Physical Education

The annual checkup has gotten a lot more comprehensive in the past few years. See how yours stacks up against these top examples.

It was time for the payoff at The Greenbrier Clinic—part of The Greenbrier resort in White Sulphur Springs, West Virginia—and I was apprehensive. I had just spent two days at the clinic undergoing the most comprehensive physical of my life, and now Dr. Thomas Mann was about to give me something unusual: good news. "You represent a rare phenomenon at this clinic," Dr. Mann said. "Most of the time I find something significant that the patient needs to be aware of."

While diagnostic medicine has made tremendous strides in the past decade, the average physical hasn't changed much. That, plus the fact that bottom-line medicine usually means doctors perform a minimum of screening tests, has led more and more executives to turn to high-quality clinics specializing in comprehensive physicals.

Throughout the 1950s and into the late 1960s The Greenbrier and a few other programs owned this franchise. Today one can choose from an array of clinics and locations that include elite medical institutions like the Mayo Clinic, Cleveland Clinic Foundation, Scripps Memorial Hospital La Jolla, Duke University Medical Center, and Johns Hopkins. Each offers a one- to two-day, all-encompassing evaluation, complete with immediate consultation with a specialist should a problem be discovered. The cost runs from $1,000 to $2,500.

The Greenbrier, however, is singular because it is a resort renowned for its Southern hospitality and three world-class golf courses. But since 1948 businesspeople have combined minivacations here with the clinic's encyclopedic physical. The clinic was the brainchild of Edward R. Stettinius Jr. (a board member of the Chesapeake & Ohio Railway Company, which then owned The Greenbrier), who was concerned that America's corporate captains weren't taking care of themselves. Each year the clinic's 10 board-certified physicians (including two radiologists and a cardiologist) see between 2,000 and 3,000 corporate executives—an average of 27 patients a day—not only local entrepreneurs but top managers from such Fortune 500 giants as State Farm Insurance and Dow Chemical. Like most programs of its kind, the clinic's emphasis is on preventive medicine. Yet over the years it has earned a reputation for diagnostic prowess. "A big part of the practice is diagnosing problems that others haven't," Dr. Mann says.

As part of this survey of top physicals, I went through The Greenbrier regimen. On day one, we began in Dr. Mann's office. An affable man in his late forties, Mann explained that the basis of the examination was a core group of tests and a hands-on physical. My family history, symptoms, and results would determine the need for additional tests. He spent an hour poring over my Defined Medical Database—the medical history form—gently prodding me for more information. His subspecialty in lipid disorders made him particularly interested in my mother's carotid artery surgery two years ago. The direct familial link convinced him to order a series of sophisticated blood tests from California's Berkeley HeartLab, Inc., considered one of the foremost cardiovascular diagnostic labs in the country. The test would search for familial excess of lipoprotein (a), which has been associated with clogged carotid arteries. Likewise, a mild bout of myocarditis three years ago, a condition that alters the heart's circulatory capacity, and my desire to exercise vigorously prompted him to order an echo stresstest. "A lot of patients come here with heart disease," Dr. Mann said. "We tend to be very aggressive with our recommendations, and patients are drawn here for our reputation."

It was that reputation that convinced George N. McMath to visit The Greenbrier Clinic about 10 years ago. Although McMath had regular checkups he'd never had an exam like this one. "The Greenbrier exam is much more extensive than most and is done pleasantly," states McMath, 67, the former owner of a Virginia-based publishing company. "It's reassuring to know that if there is anything wrong with you they'll find it."

McMath credits the examination for detecting his prostate cancer. During his second visit to the clinic in 1992, Dr. Mann used a prostate-specific antigen (PSA) blood screening, then a relatively new test. He discovered McMath had abnormally high PSA levels and advised him to see a urologist, who found nothing. Two years later, Dr. Mann repeated the PSA test, and he found that McMath's levels had risen. "I did have prostate cancer and underwent surgery," McMath says.

Several degrees from The Greenbrier is the four-year-old Johns Hopkins Executive Health program. "I can't offer you much of a golf course, but that's not why people come here," says Dr. George H. Sack Jr., the medical director. "Our emphasis is on efficiency. We spend a good deal of time on the telephone or e-mailing in advance so that we can get people out in one day."

Although they are all very efficient, the top screening programs are also designed to assure patients plenty of contact with physicians. "We have all the technology, true, but the real value is sitting down with a doctor and talking about what technology you need applied to your screening examination," offers Dr. Richard S. Lang, who is head of the Section of Preventive Medicine at the Cleveland Clinic Foundation.

"One of the things that people are currently seeking most in medicine is the opportunity to get into a room with a doctor, close the door, and be able to talk in confidence about their health for as long as they like," says Dr. James R. Clapp, director of the Duke Executive Health Program in Durham, North Carolina.

The typical top-of-the-line physical begins with a doctor taking a detailed medical history, generally a 30- to 60-minute session. That's followed by a hands-on examination. Among the standard components are a chest x-ray, hearing, vision, and pulmonary function tests, a battery of blood chemistry and hematology tests, an electrocardiogram, urinalysis, and nutritional and lifestyle consultations. But the lineup of tests varies slightly from clinic to clinic. For example, the Scripps Center for Executive Health in La Jolla, California, includes a PSA blood test for men beginning at age 35, while Johns Hopkins tests every male patient. (The general recommendation from the American Cancer Society is that PSA testing should begin at age 50, but earlier for African-American men or men with a family history of prostate cancer.) "Guys really want to know what that number is," states Hopkins director Sack. Depending on age and risk factors, patients may undergo such procedures as an exercise stress test and a flexible sigmoidoscopy, or colon cancer screening. Some clinics also offer a fitness assessment as part of their standard package. After all of the tests are completed, the physician spends another 30 to 60 minutes reviewing test results with the patient and making recommendations. A written report typically follows in two to three weeks.

Women, who represent a growing number of patients, receive the same core tests plus an optional gynecological examination, Pap smear, mammogram, and bone-density scan. Of the half-dozen programs reviewed, the Scripps Center seemed the most in tune with women's needs because it makes a hormone assessment, a pelvic ultrasound, and a cancer antigen blood test available to all its female patients.

"We address them as females," explains Laura Johnson, the executive director of the Scripps program. "They have different issues, so we tailor the interaction to that."

How do you choose the best executive health program for you? Once you distill the marketing spin, you'll find that what separates the elite programs from one another is more style than substance. Even the doctors seem to agree. "If you asked The Greenbrier Clinic about the Cleveland Clinic, they would probably say that it's a good exam," says Dr. Lang. "If you asked us we would say that The Greenbrier is a good program and that the Mayo Clinic is similar to ours in content." That said, here is an overview of programs by category—the medical center affiliate, the stand-alone clinic, and the resort clinic.

The Medical Center Affiliate

The key advantage to using an executive health program associated with a medical center is that regardless of what turns up, a specialist and sophisticated medical technology are a floor or two away.

"We have virtually every medical subspecialty there is, and we can get consultations to treat the problem," explains Dr. Donald Hensrud, director of the Mayo Executive Health Program at the Mayo Clinic in Rochester, Minnesota. Nearly everyone considers the 30-year-old Mayo program to be the gold standard. Its eight physicians see about 3,000 patients a year, approximately four patients per doctor per day. And while it strives to get patients through in one day, that doesn't always happen.

The real problem, however, is getting an appointment. "Right now we're booked a year in advance," says Hensrud. "We've experienced an incredible demand for our services over the past five to seven years."

If a year is too long to wait, how about two to three weeks? That's how long it takes to get into the Cleveland Clinic. The five staff physicians here also see approximately 3,000 clients a year.

"These are often people who have never had a chance to show any weakness," says Dr. Lang. "The most valuable part of the program is for patients to let things out and to ask questions about this pain they had a couple of weeks ago. For a lot of these folks, this is their only encounter with a physician for a year."

A decade ago an examination at the Scripps Center for Executive Health took three days. But today the typical evaluation lasts a day. "We responded to patient demand and streamlined our program to accommodate their schedules," says Laura Johnson of Scripps. The center, which now conducts 1,500 physicals a year, has a staff of eight internal medicine and family practice specialists, five gastroenterologists, and a cardiologist. Lifestyle counseling is offered as well. This includes a visit with the Scripps Center's mind/body counselor. (This is California, after all.) "We want to help people create health by educating them in stress-management techniques such as meditation, yoga, and progressive relaxation," Johnson says.

Executives have been going to Duke University Medical Center for physicals for four decades. But it wasn't until 1991, with the opening of its Duke Center for Living, that the Executive Health Program was formalized. Located adjacent to Duke University, the Duke Center for Living sees approximately 1,000 patients a year. Nutrition, fitness, and psychological assessments are part of the center's basic package. While most procedures are done at the 26-acre center, patients requiring a sigmoidoscopy, a mammogram, or other complex diagnostic procedures are escorted to the medical center a mile away.

The Executive Health program at Johns Hopkins in Baltimore goes a step further by assigning clients a personal escort. "You are seeing doctors in their milieu," says Marcia Carlson, a former corporate relations representative for the program. "It gives patients the sense that they are part of the hospital and are getting the Hopkins experience." Because of its East Coast location, a third of the 1,200 patients seen at Johns Hopkins annually are from abroad.

The Stand-Alone Clinic

Some stand-alone clinics, like the Cooper Clinic at the Cooper Aerobics Center in Dallas, are famous. But none has the pedigree of the Executive Health Group. Founded in 1913 as the Life Extension Institute, the group has long been extolling the benefits of proper diet, exercise, and not smoking. "We go back a long way with the concept of preventive health care," says William F. Flatley, company president and CEO.

Today the company has four locations (Manhattan, New Jersey, Connecticut, and Houston); it also has a 900-member provider network nationwide. This year the group estimates it will conduct over 25,000 comprehensive exams nationally, of which 11,000 will be done at its Rockefeller Plaza office in Manhattan. "Our emphasis is on a comprehensive examination in an upscale, relaxed atmosphere to make it as easy as possible," Flatley says. According to him, a standard exam will allow an executive to be back at his or her desk in 90 minutes to two hours. Optional procedures, such as a sigmoidoscopy or a stress test, add on about an hour.

In New York, EHG employs a staff of 10 board-certified physicians—including specialists such as cardiologists; at its other sites, there are three physicians per location. The company has plans to open offices in Chicago this spring, and later in Atlanta and San Francisco. "We try to make it easy for our clients," Flatley says. "One of the roadblocks to having an examination is finding the time."

The Resort Clinic

Over 50 daily activities are available to Greenbrier guests, including whitewater rafting, horseback riding, tennis, fly-fishing, and swimming, even a falconry academy and a new Land Rover Driving School. But golf is the religion here, and Sam Snead is the high priest. At 87 the former PGA champion is The Greenbrier's Golf Professional Emeritus and regularly plays its three courses. The Greenbrier Sam Snead Golf Academy opened in June of last year, offering half- and multi-day instruction.

The physical at The Greenbrier Clinic takes two days. "A lot of guys want to be on the golf course," Dr. Mann says. "We want to get people out of here by noon so they can tee off. We really bend over backward to make it work."

The Greenbrier Physical

The Greenbrier Clinic is located on the fifth floor of The Greenbrier resort's West Virginia wing. The night before my two-day physical I receive a package that contains a medical history form, a specimen cup for urine, and instructions not to eat after 9 p.m. My appointment with Dr. Thomas Mann is at 7:30 a.m.

Day One

7:30 Dr. Mann spends an hour taking a detailed family and personal medical history.

8:30 I'm measured, weighed, and have my waist/hip ratio (waist should be no more than 90 percent of hips) and blood pressure taken. Dr. Mann conducts a skin examination and with a stethoscope listens to my carotid arteries and heart. My thyroid, eyes, abdomen, and reflexes are also inspected. Three vials of blood are taken before a digital prostate exam, followed by a flexible sigmoidoscopy. "It's the only unpleasant part of the physical," Dr. Mann says. He's right.

9:30 Post-exam snack.

10:00 At the reception desk, I pick up my itinerary for the rest of the stay.

10:15 After having a chest x-ray and an EKG, I slide into a soundproof booth for a hearing test, and then I go across the hall for a series of vision examinations, including glaucoma screening.

11:15 I can't remember when I last had a tetanus shot; Jeri Via, R.N., does the honors.

11:25 Bone-density scan. The 40-minute wait is the only delay in two days of testing.

12:30 More blood work at the lab, then a lunch break.

2:30 Back in the lab, this time hard-wired with 12 electrical leads and put on the treadmill for an echo stress test. While my goal is to reach 173 heartbeats per minute, I reach 180 as Dr. Mann walks in. Registered nurse Belinda McFerrin quickly takes ultrasound pictures of my pounding heart as I lie huffing like a racehorse. Later, Dr. Mann shows me the before (resting) and after (under stress) pictures and declares my heart healthy.

Day Two

8:00 Ultrasound scanning of my aorta, liver, gallbladder, bile ducts, pancreas, kidneys, and spleen for tumors, aneurysms, stones, blockages, polyps, calcification, and wall irregularities.

8:45 A cardiac fluoroscopy checks for calcified plaque in my heart's arteries.

9:00 Breakfast.

11:00 Evaluation by Carolyn Gaydos, the clinic's registered dietician, who agrees with Dr. Mann that I could lose 10 pounds. She suggests a few ideas, but I'm pressed for time, so Gaydos promises to follow up via e-mail. A week later I receive a one-page report with several weight-loss and hunger-control suggestions.

11:45 Final meeting with Dr. Mann to discuss results. Not counting blood work, I have had a physical and 10 tests.

Presence of Mind

Among the psychological components of a Greenbrier physical are optional stress-management sessions. The Greenbrier offered the option 10 years ago, when Dr. Connie Bradley Mann joined the staff, and has found it to be very popular. "I've been surprised at the number of patients that have requested these services," says Mann, who is the wife of clinic physician Dr. Thomas Mann. Mann helps executives understand their personality style through tools such as the new EQ-i inventory, which assesses an array of personality and social skills that can help people cope with work-related stress. "Things are only going to get faster. The pressure on these people is tremendous," says Mann, "and they want stress-management techniques."

Although Mann feels strongly that even one session can be tremendously helpful, she is also developing new ways of keeping in contact with executives who come to see her while at The Greenbrier. These include telephone coaching and consultation, with sessions in the early morning or evening, when the executive can be assured of privacy. "I'm a stickler for confidentiality," Mann says, acknowledging that among top executives there remains a concern about how they will be perceived if colleagues learn that they are seeing a psychologist.


The Cleveland Clinic Foundation
9500 Euclid Avenue, Cleveland; 800-223-2273 or 216-444-5707;
Fax 216-445-6494;

Cooper Clinic, Cooper Aerobics Center
12200 Preston Road, Dallas; 800-444-5764 or 972-239-7223;

Duke Executive Health Program, Duke Center For Living
3475 Erwin Road, Durham, North Carolina; 800-235-3853 or 919-660-6712; Fax 919-684-8246;

Executive Health Group
10 Rockefeller Plaza, New York. For The Facility Nearest You Call 800-362-8671;

The Greenbrier Clinic, The Greenbrier
320 West Main Street, White Sulphur Springs, West Virginia; 800-362-7798 (For Appointments Only); 304-536-4870;
Fax 304-536-1664;

Johns Hopkins Executive Health
601 North Caroline Street, Suite 7165, Baltimore; 888-544-1340 or 410-955-9819; Fax 410-614-8816;

Mayo Executive Health Program, Mayo Clinic
200 First Street, Sw, Rochester, Minnesota; 507-284-2288;
Fax 507-284-0909;
4500 San Pablo Road, Jacksonville, Florida; 800-851-9022 or 904-953-7392; Fax 904-953-2732
13400 East Shea Boulevard, Scottsdale, Arizona; 480-301-8088;
FAX 480-301-7569

Scripps Center For Executive Health,
Scripps Memorial Hospital La Jolla

9850 Genesee Avenue, Suite 520, La Jolla, California; 800-345-1130 or 858-626-4460; Fax 858-626-4465;

Bob Calandra is a Pennsylvania-based freelance journalist.