….providers range from ‘well-meaning to cynically preying on people’s health anxieties for financial gain’. Unauthorised programmes may cause ‘significant harm’
London GP and RCGP overdiagnosis group chair Dr David Spitzer
I was inspired to write this post after reading an article in “Pulse”, a widely read publication for doctors. The article was entitled “Screening by the back door”. Written by medical journalist Emma Wilkinson (@Emmajourno). The availability and accessibility of a wide range of screening tests to diagnose disease or predict future disease risks has the potential to massively increase our health. Government backed screening programmes are run only after significant time and expertise has been invested to ensure they are fit for purpose and have a significant impact on the health of the UK population. Strong value for money and “risk benefit” calculations are a big part of the government’s assessment.
Private screening tests
There remain plenty of other screening scenarios where there are still significant benefits to the appropriate patients but where for various reasons (often financial) the screening tests cannot be done on the NHS. So therein lies the case for private screening. With a rapidly increasing breadth of tests becoming available claiming they can detect/predict a wide range of conditions why shouldn’t people part with their hard earned cash in return for peace of mind? As with many things in life the answer is “it depends”, and on what it depends begins with being well informed about the appropriateness of the test/s for you….
Appropriate screening
Appropriate screening, defined as the appropriate test/s performed only on patients that fit the criteria for which the screening test was designed can be highly beneficial. Combine good screening tests with interpretation from a doctor who has a good knowledge of the individual patient and you have the basis for tests that can prove valuable and in more extreme cases life saving. Particularly for patients with good reasons to fear a certain disease (eg family history) to be tested and know more about their likelihood to be affected by a given disease can be invaluable in making decisions about their health.
The dangers of screening tests
A poor screening test can throw up lots of false positives (in statistical parlance this means they lack sensitivity), which results in a lot of “worried well” people who not only may suffer emotional harm from worries generate but may also go on to have further tests. Alternatively they may lack sensitivity and so fail to flag up disease risks and leave a patient incorrectly reassured they are OK. (For a fun explanation about sensitivity and specificity try this video.) You might be sitting there thinking well surely if the tests are good enough surely they will be 100% sensitive and 100% specific but the reality is this is a never possible!
Both the above scenarios are an “everybody loses” situation where less scrupulous testing organisations bounce the now terrified patient back to the over stretched NHS or, possibly worse, recommend further private tests and investigations. In the second case patients don’t take precautions or make lifestyle adjustments that could improve their health and or life expectancy because “the test said I was OK”!
To be tested or not to be tested, that is the question…..
I recommend the following four step guide to be able to make an informed decision about whether you wish to be screened for a given medical conditions/s
1 – Do your homework. Find out about the test, there’s lots of peer reviewed material out there published by governments and independent institutions.
2 – Is the same test available to you on the NHS? There is a very informative page on the NHS website here.
3 – Ask questions of any service provider about WHY is this test/s appropriate for YOU? WHAT does the test actually test for? How sensitive are the tests? How specific are the tests?
4 – Consider carefully before buying any test kits, scans etc that are offered with no or limited consultation with a doctor.
Here at OxMed Private General Practice we set our fee structure so that we make no income from commissioning tests. All tests can only be requested by one of our experienced GPs after they have listened carefully to your concerns and are confident you are able to make well informed decisions about what tests you would like.
If you want to discuss screening tests, we offer a wide range of individual tests and wellness packages. We are always happy to respond to any enquiries with no obligation to proceed.
OxMed Private General Practice 