Comprehensive Health Assessments: Why Preventive Healthcare Matters
By Dr Victoria McBride, GP & Clinical Director, Courtyard Health Clinic
One of the things I have learned after more than 20 years in medicine is that when we find something can matter almost as much as what we find.
Take high blood pressure. Finding it in your 40s, when you feel completely well, gives us an opportunity to understand why it is raised, assess your overall cardiovascular risk and, where necessary, do something about it.
Finding it years later, after it has quietly been affecting your heart, kidneys or blood vessels, is a very different conversation.
That is really what preventive healthcare is about.
At Courtyard Health Clinic, we see people from Edinburgh, East Lothian and across Scotland for private health checks and comprehensive health assessments. Many arrive saying exactly the same thing:
“I feel absolutely fine. Do I really need a health check?”
My answer is that feeling well is obviously a very good thing. But it doesn’t necessarily tell us what is happening with your blood pressure, cholesterol or blood sugar.
Why have a health check if you feel well?
Some of the most important risk factors we deal with in general practice are completely silent.
You cannot feel raised cholesterol. You can have significantly raised blood pressure without knowing it. And blood glucose can gradually increase for years before somebody develops the symptoms we traditionally associate with diabetes.
That is why I am such an advocate of knowing your numbers.
Not because every slightly abnormal result needs treatment, but because once we know what is happening, we can put it into context.
The purpose of a good health assessment isn’t to find something wrong with everybody who walks through the door. Quite the opposite. It is about establishing where you are now, identifying important risk factors and deciding whether there is anything we can sensibly do to protect your future health.
What can a private health check detect?
A comprehensive health assessment can identify or help assess a range of conditions and risk factors, including:
• high blood pressure
• abnormal cholesterol
• increased cardiovascular risk
• type 2 diabetes and increased diabetes risk
• anaemia and iron deficiency
• thyroid dysfunction
• some vitamin deficiencies
• kidney and liver abnormalities
It can also provide a useful baseline against which we can compare future results.
Sometimes we identify something that needs treatment or further investigation.
Sometimes the results lead to a conversation about relatively simple lifestyle changes.
And sometimes everything looks reassuring and the answer is simply: keep doing what you’re doing. That is useful information too.
What does the evidence tell us about preventive healthcare?
We have very good evidence that a substantial proportion of cardiovascular disease is associated with modifiable risk factors including smoking, high blood pressure, abnormal cholesterol, diabetes, obesity, diet and physical inactivity.
Cardiovascular risk does not suddenly appear when somebody reaches their 60s or 70s. It develops over many years. That makes midlife an important opportunity to assess risk properly.
But there is an important caveat.
Health screening needs to be sensible.
Large reviews of generic health checks have not consistently demonstrated reductions in overall mortality. I think that is important to acknowledge.
That is different, however, from saying there is no benefit in identifying and appropriately managing established cardiovascular risk factors. There is strong evidence supporting the detection and appropriate management of conditions such as hypertension, diabetes and significant lipid abnormalities.
For me, therefore, the value of a good health assessment isn’t simply in performing lots of tests.
It is in interpreting those results properly and deciding what, if anything, we should do with them.
Blood pressure: the risk factor you may never feel
High blood pressure is common and frequently causes no symptoms at all.
Persistent hypertension increases the risk of stroke, cardiovascular disease, kidney disease and other complications.
Yet measuring blood pressure is one of the simplest things we can do. If we find a raised reading, that doesn’t automatically mean somebody needs medication. We can confirm it properly, often using home or ambulatory blood-pressure monitoring, and consider the result alongside age, lifestyle, family history and overall cardiovascular risk.
Diabetes and HbA1c testing
Type 2 diabetes is another condition that can develop quietly. By the time somebody develops significant thirst, frequent urination or unexplained weight loss, their blood glucose may have been abnormal for some time.
An HbA1c blood test allows us to assess average blood glucose levels and can identify both diabetes and people at increased risk of developing it. Identifying increased risk earlier gives us an opportunity to intervene, and changes to weight, diet and physical activity can make a meaningful difference for many people.
Cholesterol, ApoB and lipoprotein(a)
Cholesterol is slightly more complicated than dividing results into “good” and “bad”.
When assessing cardiovascular risk, I am interested in the whole person: blood pressure, smoking, diabetes, family history, kidney function, weight and lifestyle, as well as the lipid profile itself.
In selected patients, additional markers such as apolipoprotein B (ApoB) and lipoprotein(a), or Lp(a), can provide additional information.
Lp(a) is particularly interesting because levels are largely genetically determined. Someone can be fit, eat well and have an excellent lifestyle but still have a significantly raised Lp(a).
That doesn’t mean something terrible is going to happen. It gives us another piece of information which may influence how carefully we manage the cardiovascular risk factors we can change.
Sometimes a health assessment explains why you haven’t felt quite right
Not everything we find during a health check is about preventing a heart attack or stroke 20 years from now.
People often put symptoms such as tiredness, poor concentration, reduced exercise tolerance, changes in weight or simply “not feeling quite right” down to stress, ageing or being busy. Sometimes that is exactly what is going on. But sometimes we identify something treatable, such as iron deficiency, anaemia, thyroid dysfunction or a vitamin deficiency. The important thing is not assuming either way.
What does a private health check at Courtyard Health Clinic include?
Our Core Health Assessment is designed to provide a comprehensive, medically led assessment of your health.
It takes place over two appointments because I don’t believe a proper health assessment should be a conveyor-belt or tick-box exercise.
The first appointment allows us to gather the information we need. Depending on the individual assessment, this includes blood tests, blood pressure and other clinical measurements, urinalysis, ECG and lung-function testing.
You then return for a dedicated consultation with a doctor. And, for me, that is the important bit.
We go through your results properly, take into account your medical history and family history, perform a clinical examination and discuss what the findings actually mean for you.
What blood tests are included in our Core Health Assessment?
Our blood panel is deliberately comprehensive and includes:
• full blood count
• kidney function
• liver function
• HbA1c and glucose
• detailed cholesterol and lipid testing
• apolipoprotein B (ApoB)
• lipoprotein(a) – Lp(a)
• thyroid function
• vitamin D
• vitamin B12 and folate
• iron studies
• relevant hormone testing
• inflammatory markers, including high-sensitivity CRP
• PSA for men where clinically appropriate and following discussion
But I don’t want patients walking away with a long list of numbers and no idea what any of them mean.
At the end of your assessment, you receive a personalised written medical report explaining the important findings, what they mean and what, if anything, I think we should do next.
Who should consider having a health assessment?
There isn’t a magic birthday when everybody suddenly needs a comprehensive health check.
For many people, however, it becomes increasingly useful from midlife, particularly if you haven’t had your blood pressure, cholesterol, blood glucose and general cardiovascular risk reviewed for several years.
It may also be worth considering if you:
• have a family history of premature heart disease, stroke or diabetes
• haven’t had your cardiovascular risk assessed for several years
• are experiencing unexplained tiredness or changes in your health
• want to understand your cholesterol or metabolic health in greater detail
• are making significant lifestyle changes and would like an objective baseline
• simply want a clearer understanding of your current health and future risks
Quite a few people come to see me because they realise they know more about the servicing schedule for their car than they do about their own blood pressure and cholesterol. There is probably something slightly backwards about that.
Is a private health check worth it?
That depends on what you mean by a health check.
I do not believe there is much value in performing an enormous battery of investigations simply because we can. More testing is not automatically better medicine, and screening tests need to be interpreted in the context of the individual.
Where I do see value is in combining appropriate investigations with proper medical assessment.
The test result itself is only one part of the picture. Your age, symptoms, medical history, family history, lifestyle, examination findings and existing risk factors all matter when deciding whether a result is significant and what should happen next.
That clinical interpretation is what turns a collection of test results into a meaningful health assessment.
How often should you have a health check?
How often you should be reviewed depends on your age, medical history, family history, previous results and individual risk factors.
Someone with completely reassuring results and low cardiovascular risk may not need another comprehensive assessment for some time.
Someone with raised blood pressure, increasing HbA1c, abnormal cholesterol or a strong family history may benefit from more regular monitoring.
This is why I prefer an individualised approach rather than telling everybody to return automatically every year.
Private health checks for Edinburgh, Musselburgh and East Lothian. Courtyard Health Clinic is based at Eskmills in Musselburgh, within easy reach of Edinburgh and East Lothian.
Our Core Health Assessment is designed for people who want time with a doctor to understand their health properly – not simply a printout of blood results.
The aim isn’t to turn healthy people into patients. Quite the opposite.
Preventive medicine is about giving people the best possible chance of staying healthy.
We cannot prevent every illness, and no health assessment can give somebody a guarantee about the future. But we can identify important risk factors, act on the things we can change and make informed decisions about our health rather than waiting until something forces us to.
For me, that is the real value of knowing where you stand.
Frequently Asked Questions
Can you have high blood pressure without symptoms?
Yes. High blood pressure frequently causes no symptoms, which is one reason routine blood-pressure measurement is important.
Can a blood test detect diabetes?
HbA1c is commonly used to diagnose type 2 diabetes and to identify people whose blood glucose is above the normal range and who are at increased risk of developing diabetes.
What is lipoprotein(a)?
Lipoprotein(a), usually abbreviated to Lp(a), is a genetically influenced lipoprotein associated with cardiovascular risk. Levels remain relatively stable throughout life, so testing may be particularly useful in people with a personal or family history suggesting increased cardiovascular risk.
Does a normal health check guarantee that I am healthy?
No. No screening programme or medical assessment can rule out every disease or guarantee future health. A health assessment provides information about your health and identifiable risk factors at that point in time.
If you would like more information on the Courtyard Health Clinic Enhanced + health assessment, please call the practice on 01312976655 or email on hello@courtyardhealthclinic.com
