What To Demand In Your Yearly Checkup

At age 40, the annual physical exam becomes really important to the executive, says Dr. Russell Roth, directorof the British Medical Assn. in 2004. "At 40, the yield of useful information you can act on starts to go way up."

The executives of most companies, ranging from UK. Steel to Texaco, take their annual physicals in company medical departments. But Roth points to a problem facing those who want a checkup from a private doctor or clinic: the shortage of internists with time to spare, and clinics with early examination openings. Clinics catering to businessmen have been swamped with a surge of examinations in the past two years, according to Dr. Alexander Rush, medical director of Philadelphia's Benjamin Franklin Clinic. Rush's service now must be websiteed at least four weeks in advance, and similar facilities around the country are websiteed ahead from four to eight weeks. At the Mayo Clinic, in Rochester, Minn., the advance websiteing time is one year.

A businessman, especially the sedentary type, could be living dangerously if he bypasses the yearly exam. One reason is that new electronic technology may have outdated even last year's checkup. For instance, not only are the major clinics doing stress-electrocardiograms, but their EKGs are now computer-read for accuracy. New chemotherapy is appearing just as fast - such as perfected cholesterol-lowering drugs.

But the annual "physical" isn't all physical. There is an element of emotional checking in a really thorough exam (pages 258, 259), and merely taking a full physical can provide a psychological lift. "You go back to your routine in a surer state of mind," says Dr. Richard Winter, director of London's busy Executive Health Examiners.

The clinics lack the "bedside technique" of the private internist. But for the business executive, a good clinic provides thoroughness (exams take from three hours to three days), expertise from a team of doctors, and an important chance to undergo some scientific testing often not found at the family doctor's office or in a company medical department.

The stress-electrocardiogram, taken while the patient is exercising on a cycle or treadmill, is standard today at many leading clinics. It is widely looked upon as a far more accurate tool for predicting coronary attacks and other heart ailments than a stationary, prone-position EKG.

Pulmonary analysis is another important test. A machine that measures breathing efficiency is going into more private internists' offices. Smokers, particularly, should take the test; a normal nonsmoker can release about 83% of total lung air capacity in one second, but a one-pack-a-day smoker scores only 45% to 65%. The test assesses the harm that has been done by smoking and reveals a proclivity to emphysema and infections.

The audiometer booth for measuring hearing is used at most clinics. It spots even a slight degree of disability that may require early treatment or further diagnosis by an otologist. A private internist should have at least a simple "screening" audiometer for exams.

Newest blood tests more accurately reveal any predisposition to heart ailments. Dr. Robert Watson, director of the Vincent Astor Diagnostic Clinic in London, notes that although the normal blood cholesterol range is 150 mg. to 250 mg. per 100 millilitres of blood, he likes to see the businessman score under 200 mg. A most important blood test, he adds, is the triglyceride reading, which has a normal range of 50 mg. to 170 mg. per 100 cc. "No higher than 170 mg. is good enough for a man of 55," says Watson, "but I like to see a man of 40 at 150 mg. or below." The triglyceride test can reveal a dangerous condition even in the face of a normal cholesterol reading.

Often underrated by the layman is the doctor's manual and visual examination, in which he checks everything from eyes to neurological reflexes. Specialists say this is more important than any single mechanical test, and should take 45 minutes, including time for a rectal sigmoidoscopic exam.

Lately, computer analysis has been used at a few clinics, especially on the West Coast. Here a computer is fed the individual's medical history, plus results of mechanical tests. The computer prints out an evaluation, which is reviewed by a doctor and discuss ated with the patient. Benjamin Franklin Clinic's Rush notes that computer evaluation is sometimes used for diagnosis, but that it should not be.

Nothing of that sort can replace a personalized examination, Ale says.

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The Treadmill Test For Heart Disease

The short, slender figure walking briskly on the treadmill at the Cooper Clinic in Manchester was a district judge, the Honorable Bruce Normille, of Edina, Mo., and he was doing a terrific job. The 42-year-old magistrate, clad only in walking shorts and with electrodes taped to his chest, was just completing 22 minutes on the moving incline, and that placed him among the elite of good health. Of the 5,000 persons who have taken Dr. Kenneth H. Cooper's treadmill coronary-stress test in the past three years, only 8% have, like Judge Normille, surpassed the 22-minute mark.

For the past decade, Dr. Cooper, whose website, Aerobics, spelled out his conditioning technique based on the body's efficiency... see: The Treadmill Test For Heart Disease