In the BMJ Editor’s Choice this week, Fiona Godlee describes David Loxterkamp’s Essay which looks at the influence of computerised systems in healthcare and talks of the ‘shift in our gaze’ (away from things that matter to patients) to patients’ ‘physiology and chemistry and to our performance in managing it’.(doi:10.1136/bmj.f5539)
The time which used to be given to talking and listening to patients is now taken up with pressure to complete chronic disease flow charts and checklists of overdue prevention measures, yet we know that routine health checks do not reduce mortality or morbidity and he goes on to list other useless or harmful interventions.
He spells out a need to acknowledge the person beneath their symptom complex; to base their treatment plan on the best information; and to ask patients if their concerns have been heard and their needs met’. He concludes: “patients are not only data fields for the doctor to harvest, objects to be imaged, or problems to be solved. They are also our neighbours asking for help.”
Cite this as: BMJ 2013;347:f5817
Recently, I have been invited to breast screening as part of the NHS Age Extension Breast Screening Programme (but not told that acceptance would automatically enter me into a randomised controlled trial); invited to a GP surgery health check; invited to have a ‘flu jab; told by supermarket loudspeaker that I could have a free cholesterol check (there and then) – and reminded of this by notices on the back of said supermarket toilet doors.
The NHS Breast Screening Programme has at last brought out as new leaflet. As one of the Kings Health Partners’ Panel of Experts who were invited to participate in devising this new leaflet, I am disappointed that it compares so unfavourably with information about prostate cancer offered to men. They are not told it will ‘help them choose’ – I don’t need help – just give me honest information!
The level of harms of breast screening are not explained pictorially (as we had understood would be the case) – in fact they are not explained explicitly at all – but they continue to quote ‘1300 lives saved’ – with questionable justification – The Cochrane review says that one woman for every 2000 women avoids dying from breast cancer – but after 10 years of screening! Compare the NHS leaflet with the Nordic Cochrane Centre’s screening leaflet http://www.cochrane.dk.
And one in 1200 cancer ‘missed’ by screening mammography seems rare, until it is presented in different terms:
In the event, our panel of ‘experts’ – all of whom who had been speaking out and calling attention to the research showing lack of benefit and high levels of harm – had no input into the leaflet at all. (Some might think we had been nicely ‘silenced’ while the process continued.)
When the harms of breast screening from overdiagnosis and unnecessary treatments (including mastectomy and death) outnumber the benefits 3 to 1 (even at a conservative estimate – Marmot Report) it is surely time for a re-think about what doctors are asked to do (they did not sign up to harm patients) and about real openness, health checks and breast screening?
Should healthy populations be screened for breast cancer? A perspective from someone with previously diagnosed breast cancer. Qual. Prim Care.
Volume 21(3)2013 187-8
Blennerhassett M. An ethical dilemma or an opportunity for openness. Qual Prim Care. Volume 21(1) 2013 39-42.