Executive decision

It's tough at the top and if executives want to stay there, they have to stay healthy. Vernon Baxter hears how the world of commerce is handling its leaders with cotton wool and colonoscopies.

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One of the perks of being a top executive is that you get used to the finest things in life. One of the pitfalls, of course, is that often every aspect of that life has to play second fiddle to the job - and this can include an executive's health.

For some, a work-life imbalance is simply the price paid for wealth and power. It might shorten your life-span, but few get to the top by having 10 hours sleep a night and spending their Wednesday afternoons with a Reiki master.

Still, when it comes to healthcare too many executives - and their companies - have got their priorities wrong, according to leading physicians.

Executives are the key components to any company, argues Dr Donald D Hensrud, the director of the Mayo Clinic's Executive Health Plan, and it's time the business world starting protecting its assets. "We are not saying that these executives are more important as people," reasons Hensrud, "but an investment in an executive is an investment in the company."

Hensrud points to the recent untimely deaths of McDonalds' CEOs, Jim Cantalupo and Charlie Bell as examples of how - rightly or wrongly - unhealthy executives are linked to unhealthy economic performance. An employee of the company for 28 years, Cantalupo was made CEO in January 2003. Just 15 months later he died of a myocardial infarction at age 60.

His successor, Bell, was diagnosed with colon cancer within weeks of taking the role and died less than a year later. He was only 44 years old. Stock prices tumbled in the wake of the deaths and international press waxed lyrical on the 'obvious' dangers of the 'McDonald's diet'.

As people unused to doing things by half, executives can be ideal patients, claims Dr Kevin Waters, director of Duke University's Executive Health Program. "This can be a good demographic to treat because they are highly motivated people," he says.

"Once you make them realise what they have to do and how important it is then most of them are really willing to make those changes."

From a business sense, it is understandably difficult to pitch executive health programmes to the top brass. They need to be convinced to pour time and resources into a project with an indefinite timeline, questionable returns and no get-out clause - themselves. But once an executive is on board, it can be the most worthwhile investment they'll ever make.

The test of time

Top executives face the same problems that any individual does with healthcare - busy physicians and a long line at the MRI machine. The difference is that executives have the resources to skip to the front of the queue.

"Patients within the US are pushed for time when they meet with their own physicians - they get a 20 minute visit at best and they don't get to discuss a whole lot of things," explains Dr Bimal Ashar, medical director of the Johns Hopkins Executive Health Program.

These short visits are often interspersed with long waits for test results that are likely to require second or even third appointments. "Our programme here is designed for the individual who just does not have time to do all that and wants to discuss things and take hold of their healthcare in a proactive manner," says Ashar.

"With the total visit, my goal is to have all their questions answered and, from a medical standpoint, I want to have all my questions answered," states Hensrud.

"We leave no stone unturned and we will take whatever time that takes." Comprehensive check-ups obviously benefit the patient, but physicians working on executive health programmes are almost apologetic when it comes to acknowledging their virtues. "My heart goes out to physicians on the front line who have 10 to 15 minutes to see a patient and pick any one or maybe two problems if you are lucky," admits Henrsud.

Special treatment

To work on one of the top executive health programmes it is likely that you will have already had a distinguished career as an internist. Most of the top institutions have a rotational policy where leading physicians will be completely available to the programme for a handful of days each month, keeping staff motivated and skill levels high.

Considering typical patients include Fortune 500 executives and members of the wealthiest families in the world, accusations of elitism are impossible to brush off.

"There are certainly people that feel that it is unethical because this is not the sort of care that everyone is able to get," concedes Dr Bimal Asher. "[But] patients want more than what the health system, with the current insurance scheme, can offer them - I don't feel we are doing anything unethical: we are trying to offer better care by working in a different payment system."

Asher adds that at Johns Hopkins, each of their physicians have practices that face the usual restrictions of money and time. He argues that private patients and companies are paying out of their own pocket and not through insurance.

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