This is an advert from this week’s BMJ. I am positively fuming about it.
Nuffield Health are responsible for some non evidence based practices via their ‘health assessments‘. These currently consist of annual mammograms for women over 40, annual cervical smears, pelvic (ie vaginal) examination, urine analysis, ‘hydration levels’ and a chest xray ‘if clinically indicated’.
In practice, this means that people show up to me – within the NHS – with a bundle of paperwork for interpretation and sorting out. (This is a fact, Nuffield.) Very often, people have been told to see their GP because some of their results are abnormal. Very often, said people are anxious and alarmed because their tests have been ‘abnormal’.
What Nuffield are offering are a raft of mainly non evidence based screening tests, some of which are intimate examinations. The NHS Screening portal contains information about which screening tests are recommended for use in the UK. The problem is that screening tests come with strings attached; harm is inevitable. Screening tests require to be properly validated before they can be recommended, and informed consent is required because of the risk of overdiagnosis, investigative harm and overtreatment screening can lead to.
It isn’t fair that the NHS has to sort out the non evidence based testing results. It isn’t fair that patients are often not aware that these tests are done out with national screening guidelines. Doctors should not be doing intimate examinations without evidence of benefit from them.
Nuffield have placed this advert which is looking for “health assessment doctors” who have “a warm heart that can feel what’s right” and who “understands preventative and evidence-based medicine”. I think this presents a contradiction. I don’t think the assessments Nuffield offer to do are evidence based, yet they want doctors who are.
If you apply for the job, do let me know what kinds of evidence they think their screening package is based on.