Category Archives: health screening

Men of action

Screen Shot 2016-03-08 at 22.08.41Doctors, writes Dalrymple,

are inclined to believe that doing something (especially when it is them doing it) is better than doing nothing. They mistake benevolent intentions for good results, believing that the first guarantee the second.

Besides, doing something

stimulates the economy.

Dalrymple comes across a paper by Danish researchers that

assesses the extent to which published reports of trials of screening procedures, such as mammography, colonoscopy, PSA testing, etc., note their harmful effects and consequences as well as their positive ones.

This is important ethically because

screening reverses the usual relationship between patient and healthcare system. In screening it is the healthcare system that initiates the contact, not the other way round. Screening is offered to healthy people, or at least to those complaining of nothing; moreover, the chances of benefit from screening are often slight, and those who benefit do so in a sense at the expense of those who are harmed.

Physician, absent thyself (from my inbox)

Screen Shot 2016-03-02 at 10.16.18Dalrymple writes:

I have always taken my health for granted, and believed that health is for enjoying rather than for worrying over.

He says that his doctor

keeps calling me (by computer) for various screening tests but, though — or because — I am a doctor myself, I never attend, even though the tests are free. Once you are in the clutches of doctors it is difficult to escape them and the statistical chances of such tests saving my life are minimal. There is enough to worry about — the wasps’ nests, the weasels in the roof, the dead tree that might fall across the track — without worrying over one’s health.

The case for masterly inactivity

Rectal biopsy forceps

Rectal biopsy forceps. ‘My doctor,’ says Dalrymple, ‘whom I have never met, sends me (or rather his computer sends me) repeated calls for screening. I don’t want to know whether or not I have a 10 per cent chance of a heart attack within the next 10 years.’ Dalrymple always respectfully declines screening offers from fellow physicians. For example, when receiving a colonoscopy invitation, ‘I always tell myself I am too busy just now, I will have it another time.’

Many screening procedures, writes Dalrymple,

are doubtful at best; some do more harm than good, by arousing anxiety or by promoting unnecessary surgery, as well as through more immediate side-effects. Increasingly, the patient is not so much ill as the bearer of risk factors for disease, whose statistical effect the doctor attempts to nullify.

Annual health checks may be

a waste of time—unless wasting time by occupying it is the whole object of the activity, in which case wasting time is not wasting time but using it gainfully. Gainfully, that is, to the person who wastes his time (the doctor) rather than has his time wasted for him (the patient). His time is well and truly wasted.

There is, says Dalrymple,

the assumption that doing something must be better than doing nothing. Doctors of the past, because there was so little they could in fact do, employed a technique known as masterly inactivity: they assumed an alert watchfulness, giving the patient the impression, which was false but reassuring, that they would do what had to be done in the event that anything untoward happened. Since most people got better anyway, this seemed to confirm the wisdom of the doctor.

But masterly inactivity

is no way to increase your fee for service or gain a reputation for technical mastery. Patients too prefer to think that they are doing something rather than nothing to preserve themselves. That is why some of them are not merely surprised, but aggrieved when illness strikes them: for they have done all that they were supposed to do to remain in good health, from eating broccoli to regular bowel biopsies.

PSA test? Thanks, but I’m too busy just now

I’ll have it another time.

So far, writes Dalrymple,

I have managed successfully to resist all attempts by my medical colleagues to measure my prostate specific antigen.

He desires

to have as little to do with doctors as possible, other than socially of course, and there is nothing quite like a high PSA level to provoke doctors’ interference in a man’s life.

It might be, he says, that

avoidance of a diagnosis of prostate cancer brings with it immense benefits from the point of view of quality of life: for if you are diagnosed with a cancer, however benign it is supposed to be, your anxiety is likely to be raised and you will be subjected to medical procedures that may be unpleasant or hazardous.

One paper estimates that

the sepsis or infection rate after biopsy of the prostate is 2-4 percent, so that if you have several such biopsies the cumulative chances of such sepsis must be high, at least if each biopsy is an independent variable for sepsis.

Dalrymple wants

desperately to have to do nothing for the sake of my health. I’ll wait for my symptoms to develop, then we’ll see.

A Midland medic warns

The pleasant market town of Bridgnorth, Shropshire

The pleasant market town of Bridgnorth, Shropshire

The onetime specialist at Birmingham City Hospital and at Her Majesty’s Prison, Winson Green, on cancer screening.

Dalrymple has a home in nearby Bridgnorth, Shropshire, though he lives much of the time in France with his French wife. He has explained that Bridgnorth is a zone of low crime except on Friday and Saturday nights, when young people converge on pubs and clubs in the town, ending up in the gutters hog-whimperingly drunk after rutting and brawling.

Mammographic musings

There is more rejoicing by malpractice lawyers over one false negative than over ninety-nine false positives.