“Setting an example?” – BMA news article on screening misses the point.

I wish I could link to this article, which is published as a feature in BMA News, a supplement that comes with the BMJ.

It’s worrying. “Professor (Erica) Frank, research chair in preventative medicine and population health at the University of British Columbia in Vancouver, Canada, has spent more than 20 years examining the relationship between doctors’ own health-related behaviours and those of their patients. ‘In population after population- in fact, every place we have looked – we have found that if physicians do it personally, they talk to their patients about it…..Professor Franks found that among female patients whose doctors were eligible for regular mammograms and chose to attend for screening, 74.5% took up the offer of breast cancer checks. Among those whose doctors were eligible but did not attend for screening, the proportion was 70.5%. Similarly, 45.5%of patients eligible for colorectal cancer checks went for screening if their doctor did the same, while among those whose doctors were invited but did not attend, the proportion was 41.6%. Even more startling was the fact that among patients whose doctors took up the offer of a regular mammogram, 46.1% attended for colorectal cancer screening, compared with 40.1% of those whose doctors did not undergo breast cancer checks – a proportionate rise in take up of 15%.”

I’m too disheartened to type any more. Franks thinks that doctors should be offered special inducements to get health screening as a way of increasing take up in the population.

The premise  is flawed. Doctors are not superhuman, and should not be held up as vitrous examples of how to live a perfectly healthy life. More importantly, if doctors decide not to have medical screenings, they may have just decided that, in view of the false positives and false negatives involved, a limited potential benefit and in terms of harm, that they JUST DON’T WANT TO HAVE IT. They may also have decided that withholding fair evidence about the pros and cons of screening tests is unethical, and they may have shared these with their patients, and their patients may have decided that they don’t want screening either. Patients may also be choosing for themselves the kind of doctor who will help them make good evidence based choices, in keeping with their own priorities.

The idea that more screening is good and less is bad is unhelpful and wrong. Academics that use this as a starting point for research don’t help patients make better decisions.

One Response to ““Setting an example?” – BMA news article on screening misses the point.”

  1. Martin Budden April 18, 2011 at 7:17 am #

    “Doctors are not superhuman, and should not be held up as vitrous examples of how to live a perfectly healthy life.”

    I remember years ago, I had just signed up with a new GP and went for my first visit (for a minor complaint). I was sitting in the waiting room and a woman in her late fifties made her way through the room. She was grossly overweight, was walking very slowly, with some degree of difficulty, and was wheezing with every step she took. I remember thinking “poor woman”. Five or ten minutes later I was called in for my appointment. The woman I had just seen in the waiting room was my new GP.