By Dr Meneka Kumaran, MD, MBA
“Doctor, everything is normal. So why am I still so tired?”
It is a question that can arise during health screening.
The blood pressure is acceptable. Blood sugar and cholesterol may be reassuring. Thyroid function may be normal. There may be no obvious abnormality on the investigations performed.
Yet the person sitting across from us may still say: “I just don’t feel like myself.”
As doctors, we are trained to look for disease. In preventive healthcare, we also look for risk before disease develops. But there is another important part of health that may not fit neatly into a laboratory report: how a person is actually coping and functioning.
As we mark World Mental Health Month, perhaps it is worth broadening the way we think about a “normal” health screening.
Mental and physical health are connected
Mental and physical health do not exist in completely separate compartments.
The World Health Organization (WHO) describes mental health as an integral component of health and emphasises the importance of integrating mental-health care into general healthcare, including primary care.
This matters in preventive medicine because psychological wellbeing can influence physical health both directly and indirectly.
The American Heart Association (AHA), for example, has highlighted evidence linking psychological health with cardiovascular health and cardiovascular disease. Its scientific statement on the “mind-heart-body connection” notes that psychological health may influence cardiovascular risk through both biological processes and health behaviours.
In everyday practice, however, the connection may appear much more simply.
A patient may complain of persistent fatigue, headaches, muscle tension, palpitations, gastrointestinal symptoms, difficulty concentrating, appetite changes or disrupted sleep.
Of course, these symptoms should never automatically be dismissed as “stress”.
Fatigue may warrant assessment for anaemia, thyroid disorders, nutritional deficiencies, infection, sleep disorders or other medical conditions depending on the individual. Palpitations may require cardiovascular evaluation. Unexplained weight changes deserve appropriate investigation.
That is precisely why health screening and proper clinical assessment remain important.
But when appropriate investigations are reassuring and symptoms persist, the conversation should not necessarily end with:
“Your results are normal.”
Sometimes, that is where another conversation needs to begin.
The high-functioning patient
One group that can be particularly easy to overlook is what I think of as the “high-functioning patient.”
They arrive at work every morning.
They meet deadlines.
They care for their children or ageing parents.
They answer emails, attend meetings and continue fulfilling everyone else’s expectations.
From the outside, they appear fine.
Ask a few more questions, however, and a different picture may emerge.
They may be sleeping five hours a night. They may wake already feeling exhausted. Exercise disappeared from their routine months ago. Meals are eaten hurriedly or skipped. They cannot remember the last time they genuinely switched off from work.
And because they are still functioning, they assume nothing is wrong.
We have become remarkably good at equating productivity with wellbeing.
They are not the same thing.
The WHO estimates that 15% of working-age adults had a mental disorder in 2019. It also estimates that depression and anxiety result in approximately 12 billion lost working days globally every year, costing around US$1 trillion annually in lost productivity.
Importantly, the workplace itself can either support or undermine mental wellbeing. Excessive workloads, low job control, job insecurity, discrimination and other poor working conditions are recognised by WHO as potential risks to mental health.[3]
A person therefore does not have to reach a crisis or become unable to work before their mental wellbeing deserves attention.
Sleep deserves a place in the conversation
One of the questions I believe deserves greater attention during preventive-health consultations is surprisingly simple:
“How are you sleeping?”
Sleep and mental wellbeing have a close and complex relationship.
A 2026 study published in JAMA Network Open involving 1,476 people seeking mental-health care examined sleep, physical activity and subsequent mood. Researchers found that both shorter and longer sleep duration were associated with poorer subsequent mood, while physical activity was positively associated with subsequent mood.
This does not mean that simply sleeping longer or exercising will “treat” every mental-health problem.
It does remind us, however, that sleep, activity and psychological wellbeing interact—and these are areas worth discussing when assessing a person’s overall health.
Stress can influence the way we live
It is important not to blame every abnormal health marker on stress.
However, prolonged psychological strain can influence behaviours that are central to preventive health.
When we are overwhelmed, we may sleep less, exercise less, rely more heavily on convenience foods, increase caffeine or alcohol consumption, or simply stop making time for ourselves.
Over time, these behaviours can contribute to cardiovascular and metabolic risk.
This is one reason psychological health deserves consideration when we discuss cardiovascular prevention.
The AHA scientific statement concluded that there are substantial data demonstrating associations between psychological health and cardiovascular disease and risk and recommends that psychological health be considered when evaluating and managing people with or at risk of cardiovascular disease.
So when I discuss cardiovascular risk with a patient, for example, I am interested not only in their cholesterol.
How are they sleeping?
Are they physically active?
What does their typical working day look like?
Do they have time to eat properly?
Are they constantly exhausted?
These questions provide context that a number on a laboratory report cannot.
A health screening is a snapshot, not a guarantee
One misconception about health screening is that receiving a collection of “normal” results means everything is fine.
Screening is valuable, but it has limitations.
It gives us information about selected aspects of health at a particular point in time. It helps identify certain diseases and risk factors early. It provides an opportunity to discuss family history, lifestyle and prevention.
It cannot measure every dimension of wellbeing.
This is why the consultation surrounding a health screening can sometimes be just as important as the investigations themselves.
A patient telling me:
“I haven’t been sleeping properly for six months.”
“I don’t enjoy things the way I used to.”
“I feel overwhelmed all the time.”
Or simply:
“I’m not okay.”
Those sentences deserve attention.
Prevention should include mental wellbeing
We have spent decades encouraging people not to wait for symptoms before checking their blood pressure, cholesterol, blood sugar or cancer risk.
Perhaps we should apply some of that same preventive thinking to mental wellbeing.
We should not have to wait until someone is unable to work, unable to sleep or completely overwhelmed before acknowledging that they may need support.
This does not mean turning every difficult week into a diagnosis. Stress, sadness and difficult periods are normal parts of life.
It means recognising when something has become persistent, is affecting daily functioning or simply does not feel right.
For some people, addressing sleep, physical activity, nutrition, boundaries and social connection may be helpful.
For others, it may mean speaking with their doctor or an appropriate mental-health professional.
And where there are severe symptoms, thoughts of self-harm or concerns about immediate safety, urgent professional help should be sought.
Ask one more question
Preventive medicine is ultimately about identifying problems early and reducing future risk.
That philosophy should extend beyond the diseases we can detect through a blood test.
The next time you attend a health screening, certainly ask about your cholesterol, blood pressure, blood sugar and cancer-screening needs.
But consider asking yourself another question too:
How am I actually doing?
And perhaps healthcare professionals can ask it as well.
Because sometimes the most important finding in a health screening is not a number highlighted on the report.
It is what the person sitting in front of us finally feels able to say.
