5 - A well person health check, health promotion and disease prevention: different lifestyles, different values

Summary

This chapter considers the meaning and nature of health and what it means to be healthy, the utility and value of check-ups for health and well being, including screening tests. We work through different scenarios relating to check-ups in primary care.

Tuesday afternoon and it is the monthly clinical practice meeting, which is attended by all the clinical staff (GPs, nurses, the pharmacist and the counsellor), plus the practice manager, Megan Daly. At the Station Road practice there are a number of special clinics for patients with specific health needs and problems: diabetes, asthma, cardiovascular risk, family planning, travel clinic. The nurses also check the health of the over 75 year age group.

Dr Steven Reynolds has asked the practice team to discuss well person checks and what these should involve based on evidence. He says he was asked by a 35 year old man for a check-up in a 10 minute appointment. When he asked the patient if he had any particular concerns about his health, the man replied that no he just wanted a ‘going over’ to make sure he had no hidden illnesses, ‘you know, like those private health checks they advertise in magazines, an MOT’. Dr Reynolds admits to feeling irritated by this request. MOT after all stands for Ministry of Transport and refers to a roadworthy assessment of a vehicle, not a human being. Private health checks are an expensive waste of time in his opinion. Moreover he points out that the cardiovascular risk assessment is offered to the over 45s in the practice and carried out by the practice nurses. What does everyone think about other check-ups? Ann Lorimer, the most senior practice nurse, says that all patients should be able to have a health check if they request one: what should be done in this would depend on their age and family history. Women were used to coming in for smears, from their twenties, and would be asked about smoking and other lifestyle choices, so why not offer something for the men to encourage them to attend for advice about healthy living.