Are you a hard-working high-flyer? Then you could be in need of an executive check-up. Robert Love stops avoiding men with stethoscopes - and is surprised by the results
Medical statisticians tell us men are much less likely than women to visit their GPs if they're feeling unwell. Much to my wife's chagrin, I fit that stereotype neatly. Even five years as a medical journalist and the welcome friendship of doctors of all specialities have failed to persuade me of the value of regular visits to my local surgery. It's not that I don't occasionally feel unwell, it's just that I need to be on my deathbed before I give in and go, and even then it's under protest.
Next month I hit 35 and enter midlife. The age marks a turning point for men's health. It's pretty much a given that men rapidly develop much more sedentary lifestyles after passing the milestone, assuming they haven't already succumbed to expanding waistlines and less active habits. In my case, the past six months have seen me become involved in a new career and a start-up business, with stress levels rising accordingly.
And so with an eye on the bigger picture, I finally agreed that now was the time to go for a health audit. Having battled this far, I appreciated that I needed the works. I had never even had my blood tested. This visit would tell me if I had high cholesterol, if I had a leaning towards hereditarily high blood pressure and if there was something lurking on the health front that I hadn't anticipated.
General practice is the place Irish patients go for such appraisals. There's much debate about the quality of the health services, but GP land is one place where the system seems to work well. Unlike in the UK, you can walk in off the street and they'll treat you. But where to have my check-up? I'd so successfully avoided the men with stethoscopes since moving to Dublin six years ago, that I hadn't even got a GP.
Defining quality healthcare in Ireland's unique system is problematic at the best of times. The well-developed private sector means every major Dublin hospital has a private clinic packed full of consultants. But even in such a well-furnished field, it's almost impossible to define which is best. There are no league tables, and doctors are barred from advertising.
The ban is even more problematic for GPs. Private health insurance plans don't really direct patients to their doors, and they must work even harder than hospital-based colleagues to attract patients, through word of mouth.
Because I work in healthcare, I was aware that an innovation in general practice was under way in Dublin that seemed to offer just the package to meet my requirements. Further investigation revealed the Well, a new multi-GP development at the Beacon Clinic, a sparkling glass and steel building in Sandyford industrial estate in south Co Dublin.
The practice, an Irish first, is the brainchild of a GP who has worked in similar developments in Australia. In essence, it's high-end primary care for paying patients, with the notion of service at its core - a facet of healthcare internationally, particularly in the US.
From the GP's perspective, the fulfilment comes from being better able to treat patients, without needlessly referring to hospitals because technology is not available in the practice.
The Well's focus is on modernity, cutting-edge medical technology and a friendly, welcoming environment. Indeed, the clinic will probably prove yet another example of the private sector raising standards in Irish medicine. The inequity of a system that offers solutions to those who can pay is apparent to all, but it's also often forgotten that private medicine has consistently raised the bar in terms of service and technology.
MRI scanners were introduced to Ireland by a private hospital, in 1987, and the sector that modernised radiotherapy facilities is now leading the way with cancer-detecting PET scanners.
The Government's new primary-care blueprint envisages partnerships of GPs in centres of excellence, and pilot projects will soon begin in state-of-the-art facilities that house not only doctors but also other healthcare workers. But the Well is already there. It boasts nursing staff specialised in both general practice and occupational health, and the Well's physiotherapist and dietician are integral parts of the practice.
The patient-oriented focus is certainly refreshing. It hits you as soon as you arrive, from the 7 a.m. to 7 p.m. opening times and the underground car park to the fruit in the waiting room. The Well pledges no delays and all test results within 24 hours. A particularly significant advantage is that blood-test results are available in two hours, a service light years ahead of that provided by your average general practice.
Because the Well works in partnership with the Advanced Radiology Centre, a neighbour, it can offer state-of-the-art CT scans alongside more traditional MRI services. This allows the clinic to provide a real alternative to accident and emergency for non-life-threatening breaks and strains and again puts the Well ahead of its time.
A convincing argument has been made that new GP centres of excellence should be on hospital campuses, to speed up links to other services.
I went for what the Well's brochure terms a Gold Executive Medical and a Lifestyle Prescription, at €399. Despite my prompting, I was not advised to have an ultrafast CT scan (an additional €400) to examine calcification of my coronary arteries. My medical history may have suggested this was not a risk factor but, at 11 seconds, I was intrigued by the prospect.
The entire process was so thorough I thought something must surely turn up. My hearing and eyesight were checked using devices that wouldn't look out of place ia sci-fi film. Then it was off to face the dietician for a run through my eating habits before a trip to the clinic's physiotherapist, for an extensive examination focusing on a bit of back pain I'd been experiencing. This was fascinating, because, without the aid of gizmos, the physio identified the source of my problem as a weakness in a muscle above my hip - the result of poor rehab after a rugby injury eight years ago. It was also affecting my balance.
I was given good advice about how to rebuild the muscle, then headed off for a computer-based test to indicate how stressed I was and how it could harm my health.
Next it was on to more traditional tests, as blood and urine were checked for cholesterol, kidney function and any sign of diabetes, a hereditary risk for me. An ECG was added to check my heart function, combined with a blood- pressure reading, and I was questioned in detail about my lifestyle.
Finally, I sat down with all the results to discuss my health with one of the clinic's GPs. I was impressed by the precision of the prognosis. James - it's first-name terms at the Well - first offered me a projected risk appraisal for coronary heart disease, Ireland's biggest killer of men over 35. Then he profiled my cholesterol, blood pressure, weight, alcohol intake, exercise levels and stress scores as part of an overall risk profile.
The news was overwhelmingly good. To my great surprise, I wasn't overweight and, bar slightly elevated cholesterol, everything else was fine. My risk for coronary heart disease by the age of 65 was less than 6 per cent. One of the most interesting aspects of the results was James's ability to show how I could cut the risk by a third by reducing my cholesterol level. I scored eight out of 10 for stress, but the test showed I was dealing with at least a portion of it, and James offered some useful tips on how to cope even better.
Emerging from the clinic's car park into unseasonably bright sunshine, this typically healthcare-shy male was forced to admit that the extensive medical had lifted an apprehension. I'm not a worrier, but the threat of ill health lurks in the background for everyone, and, perhaps for the first time, the wisdom of being proactive has hit home.
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Well, well: A second opinion
Robert Love's experience at the Well suggests a well-developed and highly professional service. It also indicates a thought-out approach to medical screening, sometimes a controversial area.
When "executive screening" first became available, some doctors criticised its occasionally "overly inclusive" approach. It could seem to be out to dazzle with new technology rather than be based on offering a service tailored to the individual.
That Love's pitch for a CT scan was politely turned down is most encouraging. All of us, doctors included, naturally incline towards high-tech all-in-one scans.
Where screening is concerned, however, there is evidence that a more discerning approach works best.
One of the challenges of screening is not to produce a population of the "worried well". Ideally, any test done should have a high positive predictive value - in other words, a good chance of picking up disease that actually exists.
Screening should also aim to detect common problems - and steer a careful course where the esoteric is concerned.
By including a consultation with a dietician and a physiotherapist as part of the package, the new clinic is on firm ground. Healthcare professionals such as these could have a huge impact on health behaviour.
With the National Lifestyle Survey indicating that we live less active lives and drink more, good advice on exercise, nutrition and disease prevention is something we all need more of.
Dr Muiris Houston
