THE (F)UTILITY OF HEALTH PACKAGES
All of a sudden we are flooded with advertisements (there are advertisement boards even inside the Delhi metro!), pamphlets (neatly tucked inside our newspaper), bulk sms and e-mails about complete health package tests or whole body check up. There is a tremendous price war not only between existing giants but also among the start up pathology labs playing the same price game. There are even family packages and discounts if the whole family gets tested! Most of us will take the bait at least once (after all we are very health conscious nowadays!), get ourselves tested in the lab (probably offering the least pricing) and get handed over bundle of pages of report (at times the bundle can be thick enough to make a book!). Every test performed by a lab carries the normal range in the report and of course we compare our test value with the normal range and start worrying if any value is outside the ‘so called’ normal range or even worse google out to diagnose ourselves and then visit a doctor as an afterthought. Remember, most of us haven’t even consulted our family or primary physician yet before getting tested.
Ever wondered that we can have any chronic disease but the test menu in the health package is always the same for all! So since when did we (the intellectuals and health conscious) all become gullible enough to believe that ‘one sized shoe fits all’!!! “You are committing professional suicide”, a close friend of mine and an astute physician said to me. He further added, “isn’t it how you can maximize your revenue by promoting health packages?” By the way I am a pathologist attempting to establish a start up laboratory with my husband (also a pathologist).
I have nothing against health packages (not the ones offered in the market like some sort of vacation package, squeezing in maximum number of tests for minimum possible price!) but it must be tailored to the individual need and health condition. Most health packages include a complete haemogram, blood sugar, kidney function tests, liver function tests, lipid profile and some labs may also throw in thyroid function test and vitamin D just to spice up the test menu. Suppose say a diabetic person gets a health package done (now there is a diabetic in almost every urban Indian household and this a very common scenario I have encountered) and feels assured that everything is under control when all his values fall within the ‘normal range’. But is this really true!! Did you know that serum creatinine (an important parameter in kidney function test) does not rise until at least half of the kidney’s nephrons are damaged! And all the while you thought your kidneys are perfectly ok. Also a normal fasting or post prandial blood sugar test done on any given day does not mean your sugar was well controlled in the preceding weeks or months. And what about your eyes? Diabetes is a very common cause of preventable blindness and you never thought of visiting an ophthalmologist. All the while you kept accumulating bundles of pages of report which gives scant information about the state of your health. Diabetes can ravage any organ but are particularly more damaging to kidneys, heart, nerves and eyes.
The health package for a diabetic (who is on treatment) should look something like this…..HbA1c (it tells you how well your sugar was under control in preceding 2 to 3 months), urine microalbumin (to catch a diabetic kidney dysfunction at its earliest), and lipid profile (you would want to keep them within normal range as diabetics are at an increased risk for heart diseases). And of course you would want to get a periodic thorough physical check up done by your physician and drop by an ophthalmologist at least once a year to get the eyes checked. And if you are a healthy middle aged individual with a family history of diabetes and is worried that you might get it, well then just get fasting blood sugar done say at least once a year and may be a HbA1c in special circumstances. And next time whenever you get handed over a report with an ‘out of range’ value, do not hesitate to ask the pathologist who signed your report to explain you the meaning of it. Believe me we have not been trained just to take your money and run the tests (did you know by law every pathology report must be signed by a pathologist and not merely by a technician!). A pathologist’s understanding of the pathogenesis of a disease is unparalleled and he/she is duty bound to explain you the meaning and significance of an abnormal value of a test (unless of course you got yourself tested in a only technician run lab!)
These days there is huge hue and cry in most print as well as social media how health care is becoming expensive in India. This cannot be denied but then with every passing year, every commodity and service is only getting costlier and health care is no exception. But a fraction of the blame must be shouldered by those aggressively promoting these health packages and adding to the out of pocket expenditure of the unsuspecting public.