April 1 2004 by William J. Holstein
David Goode, chairman and CEO of Norfolk Southern, had been getting thorough physical exams every year at the Sentara Executive Evaluation Center in Norfolk, Va., where his railroad company is headquartered. Like many chief executives, he was traveling too much, eating too many rich meals-and in need of losing a few pounds. “I’m your typical €˜work more and don’t play as much as I should’ CEO,” he quips.
Three years ago, at age 60, Goode got a nasty surprise when he took his annual physical. His levels of prostate-specific antigens (PSA) had become elevated. Working with his doctors at Sentara, part of a regional nonprofit health group, Goode underwent a biopsy of his prostate. It turned out that he had a rapidly spreading form of cancer. “There was no way I could have known,” he says. “I had no symptoms.”
After evaluating different forms of treatment, Goode elected to have surgery to remove his prostate. “I’m a poster child” for getting regular physicals, he says now. “We got the problem early and got it clean.”
Statistics are difficult to come by, but it seems more CEOs today are getting these in-depth physicals, which offer the latest tests and diagnostic equipment. Established players such as the Mayo Clinic report increasing numbers of executive exams, and new providers of the service are popping up, such as Canyon Ranch, which is best known for its spa offerings. “I suspect that if you surveyed CEOs today and compared that with 10 years ago, you’d find that a lot more are opting for some program of this type,” says Goode. “When you can discover [a health problem] early, that has obvious benefits not only to the individual but to the corporation.”
As I found in exploring the world of CEO health evaluations, there are lots of variables in deciding how to get one. The most obvious are geography and time. If a CEO wants to get a complete physical in the most time-concentrated fashion, the Sentara approach makes sense. The day starts at 7 a.m. and by 3 p.m., the doctors have done a complete physical evaluation and can discuss a patient’s long-term health challenges in detail. Each patient is furnished with a well-appointed suite, with complete Internet and telephone connections, so you don’t have to be out of touch with what’s happening back in the office. But to get Sentara’s concentrated attention, you have to travel to Norfolk.
The Mayo Clinic offers multiple locations (see table, right) but requires a CEO’s corporeal presence for up to two days. The Greenbrier Clinic in West Virginia also demands two days, although the patient can play golf or take advantage of other recreational opportunities in the afternoons.
The most time-consuming option is the approach offered by Canyon Ranch, in either Tucson, Ariz., or Lenox, Mass. This evaluation can last four days. For many CEOs, it might make the most sense to build this into a weeklong vacation with someone (like a spouse) who enjoys spas. Canyon Ranch offers everything from Oriental facial rejuvenation to a Parisian body polish and an aromatherapy rose manicure.
There are also very different styles to the physical evaluations themselves. At Sentara, six patients (five men and one woman) had the full attention of four physicians, plus a variety of support staff. That allowed lots of one-on-one interaction with a single doctor.
The Mayo Clinic’s style revolves around making many different kinds of specialists available. Canyon Ranch throws in nutritionists, behaviorists and exercise physiologists as part of what it calls a more “integrative” approach to health and healing. “Nobody can make the stress go away,” says Marketing Vice President Harley Mayersohn. “What we can do is make you stronger and more resilient.”
The biggest single question may be what kind of colonoscopy to choose. One of the reasons I was attracted to Sentara is that it offers a “virtual” colonoscopy. You still have to avoid solid foods the day before the examination and you still have to drink three ounces of Fleet Phosphosoda the night before, which completely cleans out your system.
But the virtual exam involves a painless procedure of inserting a device of just a few inches in length into the rectum, allowing air to be pumped into the body. So the patient is spared the need for full anesthesia and the much more invasive procedure of running a tube several feet into the body, which traditional colonoscopies require. In the virtual process, after the patient is prepared, a futuristic $1 million-plus spiral computerized axial tomogram (CAT) machine can capture the most remarkable images of all internal organs and passageways, not just the prostate.
Many doctors do not recommend the virtual colonoscopy because it can yield a “false positive.” That means doctors may see something on the computer screen that looks like a polyp and then you have to go through the whole process again with a traditional colonoscopy. By contrast, if doctors see a polyp during a traditional colonoscopy they can remove it on the spot.
The Mayo and Greenbrier clinics say they offer only the traditional colonoscopies. Canyon Ranch, which conducts some medical testing off site, says it offers whichever approach is requested.
My own view is that everyone should do what makes the most sense for them. At age 52, I thought I could take the minimally invasive approach. And I got a clean bill of health. No false positives. Not only did I get to take a virtual tour of my colon on a computer screen, but the technicians also showed me all of my internal organs, one slice at a time, like layers of an onion. My decision to go for a virtual colonoscopy worked for me, at least for now.
So there are many questions about how to get a complete physical evaluation. But anyone over the age of 50 should do it, at least once. The technology has improved so much that doctors who use CAT scans and ultrasound devices and rely on much more powerful computers can obtain a staggeringly detailed view of the human body. To get all these tests could take months for your personal physician to schedule at different hospitals or clinics. Getting them all done in a day or two is much more efficient.
Some individual doctors say these executive evaluations involve way too many tests that aren’t necessary. But that’s precisely how they find things that regular medicine typically misses, says Dr. William M. Bethea Jr., who conducted my evaluation at Sentara. “It’s because we do unnecessary things” that Sentara discovers prostate cancer or a heart condition that the patient didn’t detect, says Bethea. Several CEOs have gone straight from Sentara to the hospital for treatment of heart or prostate problems, he says.
In his view, traditional medicine doesn’t really treat the patient until something actually goes wrong. By that time, it may be too late to alter underlying behaviors or take long-term medical steps to mitigate diabetes or high cholesterol, for example. Bethea and like-minded physicians argue that the way to go is “preventive care,” which identifies potential problems long in advance.
Of course, insurance companies don’t like paying for elective tests, which is what makes CEO evaluations so expensive and why the vast majority of Americans will never get access to this quality of medical care. Some companies pay for their top managers to have full physical evaluations; in other cases, individuals themselves pay. “Preventive care is going to move toward being more of a discretionary kind of spending and it’s going to be paid for by individuals or corporations,” says Bethea.
My own long-term concern is that my forebearers tend to live long lives but suffer from various forms of senility. To help me avoid that, they told me that my LDL cholesterol scores are too high, at 165. And a special blood test revealed that homocysteine, an amino acid, is also present in my blood at relatively high levels. The reason all this is important is that cholesterol can build up on the walls of blood vessels and turn to plaque; the homocysteine can also damage arteries. These problems are usually associated with the heart, but they also can cause hardening of the arteries in the brain, strokes and other degenerative problems, perhaps including Alzheimer’s. Using ultrasound, my doctors were able to tell me that they could pick up very faint traces of plaque buildup in the blood vessels leading to my brain. They convinced me that I have a health issue, which my personal doctor had not been able to do.
If I take Lipitor and Foltx, a supplement including folic acid and the vitamins B-12 and B-6, I can dramatically reduce my risks. Sentara also strongly recommends taking aspirin every day.
So if these steps result in five more years of “quality” life in my 80s when I can still play sports, travel and eat well, is that worth the cost of the exam? I came away convinced it’s a bargain.