Have you ever received one of those compelling invitations from a private health provider inviting you to have a ‘Health MOT’ or ‘Health Check”? Was the attraction of an ‘official’ clean bill of health enough to persuade you to sign up immediately? Retireista and retired GP Rick Crooks was quietly enjoying his morning cuppa with the newspapers when such an invitation popped through his letterbox. It claimed to offer checks not available from his GP or, indeed, the NHS. And all for just £129. He sighed, folded his paper and turned his attention to weighing up the pros and cons of the offer.
In return for 30 minutes of his time, the invitation proposed to provide:
- A body composition analysis
- An ECG [Electrocardiogram]
- Blood pressure measurement
- Measurement of peripheral arterial blood flow
- A 25 component blood analysis
Sounds impressive. But as a retired (and rather cynical) GP, Rick was concerned that there was no mention of the tests involving a general physical examination by a health professional or a review of his full medical history. Taken in isolation without this fundamental information, he wasn’t convinced that the invitation was worth following up…
Rick’s Story …
Putting aside my concerns about how the providers had secured enough personal information about me to send such targeted direct mail to my home address, the main question I had to ask myself was, is such screening worthwhile?
It’s common knowledge that private screening tests are becoming increasingly popular. The premise that early detection and treatment of various conditions can lead to life lengthening or even life saving results is rife. After all, we’re all keen to stay as healthy as we can. Regular medical check-ups are up there with regular exercise and a balanced diet.
But you don’t have to delve too deeply into Google to learn that private health screening also has the potential to cause harm. This might arise from over diagnosis, over-treatment or even undue anxiety. Apparently, it’s all too easy to be wrongly identified as having a condition due to an inaccurate test. Or you could be treated for a condition that you do have, but would never have caused you any harm in your lifetime.
Then, of course, there’s also the cost to consider.
Pulse, the website and magazine dedicated to serving and informing GPs, believes private health screening is creating an excessive volume of work for GPs and risking harm to patients; the UK National Screening Committee that evaluates screening tests for the government, is worried about the way these tests are being sold; and the British Medical Association is calling for tighter regulation of private screening practices. So what are we to do?
Let’s first take a look at what screening is actually about …
What is screening?
Screening, according to the Oxford English Dictionary, may be defined as ‘a system of checking for the presence or absence of a disease, ability or attribute’. Medical screening uses a series of criteria to identify the value of a procedure. These criteria were first determined in 1968 and have since been reviewed and updated – most recently by the UK National Screening Committee.
In summary, the basic principles are:
- The condition being screened for should be an important problem
- The nature and progression of the condition should be well understood
- There should be an early detectable stage
- Treatment at an early stage should be more beneficial than at a later stage
- A suitable test exists
- Such a test should be acceptable to those being screened
- Intervals for repeating the test should be determined
- The health service should be able to cope with any additional workload resulting from screening
- The risks both physical and psychological should be less than the benefits
- The costs should be balanced against the benefits
One important principle not mentioned in this list – and excluded from my not-to-be-ignored invitation – is to view the person screened as an individual and to review that person as a whole.
Getting the whole picture
Identifying key facts about the individual in the form of a medical history is crucially important. It allows test results to be more accurately interpreted. A physical examination will add even more clarity to that interpretation. Such process allows any tests to be targeted to an individual. Without this piece of the jigsaw, it could be argued that my bargain Health MOT might be based on incomplete information.
It is also important to be aware that one individual measurement may not always be indicative of a problem. For example, a single isolated blood pressure reading may be erroneous for many reasons. An anxious and poorly relaxed individual, poor equipment calibration or observer error, are just some of the possible reasons for this.
Common screening tests
A quick look at some of the most widely offered tests clearly demonstrates how easy it might be to receive an inaccurate result if performed without reference to the ‘bigger picture’ of the individual’s specific medical history and overall state of health:
- PSA testing as an indicator for prostate cancer. The UK National Screening Committee has actually ruled out the PSA test as being too unreliable. It suggests that the potential harm caused by treating men who incorrectly test positive outweigh the benefits.
- Electrocardiographs (ECGs), carried out as part of a general heart health check and to identify the possible presence of arrhythmia or atrial fibrillation in older people, have similarly been deemed inappropriate. The reason given for this is that the potential harm is thought to outweigh the benefits.
- CT / MRI Scans. These are often carried out as part of a full health MOT. They carry with them a risk of radiation exposure. There is also the possibility of the detection of benign growths that are unlikely to cause problems but could lead to the need for further investigation and even unnecessary intervention.
- Cholesterol tests,. These are only effective when viewed in the context of a person’s overall predicted cardiovascular risk.
- Calcium testing, which is often included as a way of checking ‘bone bio-chemistry’ or ‘bone and muscle function’. The NHS will only order this for diagnostic and monitoring purposes and a finding of raised levels can be spurious when taken out of context.
8 screening tests that could save your life
It’s important to know that I’m not trying to stop you looking after your body. Far from it. I’m just suggesting that private health screening might not necessarily be the best way forward. Age UK, for example, recommends a checklist of 8 health tests – all available on the NHS – that could save your life:
- General health check (aimed at determining whether or not you are at risk from key health problems such as heart disease, diabetes, kidney disease or stroke)
- Bowel cancer screening
- Cervical screening
- Cholesterol tests
- Blood pressure tests
- Breast screening
- Skin checks
Of course, you might prefer the private sector. And that’s fine too. All I’m saying is, be informed before making a decision either way.
Weighing up the pros and cons
So the question remains – would my £129 have been money well spent?
Inevitably, the answer has to be yes and no.
On the one hand, it may have given me some psychological reassurance and enhance my feeling of well-being (assuming it gave me a clean bill of health, of course). But on the other, given my age (north of 65) and pre-existing heart condition, it may well have identified abnormalities that would have required further interpretation by a medical professional and almost certainly the repetition of some of the tests.
There are always two sides to every argument and as a final word it’s worth pointing out that a few years ago I actually did attend a screening similar to that suggested by my now much maligned invitation. The tests failed to identify any abnormality whatsoever, so it came as an enormous shock to find myself undergoing urgent open-heart surgery just a couple of weeks later.
Fortunately, all is now well and I’m still here to tell the tale. Think I’ll get back to my newspaper …