Care Built Around a Demanding Career

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 published an examination in JAMA of the preventive services included in executive physical packages at top-ranked American hospitals. Of 50 top-ranked hospitals, 32 offered such a package; service details were available for 29 of them, covering 46 packages priced between $1,700 and $10,000. Every included service was scored against United States Preventive Services Task Force grades. A Grade D means the Task Force reviewed the evidence and recommends against the service: no net benefit, or harms that outweigh the benefits.

What it found was not that the packages were thin. It was that they were pointed the wrong way.

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 pattern is a design choice, not an oversight. A package assembled to feel thorough looks different from one assembled to change outcomes, and only one of them is easy to sell to a board. The tests that feel like a serious morning — the treadmill, the ultrasound, the tracing — are the ones with the weakest evidence behind them in a low-risk adult.

We hold ourselves to the same standard we are applying here. That means being open about the tests we sell that guidelines do not endorse, which is why the lab testing page says so about the Galleri test rather than burying it in a footnote.

Read nextWhat an executive physical covers, and what it misses

What a demanding career actually does to a body

Sleep disorders. Undiagnosed obstructive sleep apnea is the most commonly missed issue in this population, and it rarely presents as snoring in the exam room. It presents as exhaustion that coffee stopped fixing, a shorter temper than you used to have, and blood pressure that will not come down on two medications.

Travel. Research on corporate travelers has linked heavy travel — fourteen or more nights away a month — with poorer sleep, more sedentary time and higher rates of anxiety, low mood and alcohol-dependence symptoms than travelers away one to six nights. On the cardiometabolic side the picture is a U rather than a line: in a separate study, both the heaviest travelers and people who never travel for work fared worse than light travelers on obesity, diastolic blood pressure and HDL. The threshold where the signal appears is lower than most frequent travelers assume.

Hours. Joint estimates from the World Health Organization and the International Labour Organization attributed 398,000 stroke deaths and 347,000 heart disease deaths in 2016 to working 55 hours a week or more. Against a 35-to-40-hour week, that workload carries an estimated 35% higher risk of stroke and a 17% higher risk of dying from ischemic heart disease. Most of those deaths were in people aged 60 to 79 who had worked those hours between 45 and 74 — the burden lands decades after the exposure.

Alcohol. Two glasses at a client dinner four nights a week is a volume most people would never describe as heavy drinking. It is also enough to show up in liver enzymes, to fragment the second half of the night's sleep, and to sit on top of the hormonal picture in ways that get blamed on age.

Hormones. Perimenopause arrives, on average, at exactly the career stage where a woman has the most people reporting to her. Testosterone decline in men gets read as tiredness and absorbed as a personality change. Both are measurable. Neither is usually measured.

Cognitive complaints, and what is actually measurable

“Brain fog” is the phrase people arrive with, and it is not a diagnosis. It is a description — of losing the thread mid-sentence, of re-reading the same paragraph, of a name that used to be instant taking three seconds.

What matters is that it maps onto a short list of things that can be measured: thyroid function, B12 and ferritin, glucose regulation, sleep quality and sleep-disordered breathing, the hormonal transition in both sexes, and alcohol. Some of those are treatable. Some are not the cause and can be ruled out, which is worth something too.

What we will not do is treat the phrase itself, or attribute it to a condition that does not exist. There is no lab finding called adrenal fatigue.

Read nextBrain fog in high performers: what is measurable

Cardiometabolic risk when you look fit

The pattern we see most often in this group is a person who trains, whose weight is reasonable, whose annual panel came back normal, and whose actual risk is not visible on that panel.

Two markers explain a lot of that gap. Lipoprotein(a) is largely genetically set and stays broadly stable across a lifetime, which is why the 2026 ACC/AHA dyslipidemia guideline says it should be measured at least once in adulthood — and why most people have never had it drawn. Apolipoprotein B counts the atherogenic particles rather than the cholesterol they carry, and the same guideline says it may be used to assess residual risk in people with cardiovascular-kidney-metabolic syndrome, type 2 diabetes, high triglycerides or known cardiovascular disease who have already reached their LDL-C and non-HDL-C goals.

Neither is routinely on an occupational panel. One of them you need roughly once in your life and probably have not had.

Read nextHeart risk when you look fit

The drinking nobody counts

Almost nobody at this level is drinking in a way they would flag on an intake form. The pattern is structural rather than excessive: dinners, conferences, board weekends, a glass while the inbox clears.

It is worth measuring for one specific reason — the effects are dose-related and they reverse. Liver enzymes move. Sleep architecture in the back half of the night improves. The interaction with hormonal changes, in both men and women, changes with intake.

We ask about it directly, we measure it, and we tell you what we see. We do not moralize about it, and we are not a treatment program for alcohol use disorder — if that is the picture, we will say so and refer.

Read nextClient dinners, conferences, and what regular drinking does

The hormone layer at peak career

The years between 45 and 60 are, for most people in this audience, the highest-leverage years of a career and the years in which the endocrine picture changes most. That collision is not a coincidence anyone planned for, and it is badly served by annual care.

For women, perimenopause can run for years before a period is missed, and its most disruptive features at work — sleep disruption, temperature dysregulation, and word-finding difficulty — are the ones least likely to be attributed to it. For men, the decline is slower and more likely to be absorbed as ordinary aging until someone measures it.

Both are handled through the same canonical programs anyone else would use — women's hormone therapy and men's testosterone therapy — for eligible patients, after evaluation, with monitoring.

Read nextPerimenopause at peak career

What an executive physical is genuinely good for

It would be dishonest to critique the category without being clear about what it does that we cannot.

An executive physical gives you a physician's hands on you, imaging that finds structural things bloodwork will never show, and a genuine chance of catching something that would otherwise sit unnoticed for years. Those are real. We do none of them.

What it cannot do is follow you. It cannot see a marker drifting inside the normal range across three draws. It cannot adjust anything in month seven. It cannot reach you at all between appointments.

Where ongoing care does more

Direction beats position. A single result inside a reference range tells you very little. Three measurements across eighteen months tell you which way you are going, which is the thing that actually predicts anything.

Behavior and physiology have to be discussed together. Sleep, alcohol, travel and workload are not context for the labs. They are frequently the cause, and the only way to establish that is a conversation plus a repeat measurement.

A finding without a plan is just anxiety. This is the failure mode of testing-only services. We treat what we find, within scope, and then remeasure to establish whether the treatment did anything.

What the first ninety days looks like

1. 1Weeks 1–2

   Baseline

   Online assessment, then a lab requisition you take to a local patient service center. One draw. No travel, no scheduled day off.

2. 2Weeks 2–4

   Review

   A clinician reads your panel against your history and the screening questionnaires, not against reference ranges alone, and you talk it through. This is where sleep, travel, alcohol and hours actually get discussed.

3. 3Weeks 4–12

   Act, if there is something to act on

   For eligible patients, treatment is prescribed and shipped. Referrals go out where we are out of scope — a sleep study, imaging, a cardiology opinion.

4. 4Around week 12

   Remeasure

   The second data point. This is the one that makes the first one mean something.

Read nextWhat your first ninety days looks like

Privacy, and your employer

A question we get asked more than any other in this group, usually near the end of a call.

What we will not claim

• That optimizing a biomarker extends your lifespan. That is not established, and anyone telling you otherwise is selling from a position the evidence does not support.
• That what we do is comprehensive. A blood panel and a history are not a complete picture of a body, and calling it one would be the same failure we have just criticized in someone else’s product.
• That a test is worth running because it is impressive. Every test has a cost that is not on the invoice — incidental findings, false positives, and the cascade of follow-up a borderline result sets off. If it will not change what we do, we will say so.
• That we can diagnose conditions we cannot examine you for. Or conditions that do not exist. “Adrenal fatigue” is the obvious example — it is not a recognized 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

Remote and asynchronous wherever it can be. Lab draws at a local patient service center in most metropolitan areas. Results and clinician review with no travel. Prescriptions, when clinically appropriate, shipped to your home. No membership fee, and full pricing published rather than quoted on request.

Where this fits in your plan

Start with a baseline panel and an honest conversation about sleep, travel, alcohol and hours.

Most of what turns up in this population is treatable. A good deal of it has been filed under stress for years. Nearly all of it reads differently as a trend than it does as an annual snapshot.

Frequently asked questions