Importance of a comprehensive executive health evaluation

Dr. Michael O Sigler M.D.

Today's physician should be able to evaluate and address disease risk markers to evaluate a patient in order to implement proactive strategies to improve health and lower disease risk. Prior to evaluating a patient one should assess the subjective and objective data points for what is being measured and compare them to the conclusion. Ask your self are they evidenced based? Do their conclusion outcomes improve health and lower disease risk?

Age management as a whole is interested in improving patients’ interval survival not their maximum life span. We are not taking care of patients before birth, we are meeting them as adults and using actuarial and literature based data to analyze their disease risk, identifying strategies to lower that risk, incorporating "normal" risk as a risk and including hormone markers as markers of disease risk. The ultimate goal of the executive health evaluation is to minimize the patient’s disease or mortality risk.

Determine Markers of Disease Risk Implementing Patient Care

• Literature Based Decision Making
• Standardized and repeatable Markers
  
• Utilize Actuarial Data
  
• Utilize Population/Epidemiological Data
  
• Prioritize Patient Risk Factors
  

One cannot over estimate the importance of a comprehensive history and adequate physical exam looking for signs and symptoms and physical findings consistent with low hormone states or high disease risk states. It is paramount to provide a clinical context for the evaluation and treatment, and to contextualize your outcome measurements.

Age Management protocols also look for problems that would exclude therapy. Each patient is unique and we cannot continue to provide a one size fits all treatment protocol. We need to provide proper lab and diagnostic testing, formulate and individualized a treatment plan and then diligently be appropriate with regards to follow up measures.

When he was asked why he robbed banks, Willie Sutton replied "because that's where the money is'." The same can be said of choosing relative risk disease markers with regard to implementing age management medicine protocols.

The most frequent cause of death in America is heart disease killing almost one million men and women per year. (Table 1.) As you look throughout this data accumulated from the 2002 census on most frequent causes of death you will see that it is a valuable resource for the expected impact of disease risk modification with regard to certain outcomes.

Currently diabetes kills only 3 % of all those who die, but it is also associated with disproportionate expense, loss of independent function and loss of productivity. It’s currently an epidemic and it’s predicted over time this will be the most rapidly raising cause of death in America.

A physician needs the knowledge and tools in order to lower disease risk in his or her patient and should be current on evidenced based literature identifying specific markers of disease risk.

The most prominent among disease risk for mortality are coronary artery disease risk markers. Laboratory parameters for coronary artery markers are many. Lipid values are well known and now C Reactive Protein has become an excepted marker of disease risk as well.

Many patients are unaware that insulin and glucose are independent markers of disease risk and both are important to incorporate into a global health care evaluation. Additionally identifying as many markers of increased cardiac disease risk as we can and endeavoring to lower each marker into the lowest risk category.

There is more to cardiac disease risk than laboratory markers, non laboratory disease risk markers must be addressed as well through a history of tobacco use, patients review of activity level and exercise recommendation, family history, gender related risk, past medical history including DM, CAD, HTN, history of obesity and non laboratory measurements such as waist to hip ratios and social factors including stress factors, diet and the importance of nutritional intervention with regard to minimizing disease risk and an adequate and complete review of systems.

For other disease risk, many times there is not a guaranteed certain laboratory result that relates to a positive risk. Proper standardize measures for cancer screening such as colonoscopy, serum psa, mammography keeping up with routine physical exam findings are part of a global approach to minimizing disease risk.

Now with electronic testing we can screen for dementia and are able to identify a situation called mild cognitive impairment, which is screened using an early cognitive possessing speed measure that is associated with dementia risk. It has also been found that early cognitive intervention is associated with better long-term outcomes.

The comprehensive evaluation should also include body composition measurements including screening for osteoporosis evaluation through bone mineral density.

Measures of mood should be included as they are also associated with global outcome and overall patient satisfaction as well as quality of life measurements.

General health screening, vaccination status and quality of life measurements are necessary to complete a comprehensive evaluation.

Many of these are not exactly glamorous age management methods, but again we are trying to identify as many causes of increase health or mortality risk and minimizing them all.

The Cenegenics Physician Training & Certification AMA/PRA Level 4 Classifications (in accordance with the American Medical Associations guidelines for Continuing Medical Education on New Procedures and Skills) trains physicians how to incorporate specific disease risk stratifications into a new or an existing medical practice utilizing current evidenced based information so the physician will be competent to practice Age Management Medicine without supervision.

Cenegenics also provides a unique business opportunity for the doctor cutting out insurance companies and long wait times to improve health and have the chance to develop a practice with patients who are loyal to you and grateful your knowledge and distinguish you as THE physician helping them restore vigor and energy into there lives.

References:
Dotson, A. The Cenegenics Evaluation of the Age Management Patient. Cenegenics Education and Research Foundation Web Site 2007. Available at: www.cenegenicsfoundation.org Accessed April 22, 2007.