Overdiagnosis – time to treat free health checks and screening with greater caution? All that glisters is not gold? And why don’t more doctors speak out about the high levels of these proven and potential patient harms

– Or just: ‘Never trust a crocodile’s smile’.

This week, in bmj Editor’s Choice, First do no Harm, editor Fiona Godlee includes a link to a piece about the UK government’s announcement that all adults aged 40-75 are to be offered regular free health checks. ‘On the face of it this sounds like a good and generous plan’ she says, but points to the article by Felicity Goodyear-Smith who asks ‘do benefits outweigh harms, do false negatives lead to inappropriate reassurance, or do false positives lead to over-investigation and over-intervention?’ (doi:10.1136/bmj.f4788. http://www.bmj.com/content/347/bmj.f4788).

Fiona Godlee also flags up an article by Ray Moynihan, part of the bmj series on overdiagnosis, in which he, along with colleagues, explain that although large numbers of people (14% of all adults) are now labelled as having chronic kidney disease, ‘the low rate of total kidney failure suggests that many of those diagnosed will never develop symptoms’. Similarly, many women diagnosed and treated for breast cancer would never have developed symptoms. (doi:10.1136/bmj.f4298. http://www.bmj.com/content/347/bmj.f4298). The authors suggest a need for ‘clinical scepticism’ about the current definition of chronic kidney disease
and ‘caution in labelling patients, especially older people’.

We certainly have enough recent research showing the harms of breast cancer screening and researched harms of other interventions are detailed in GP, Dr Margaret McCartney’s eye-opening book, ‘The Patient Paradox – why sexed-up medicine is bad for your health’. People want to trust their doctors and most will probably see only benefit from these free health checks, when the reverse is likely to be true. Why don’t more doctors speak out about these interventions – even if they do bring them more money? (See my previous post). In the case of medical interventions, ‘free’ is not likely to mean ‘without cost’.

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About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
This entry was posted in Campaigns, Compassion in healthcare, patient safety, Screening, Screening Mammography and tagged , , , , , , , , . Bookmark the permalink.

4 Responses to Overdiagnosis – time to treat free health checks and screening with greater caution? All that glisters is not gold? And why don’t more doctors speak out about the high levels of these proven and potential patient harms

  1. Moira Adams says:

    It’s not possible to access the editorial mentioned in the article without a subscription to the BMJ.

    M

    pink_lady.jpgMoira Adams

    Trustee

    Challenge Breast Cancer Scotland

    P O Box 26191

    Dunfermline KY11 3YG

    t: 0131 623 0037 m:07955 170284

    http://www.challengebreastcancerscotland.org

  2. Ernie Berry says:

    I have to admit to despair in evaluating care in the NHS. Clinicians in Primary Care have no understanding of the ‘patient in front of them’ and constantly seek to reassure themselves of their diagnostic skills by instituting a barrage of tests and Consultant referals. They see danger where there is likely to be none and subject the poor patient to (often) dangerous and certainly frightening ordeals that take huge amounts of time and resources that could well be used to treat really sick people.

    My lovely partner has suffered from a simple, well documented ‘black tongue’ phenomena that is, it seems, benign, annoying, even uncomfortable at times. But the GP decided to simultaneously prescribe a cephalosporin antibacterial and a diazole antifungal. This of course a counterproductive protocol as there is bound to be some loss of inherent flora due the former and repression of any candida from the latter, thus leaving her precisely where she began. As this was indeed the outcome, the GP then decided a referal to maxilofacial Consultant was needed. A month passed and this appointment was fulfilled but the Consultant was away on a ‘jolly’ so the Junior and then senior Registrar was seen after some two hours of waiting. Another barrage of tests, most of which had been done a month earlier including CBC, FBC and two swabs for analysis were ordered.

    Sent away for three more weeks with a promise of seeing the ‘great man’ himself and some what ‘home spun’ advice such as salt water mouthwash and increased dental hygiene and (would you believe it) consideration of the use of amptriptyline (a tricyclic anti depressant) as an analgesic.

    The appointment came and after nearly three hours we didn’t see him, just the same Registrar who had …well nothing different to say. All the results came back as normal and there was no Candida present, but no tests for any other fungi, because you have to tell the lab what you’re looking for, doh! The same advice given, and the antidepressant pitched once more, elicited a response from me based upon some real science that frankly went straight over the head of said Registrar, so we left. My partner distressed, angry and frankly bewildered as to why all of this could not have been undertaken in Primary Care and of course more swiftly.

    Although this is not likely to be life threatening, it is distressing and both she and I were hoping for much better. Vast amounts of our time, lab time, GP and Clinic costs, have been expended at a time when resources are under pressure, for a result that I, in my grumpy old biochemist guise, could almost have predicted from day one. And as for taking a tricyclic as a relief for soreness of the mouth; well the mind boggles.

    I’m pretty sick of the NHS and its lack of competence, its constant seeking of things to measure, treat, invent even, to keep us within it’s grasp. I my youth, we found all of the great things that allowed dying people to rise from their deathbed, like effective vaccines and antibacterials. Now most of that done is for the heart attack we haven’t had, the cancer we haven’t got and the borderline diabetes we got because we’re eating vast amounts of the wrong foods, ‘they’ tell us we can’t live without.

    Just popping off to see the local ‘witch doctor’; can’t be any worse than the GP.

    • bmitzi says:

      I think anyone could be forgiven for concluding that lack of access and abysmal standards, funding cuts and cuts and cuts, lower and lower and lower staffing levels (and no doubt staff morale) is a deliberate path towards NHS privatisation. It will probably get to the point where everyone will agree something has to change and that will be the tipping point. I’m so fortunate to be in touch with caring and competent doctors and others who give me the balance I need – and I feel for them. What must it be like to work in such an organisation? It is hard enough to receive criticism, but to be criticised when working in a caring profession, and with increasing difficulties, must be doubly hard. I think we all, patients and professionals, are suffering.

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