Back to Basics

Health Care

Dr Margaret McCartney in her book ‘ The Patient Paradox’ argues we should concentrate resources on people who are ill.

Over a decade ago, I read an article in the Independent which claimed that regular CT body scans were the way to stay well. At first glance, it sounded perfect – why wouldn’t you want to have preventative healthcare, spotting problems before you even knew about them? How clever, to want to pick up health problems at such an early stage – how could I object?

At that time, I had been reading up on the science of mammography screening. It was apparent that the messages women were getting from the health service – basically that turning up could save your life – wasn’t the whole truth. ‘Problems’ would get picked up when it was impossible to know whether the changes identified on the xray would lead to a harmful cancer. Because no one could be sure which were the problematic changes and which weren’t, all women were treated as though this could be harmful.
This creates over treatment – radiotherapy, chemotherapy and surgery being used when the woman could never benefit from it – because she was never going to die from breast cancer. But women weren’t getting told that this problem existed on such a wide scale. It’s estimated that for every 11 women picked up as having breast cancer at screening, only 1 actually benefits from treatment.

Similarly, cholesterol and blood pressure measurements in people who are well leads to treatment for people who won’t benefit from it- as does cervical, bowel and aortic aneurysm screening. The balance of risk versus harm is usually delicate. Yet people are advertised to as though there was no down side to consider. We are not often treated as individuals who have our own views on where the balance of risks lie. Yet for all the investment into screening as a public health tool, other effective forms of public health – like laws for a minimum price for alcohol in England, or plain tobacco packaging, or fair welfare benefit medical assessments – have been subject to political whim rather than a response to the evidence on them.

The ‘patient paradox’ I keep finding, as a GP, is that when people don’t need to be patients they are offered screenings which they are likely not to benefit from, and are turned into patients where they get side effects and risk overtreatment. Yet when we do actually need prompt attention, the wait for evidence based cognitive therapy for depression, for example, can be three or four months.

We need to get back to basics – prompt treatment for suffering, and fair information for screening. We should leave the well alone, protect them with evidence based public health law – and concentrate resources on people who are ill. Simple, but sadly, radical.

Dr Margaret McCartney is a Glasgow GP. The Patient Paradox – why sexed up medicine is bad for your health, is published by Pinter and Martin

From Healthier Scotland: the Journal