The debate over corporate health screenings: Do they lead to over-diagnosis?

Two years ago, Toronto Life magazine ran a feature on five of Toronto’s most exclusive private medical clinics and all featured comprehensive preventive screening and followup care for corporate executives among their offerings.

The cost of care at these clinics at that time ranged from $1,500 for a health examination and a year of ongoing care to $3,995 for a comprehensive health exam and followups.

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Medisys, which provides corporate health services in six cities, is representative in how it presents its services. “Not only does a corporate wellness program deliver health-related cost savings, it also increases employee satisfaction and engagement, as well as productivity,” the company website states. “An employee wellness program just makes good business sense.”

However, the types of comprehensive screenings offered by these clinics, which now sometimes extends to genetic testing‚ can be at odds with the current Choosing Wisely effort urging physicians and patients to think twice about what tests need to be ordered.

This fundamental difference in philosophy between these two approaches played out most vocally on social media a year ago, when U.S. billionaire Mark Cuban repeatedly urged people to have their blood tested quarterly and was roundly criticized for these views.

“I have a few friends who do these kind of executive medicals and they, knowing my keenness on preventing over-diagnosis, sheepishly tell me of the screening programs they have as part of these clinics,” said Dr. Jessica Otte, a B.C. physician and advocate for reducing unnecessary tests.

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“On the plus side, because they are doing these physicals for the private system, they do have the time to talk about risks and benefits of each test in detail with the patient — something that is essential and yet is considered a luxury in the public system because there simply isn’t the time to discuss everything,” she said in an online interview.

“Historically, we touted the benefits of screening: ‘early detection is key!’ because we thought it was true. It turns out, it isn’t. At least, not for many diseases.”

“Many would say anecdotally that this is especially true when they are executives whose companies often have succeeded because of meticulous attention to detail, increasing production volumes and global expansion — all things that might reinforce the ‘more is better’ concept. In those seeking executive physicals, I would argue they are self-selected to want more things done (since they have sought out this service in the first place).”

Dr. Otte added that “executive physicals are usually offered by companies that want to make a profit by catering to any client that can afford it; there may be a conflict, in that their payment is contingent on encouraging patients to have tests, followups, et cetera even if not really necessary.

“Also, the ordering physician rarely has a longitudinal relationship with the client and may not get to know them as a person. How could this physician meaningfully discuss risks and benefits, and journey through the process with a patient, if they don’t have the responsibility of caring for a person over time?”

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Executives for Medisys and other large private clinics contacted for comment on this article did not respond to requests for interviews.

However, it should be stressed that even when comprehensive screening is part of an executive health plan, it’s not necessarily overdone. For example, in the Toronto Life article, it was noted that the Healthcare 365 clinic “won’t test for conditions for which patients have no symptoms.”

This article originally appeared on the website of Benefits Canada’s companion site, Medical Post.