In short
Four things get done properly here that executive packages routinely do badly.
- Blood pressure. Confirmed outside the clinic before any diagnosis is made, not from one rushed reading
- Alcohol. Screened for every year, with a specific question rather than a polite one
- Mood and anxiety. Screened with validated tools, then properly assessed if positive
- Vaccinations. Checked, which almost no executive package does
Tests that are not recommended for you are named and left out, including routine thyroid and vitamin D in people with no risk factors.
Treatment Overview
Why is blood pressure the most commonly mishandled measurement?
Because a single clinic reading in a rushed appointment is exactly the situation most likely to mislead, in both directions.
Out of office measurement is recommended to confirm a diagnosis of hypertension before treatment is started. The definition of high blood pressure itself depends on how it was measured.
| From 40 | Screen yearly |
| 18 to 39, normal and no risk factors | Every three to five years |
| Higher risk, including 130 to 139 over 80 to 89, overweight or obesity | Yearly |
Why is alcohol asked about specifically?
Because every adult should be screened for unhealthy alcohol use, annually, and because a vague question gets a vague answer.
The screening question is concrete: do you sometimes drink alcohol, and if so, how many times in the past year have you had five or more drinks in a day, or four or more for women. That is a countable question.
What about mood?
Screening is suggested for everyone from 12 upwards using a two question tool, and for anxiety from 13 to 64 using a validated scale.
A positive screen is followed by a proper clinical assessment, not by a prescription. Screening only helps when there is something in place to follow it up, which is why it is not done as a box tick.
Which blood tests are deliberately not ordered?
- Thyroid, unless you have a risk factor: goitre, autoimmune disease, previous radioiodine or neck radiation, family history, or a medication that affects thyroid function. There is no evidence that finding and treating subclinical hypothyroidism in symptom free adults improves outcomes
- Vitamin D, unless you are at high risk: very limited sun exposure, obesity, osteoporosis or malabsorption
- Iron studies, unless you are at higher risk, which for men usually means a reason for blood loss
What gets checked that packages usually skip?
- Vaccination status against the adult schedule
- A comprehensive eye examination from 40, for glaucoma, earlier with risk factors
- Alcohol, formally, every year
- Family history on both sides, with ages, which changes cancer screening more than any test does
Who Is a Good Candidate?
- You want the basics done properly rather than a long list of extras
- You have been told you have high blood pressure on a single clinic reading
- You have never had your vaccination status reviewed as an adult
- Alcohol has crept up and you want it looked at without a lecture
- You are 40 or over and have never had an eye examination for glaucoma
- An active symptom, which needs a diagnostic appointment rather than a screening one
- Chest discomfort or breathlessness on exertion
- Thoughts of self harm, which need same day assessment
What Happens During the Consultation
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1
History, including the awkward parts
Alcohol with a countable question, mood and anxiety with validated tools, sleep, activity and sitting time, and family history on both sides with ages attached.
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2
Measurements taken to standard
Blood pressure measured properly and confirmed outside the clinic before any diagnosis. Weight, waist, and a focused examination.
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3
Bloods that are actually indicated
Lipids, glucose or HbA1c, kidney and liver function. Thyroid, vitamin D and iron only where you have a specific risk factor, and you are told why they are or are not included.
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4
Screening, vaccination and a plan
Age appropriate cancer screening arranged, vaccination status reviewed against the adult schedule, cardiovascular risk calculated, and a review interval set.
Program Structure & Follow-Up
After the assessment
You get the results with an interpretation, including what each borderline value means and whether it needs anything doing.
What gets repeated and when
| Blood pressure | Yearly from 40, every three to five years from 18 to 39 if normal |
| Alcohol screening | Yearly |
| Cardiovascular risk | Every three to five years from 20, yearly at borderline risk or above |
| Eyes | Periodic comprehensive examination from 40 |
| General review | Every three years under 50, yearly from 50 |
If blood pressure is borderline
The next step is measurement outside the clinic rather than a repeat visit or immediate treatment. Home or ambulatory readings settle far more of these than another appointment does.
If a screen for mood or alcohol is positive
It leads to a proper assessment, not a label. A positive screen raises suspicion and nothing more, and in primary care most positive depression screens turn out to be something else.
Benefits, Limits & Safety
What this assessment is good at
Catching the things that are common, treatable and routinely missed: undiagnosed hypertension, unhealthy alcohol use, unrecognised mood disorder, missing vaccinations, and undetected glaucoma.
None of these needs an expensive test. All of them need someone to actually ask or measure properly.
What it will not do
- It will not find every possible disease, and it does not try to
- It will not include tests without evidence for you, however commonly they appear in packages
- It will not reduce your mortality on its own. General health checks did not do that in randomised trials, though they improved blood pressure, cholesterol and BMI
Why fewer tests is the safer option
Because the harms of screening are real: anxiety from false positives, complications from the tests that follow, overdiagnosis, and cost.
Patients tend to overestimate the benefits of interventions and underestimate the harms, which is why both are stated in absolute terms rather than as percentage reductions.
The point about follow through
Screening only helps where there is a system to act on the result. That is as true of a depression screen as of a mammogram, and it is the reason the plan includes who does what next rather than ending at the result.
The basics, done to standard
Blood pressure confirmed outside the clinic, alcohol screened annually with a countable question, mood and anxiety screened with validated tools, vaccinations reviewed.
Repeat intervals
Blood pressure yearly from 40, alcohol yearly, cardiovascular risk every three to five years, eyes periodically from 40.
Left out on purpose
Routine thyroid, vitamin D and iron testing without a risk factor, and any test whose result would not change your plan.
Cost & Program Investment
The consultation and each test are quoted before they are ordered. The panel is shorter than most executive packages because tests without an indication produce borderline results that then need chasing. Vaccinations and any onward referral, such as an eye examination, are quoted separately and arranged rather than simply recommended.
Frequently Asked Questions
Not on its own. Out of office measurement is recommended to confirm hypertension before treatment is started, and the definition of high blood pressure itself depends on how it was measured.
Because annual screening for unhealthy alcohol use is recommended for all adults, and because it is one of the highest yield questions in this age group. The question is specific and countable rather than general.
Because there is no evidence that finding and treating subclinical hypothyroidism in adults without symptoms improves outcomes. It is tested where you have a risk factor such as goitre, autoimmune disease, family history or a relevant medication.
Only if you are at high risk: very limited sun exposure, obesity, osteoporosis or malabsorption. Broad population screening is not recommended.
Almost certainly some. Adult immunisation schedules are updated annually, and vaccination status is one of the most commonly skipped items in an executive check.
A periodic comprehensive eye evaluation from age 40 for glaucoma, and earlier if you have significant risk factors.
It leads to a proper assessment rather than a diagnosis. A positive screen raises suspicion, and most positive depression screens in primary care turn out to be something other than major depression.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Cardiovascular diseases
- Cardiovascular disease: risk assessment and reduction
- Hypertension in adults: diagnosis and management
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.