Byline: MARINA JIMENEZ
Settling into a black leather chair in the light-filled waiting room, Valerie MacKenzie sips coffee from Mikasa fine china, flips through the morning edition of the Wall Street Journal, and says something you don't hear in most doctors' offices: "This is almost like being at home."
There are no coffee-stained magazines from the last century or broken children's toys at Medcan Health Management Inc., a private state-of-the-art clinic in downtown Toronto that offers a wide range of medical services to time-strapped patients with the money to pay for them.
Ms. MacKenzie, a 38-year-old corporate executive, is here to undergo the Cadillac of annual checkups, a $1,000 "executive" physical.
Today a team of technicians, nurses and doctors will poke and probe every inch of her body and relay the results in exacting detail in an inch-thick report. The series of tests might take weeks to set up under the Ontario Health Insurance Plan (OHIP) and involve a dozen trips to see specialists in different hospitals and clinics.
By morning's end at Medcan, she will have a wealth of data documenting her bone density; the health of her heart, kidney, spleen, pancreas and other internal organs; the state of her hearing and sight; her propensity for glaucoma; her cholesterol level; her fitness level; and her body fat.
For months, Ms. MacKenzie put off this checkup, a perk offered to executives at MAC cosmetics, where she works as the director of product development. But with her 40th birthday approaching, and cognizant of the toll that constant travel and rich food have taken on her body, she decided to take more interest in her own health.
"I don't want to be fat and 40," she says, laughing. "As my husband said, 'This is like a real physical, a true look at where you are.' "
Founded in 1983, Medcan, with 150 staff and 15 physicians, is one of a growing number of private companies offering blue-chip medical services for a fee. Its patient roster reads like a Who's Who of corporate Canada. On one recent morning, six presidents, one treasurer and three chairmen of major corporations all came in for annual appointments, exchanging stress-test scores afterward as if they were golf handicaps.
Medcan focuses on services not covered under OHIP, thereby bypassing restrictions on private medicare, in the same way that doctors who perform plastic surgery, cosmetic mole removal and laser eye surgery do.
Typically, family doctors bill OHIP $54 for an annual checkup: a physical, an interview to determine the family medical history, and referrals for more tests if the patient has symptoms or is in a high-risk group.
As the public system gets squeezed and family doctors are forced to take on more and more patients, private clinics with corporate mottos such as "You'll never get sick of waiting for us" are gaining in popularity. They are also tapping into the public appetite for holistic healthcare.
At Medisys Executive Health Services, which has centres in Vancouver, Calgary, Montreal and Toronto, the $650-$1,000 executive physicals include stress management and a fitness-and-nutrition assessment. MDS Laboratories has an executive-health division. And smaller boutique firms, such as the Genesis Professional Group in North York, Ont., offer personalized health-care planning for $2,500 a year, which includes house calls, fitness evaluation, and lifestyle and emotional-health assessment.
Critics of two-tiered health argue that these clinics violate the spirit of the Canada Health Act, which stipulates that doctors may not charge patients extra for faster or better services.
However, Dr. Robert Francis, Medcan's founder, chairman and CEO, believes the clinic saves the public system money by focusing on preventive health care.
"The public system is a reactive process," he says. "You get sick, you go to the doctor. The annual checkup is relatively limited.
"We are addressing a void in the system. We focus on things that are not always medically necessary, such as colonoscopies, stress testing and breast screening. . . . Every year we find a few kidney cancers in completely asymptomatic patients. We find 50 to 60 prostate cancers."
Medcan patients -- including some senior doctors and executives on the boards of Toronto hospitals -- don't give this quintessentially Canadian debate about the ethics of private health a second thought. They are merely grateful for Medcan's presence, handily located in Toronto's banking district.
Glenn Miller, president of PenEquity management corporation, has been coming for 11 years, and sends his senior executives here. "I wanted to do testing over and above what the system allows and I didn't want to go to the U.S. I feel I will be less of a burden on the public system by taking care of small problems as they arise."
Tests at the clinic enabled him to find out about a hearing problem, for instance, that he was able to address. Medcan has also referred him to specialists for other health-care needs.
Medcan's pampered surroundings and well-appointed offices appeal to a wide variety of people, including Ron Ellis, a former Toronto Maple Leaf who suffered from depression, media personalities, visiting Hollywood celebrities and American rock stars.
A Nova Scotia law firm flies its partners down en masse for yearly checkups. A father and son who run a food-trading company in Guelph, Ont., come once a year for a "Medcan morning."
Not all patients are rich and famous: Some of more modest means are prepared to shell out for a once-in-a-lifetime round of exhaustive medical tests to reassure themselves they are in good health. But can all this attention to diagnostic screening lead to Woody-Allenesque paranoia and obsession about imagined symptoms? Do you really need to know about the elasticity of your eyeballs, and whether you're colour-blind and have a healthy spleen?
Patients seem to think so. Many are self-confessed type-As, who love to compare their test scores with last year's results and compete with themselves to see whether fitness and a healthy diet can stave off the inevitable aging and disease process that will eventually claim us all.
Abbey Lipson has dramatically altered his lifestyle since first coming to the clinic several years ago. He now watches what he eats -- thanks to advice from the on-site nutritionist -- and lifts weights with a personal trainer.
"I know my body better now than I ever did," says Mr. Lipson, the 72-year-old chairman of McGregor Industries Inc. "There are very few tests I'd be able to get through my family doctor, and then only if I had a family history or symptoms."
Dressed in a T-shirt, shorts and sneakers, Mr. Lipson undergoes his physical with relish. "This is the bionic man getting on the treadmill," he jokes, as the nurse straps 12 electrodes to his chest and wraps a blood pressure pump around his arm.
His respiratory test results show some breathing restriction, but he is happy his lung capacity has only decreased 5 per cent in the last year. His hearing is within the normal range for his age group. He eagerly anticipates his patient report card, noting that an ultrasound test a few years back alerted him to a kidney problem that he had treated.
"Some people feel the less they know the better, but I am the opposite," says Mr. Lipson. "I'm not a hypochondriac but I am prepared for danger. I plan to live to be 150."
The only complaint Medcan patients seem to have is with the coffee: "It is lousy," says one man, opening a fridge in the waiting room to look for something else to drink.
Marina Jimenez is a senior feature writer for The Globe and Mail.
'You're not an asthmatic, are you?'
My Medcan executive physical hasn't begun and I've already cheated. I didn't abstain from alcohol the night before, and had two morning coffees. I am about to have the most comprehensive series of medical tests in my life, and I need all the help I can get.
I've already filled out a "vitality quotient" questionnaire that measures workplace stress and rate of aging through a series of 40 questions, and it's made me nervous: Do you get annoyed easily? Do you feel low on energy? Do you wake up earlier than you plan to? Do you get uneasy waiting? Yes, to all four.
A registered nurse named Sally with a nametag bearing the corporate motto "Keeping busy people healthy" greets me at the front desk and we begin my two-hour physical without delay. She takes me to an examining room where my sight, hearing and lung capacity will be tested.
She types my age and height into a machine and then hands me a white nozzle: "Blow into this as hard as you can," she says. The effort makes me light-headed, and Sally frowns slightly at the results: "Hmm. Mild restriction on the breathing test. It could be the machine. You're not an asthmatic, are you?"
Turns out to be a false positive. I fare better on the vision test -- that is, the second time I do it, with my glasses on. At least I have no problem with colourblindness. And my hearing -- tested inside an impressive soundproof booth -- is excellent, in spite of a lifetime of rock concerts and too-loud television.
My physical-stress test doesn't go as well as I'd hoped. Hooked up to 12 electrodes, I run the treadmill for 10 minutes and an ECG machine measures how my heart responds to physical stress. My fitness level is rated only average -- something of a disappointment given my thrice-weekly runs -- though the nurse assures me I can tip over into the "good" category with more exercise.
For the body-fat-index test, the nurse uses a skinfold caliper, a metal instrument that looks like a large pair of tweezers, to pinch folds of skin around my biceps, triceps, side and back.
She then calibrates the measurements through an equation to determine my body fat. I score below average. The nurse comments tactfully that I shouldn't think of all those folds of loose skin on my one-year-post-partum belly as fat. "It's just relaxed muscle and skin that needs to be toned."
At a stop in the X-ray room, the technician compliments my "photogenic" spine: "It's not crunched at all," she says. Later, radiologists will read the chest X-ray for any evidence of hiatus hernias, kidney stones, active tuberculosis and any other signs of disease.
Next, I go for a sonogram to test my bone density, slipping my right heel onto a machine called the Achilles Express. I find out I am not in the danger zone for developing osteoporosis.
I troop into the ultrasound room for my final test, an in-depth look at my spleen, liver, kidneys and various other internal organs. The technician tells me that in other patients she has detected cysts, stuck gallstones, cancer of the spleen, and even a missing kidney in the case of one shocked woman. I watch the imaging on a small screen -- my organs look like a blurry weather map of Canada.
I am thrilled with the photo of my pancreas she gives me as a keepsake.
The next day, John Cape, Medcan's vice-president, leaves a message on my voicemail. "Marina, I'm concerned about your vitality quotient. You're in the 43rd percentile," he says.
"This is definitely a red flag. Call me back as soon as you can to talk about this. We may suggest values and goals clarification, relaxation techniques or high-performance nutrition. You guys are being run ragged over there."