Care Built Around a Demanding Career

You have probably had the executive physical, or been offered one, or put one off for two years running.

It is a good product for what it is. A day or two at a well-regarded hospital, a battery of tests, a physician who is not rushing, and a bound report at the end. For a certain kind of finding — a structural heart problem, a lung nodule, something that needs to be looked at rather than measured — it is genuinely the right tool, and nothing we do replaces it.

But it is one or two days out of three hundred and sixty-five, in one city, and then nothing. And the things that most reliably erode health in people with demanding careers do not announce themselves on a single Tuesday in February. They accumulate: the sleep that has been poor for four years, the travel pattern, the drinking that is entirely social and entirely constant, the thyroid that drifted, the hormone change that arrived at the worst possible moment in your working life.

Those are the other 364 days. That is the part we cover.

The problem with one day a year

There is a second issue with the annual-assessment model, and it is more uncomfortable than the scheduling one.

In 2019, researchers examined the executive physical programmes offered at 29 top-ranked American hospitals — 46 distinct packages, priced between $1,700 and $10,000 — and scored every included service against United States Preventive Services Task Force grades. A Grade D means the Task Force recommends against the service: the evidence indicates no net benefit, or that harms outweigh benefits.

The result is not flattering.

That last row is the one that should stop you. Low-dose CT screening in adults with a significant smoking history is among the small number of cancer screening tests with high-grade evidence behind it. It appeared in none of the 46 packages examined.

That combination — testing more than the evidence supports, while missing the thing the evidence most supports — is not an accident of any individual programme. It is what happens when a product is designed to feel thorough. We think you should hold us to the same standard, and we apply it to our own diagnostics menu in what your executive physical does not test.

What a demanding career actually does to a body

Not a mystery, and not mostly about stress in the way the word is usually used.

Sleep is the big one, and the most commonly missed. Obstructive sleep apnoea is common in American adults and the substantial majority of cases have never been diagnosed. The profile that raises risk — midlife, higher body weight, regular alcohol, male-skewed but by no means male-only — describes a great many senior professionals. And the symptoms it produces are precisely the ones this population attributes to workload: exhaustion that sleep does not resolve, irritability, blood pressure that will not settle, foggy afternoons. People spend years treating a mechanical breathing problem as a scheduling problem. More on sleep apnoea in high performers.

Travel has measurable effects. Research on corporate travellers has linked frequent business travel with poorer self-rated health and less favourable cardiometabolic markers than lighter travel, alongside higher rates of anxiety and low mood.

Hours themselves carry risk. Joint analysis from the World Health Organization and the International Labour Organization has attributed a substantial global burden of stroke and heart disease deaths to long working hours, with risk concentrated in older working age groups — the band this page is written for.

Alcohol is the quiet one. Client dinners, conferences, the drink after a hard week — none of it feels like drinking, because it is social and structured and everyone else is doing it. It still shows up on a liver panel, and it still fragments sleep.

And hormonal change arrives at the least convenient possible moment. For women, perimenopause frequently coincides with the most demanding decade of a career, and a meaningful share of women report it affecting their work. For men, testosterone decline is gradual enough to be mistaken for tiredness, and often is.

What we measure, and what we cannot

We are a nationwide telehealth practice. That shapes both halves of what follows, and we would rather be precise about it than let you find out later.

What we do. A full lab panel covering metabolic markers, a complete lipid picture, liver and kidney function, thyroid, inflammatory markers, nutrient status and hormones. Validated screening questionnaires — including for sleep-disordered breathing. Where it is useful, a continuous glucose monitor or more specialised testing. A clinician who reads the results against your history rather than against a reference range in isolation. Repeat measurement, so we are looking at a trajectory rather than a snapshot. And treatment, when treatment is warranted, with monitoring attached to it.

That last part is the difference from the blood-testing companies. Measurement that ends in a PDF is a hobby. Measurement that changes what you do is care.

So this is not a substitute for an executive physical, and it is not a substitute for a primary care relationship. It is the layer between them — the one that runs continuously, that you can reach from a hotel room, and that treats what it finds.

What an executive physical is genuinely good for

We would rather be useful than competitive about this.

The one-day assessment does things we cannot. It puts hands on you. It images structures that bloodwork cannot see. It catches a small number of findings that would otherwise go unnoticed for years, and for those people it is worth every dollar. If you have a specific structural concern, a strong family history that warrants imaging, or a symptom that needs an examination rather than a measurement, that is where to go.

What it cannot do is follow you. It cannot notice that your fasting glucose has drifted in the same direction for three consecutive years while remaining “normal” every single time. It cannot adjust anything between visits. It cannot reach you in March.

The honest read of that table is that the first column and the last are solving different problems, and the middle one stops half way.

Where ongoing care does more

Three places, specifically.

When the answer is a trend, not a value. A single result inside a reference range tells you very little. The same marker measured three times over eighteen months tells you a direction, and direction is what you act on. Most of what goes wrong in this population goes wrong slowly.

When the problem is behavioural and physiological at the same time. Sleep, alcohol, travel and workload are not conditions that a test diagnoses. They are patterns that a conversation surfaces and that measurement then confirms or rules out. That requires more than one appointment.

When something needs treating. A finding without a plan is an anxiety, not a benefit. If a panel shows a genuine thyroid problem, a metabolic problem or a hormone deficiency, we treat it and then re-measure to see whether the treatment did what it was supposed to.

What we will not claim

A short list, because in this category the claims are the problem.

We will not tell you that biomarker optimisation extends your life. It is not established, and anyone telling you otherwise is selling from a position the evidence does not support.

We will not describe what we do as comprehensive. A blood panel and a structured history is not a complete picture of a human being, and calling it one would be the same failure we have just criticised in someone else's product.

We will not run tests because they are impressive. Every test has a cost that is not on the invoice — incidental findings, false positives, the cascade of follow-up that a borderline result sets off, and the anxiety that goes with all of it.

And we will not sell you a diagnosis that does not exist. “Adrenal fatigue” is the obvious example — it is not a recognised medical diagnosis, and a good deal of this industry is built on it anyway. Your exhaustion is real. That label is not the explanation for it.

How this works around a calendar

Everything is remote and asynchronous where it can be. Lab draws happen at a patient service centre near you, or wherever you happen to be that month. Results and clinician review do not require a flight. Prescriptions, where clinically appropriate, ship to your home.

There is no membership fee, and no charge to find out whether you are eligible. Pricing is published in full rather than quoted on request, which is not the norm in this part of the market and is deliberate.

Frequently asked questions

Is this a replacement for my executive physical?

No. We have no imaging, no physical examination and no stress testing, and we will not pretend otherwise. It is a complement — the continuous layer between annual assessments, and the part that treats what gets found.

Can you tell me if I have sleep apnoea?

We can screen you with a validated questionnaire and tell you whether your risk warrants testing. We cannot diagnose it. Diagnosis requires a sleep study, and if screening suggests one is warranted we will say so and refer.

My company pays for an executive physical. Why would I pay for this as well?

Many people use both, and that is the arrangement we would suggest. The physical does the imaging and examination once a year; this does the measurement, interpretation and treatment in between. If cost is the deciding factor, our full pricing is public and you can compare it against what you would actually use.

I already get an annual panel through work. What is different here?

Two things. A standard occupational panel is usually narrower than a full one — thyroid, nutrient markers and hormones are frequently absent. And nobody treats what it finds; it is handed to you. We read it against your history and, where appropriate, act on it.

I travel constantly. Does that make this harder or easier?

Easier, generally. Lab draws are available in most metropolitan areas and the clinical side does not depend on you being anywhere in particular. Travel is also one of the things we would actively want to talk about, rather than a logistical obstacle to work around.

Do you treat women in this group too?

Yes, and the executive audience is frequently written about as though it were entirely male. Perimenopause arriving mid-career is one of the most consequential and least discussed issues in this population.

Where this fits in your plan

If you have been putting off finding out what is going on, the useful first step is small: a baseline panel and a conversation that covers sleep, travel, alcohol and hours honestly rather than politely.

Most of what turns up in this population is unglamorous and treatable. Some of it has been mislabelled as stress for years. Nearly all of it does better when it is caught on a trend line than on a single annual snapshot.

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