can look at photos from 40 years ago, but what’s your body like 40 years ago?

I don't really disagree with you! I didn't go into this blind, however. I'm on the autistic spectrum and had, perhaps unsurprisingly, meticulously researched almost every factor I could before going ahead, including the illogical sounding (to the layman) statistical issues regarding false positives and negatives.

There are few people to whom I would directly recommend similar testing, but I had medical motivations to seek it (it wasn't solely curiosity - but this is a topic for another venue) and felt psychologically and educationally equipped (whether or not this was truly the case) to handle any dilemmas that would arise.

All that aside, being able to see your aorta and circle of Willis is really cool, and being able to see my heart beating from the inside out even cooler :-)

Although there's a privacy policy published on their website, it sounds like there is a different consent-based policy which covers the detailed healthcare data they collect during testing.

Are you able to share any of the privacy policy or assurances they provide regarding your medical data?

Unfortunately not. For better or worse, it didn't, and doesn't, concern me. That said, I don't recall there being any particular assurances about this matter during the process.

These types of magazines[0] seldom write something without getting paid by the topic. I don't have proof in this case, but it sure reads like an ad.

[0] From their 'About' page: “the go-to news and luxury lifestyle recommendation platform for the affluent, on-the-go gent.”

I would guess that the author received the screening for free on condition that they wrote about their experience. It definitely reads like an ad, but ads can often be useful to learn about interesting services and what they include.

It kind of was an ad, but at least this one was well targeted.

Of course I’m an affluent, on-the-go gent. I unfortunately do not have $5,000 lying around.

They didn't mention it at the start or end of the article but I do wonder if this post was paid for by the clinic that provides the exam.

I didn't see anything mentioned in the article that you wouldn't get checked in a regular $250 yearly checkup... what was it that they did that made it cost $5k?

It's not all that different to the annual medical everyone has to do in Japan - and all costs related to that are covered.

You don't get the neurological or bone density scans but you can request them for a few hundred dollars. The larger Japanese clinics also have all the big scary science machines you would expect in a hospital, so you can get everything done on the same day.

More than 10m with a doctor that isn’t looking to get you out of his office as soon as possible?

The blood draw looks more comprehensive than you'd usually get in the US (the author mentions mercury for instance).

Also, radiology is something that is usually done only if they find something wrong during a standard checkup or if the patient is complaining about something, and that is going to bump up the price to above the usual $250 or whatever.

I've never heard of cognitive tests, comprehensive eye exams, DXA scans, or comprehensive hearing tests being part of a normal checkup. All of these things can be done but the costs would add up and they'd often be done by different doctors on different days and usually using different emr's that don't talk to each other.

Also, the author points out that "the most valuable aspects of the exam, though, is time with an experienced physician who simply has nowhere else to be". This is something that you will not get in a $250 yearly checkup from my experience.

Radiology alone can get you into the thousands in the US. For a 15 minute neck MRI, my insurance still paid over $1,000 with an initial cost listed over $3,000 IIRC. A yearly check up lasts about 10 minutes for me along with basic blood-work. They must be doing a considerable amount of testing for 5 hours. I'm actually surprised it's only 5k given the outrageous medical prices in the US.

I wonder how effective it would be to make an exam like this when you are at your healthiest as a baseline.

Then when you are not doing that well your values can be compared to your baseline and not the average person.

This sounds like the more accessible version of the Mayo Executive Health Program.

https://www.mayoclinic.org/departments-centers/mayo-clinic-e...

I saw mention of "radiology services" but I didn't see any specific mention of a CT scan.

I needed a CT scan recently. It wasn't for reasons of blood flow or anything like that. But the radiologist must have been bored (or perhaps concerned about liability) because he threw in this comment: No abdominal aortic aneurysm with mild circumferential atherosclerotic calcifications

Wow.

I didn't know that CT scans were useful in diagnosing atherosclerosis. There were all sorts of other similar tidbits in the report.

If I were rich enough, I'd want a full body CT done, perhaps every year. It shouldn't be done too often because it's ionizing radiation.

You can do the same thing in Japan for less than $1000.

Wonder how this compares to the $2000 "Executive Exam" you can get in several medical tourism countries.

Could you name any companies that offer that service?

I think it should probably be just as good. Doctors are terribly expensive in the western world.

So it's a technical interview for your body?

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