On The Guardian’s website in the UK, Dr. Margaret McCartney makes a clear, compelling case for balance in public information about screening in a piece entitled, “Patients deserve the truth: health screening can do more harm than good.” And she charges that the British National Health Service “fails to inform patients that health screening often leads to unnecessary and risky treatments.”
“It is this failure of communication that has led several prominent UK doctors to say publicly that they have chosen not to have breast cancer screening, including Fiona Godlee, the editor of the BMJ, Iona Heath, a London GP and former president of the Royal College of GPs, and Susan Bewley, professor of complex obstetrics at King’s College London. As Heath writes in the BMJ, “My worry is that I have made my decision on the basis of information that is not readily available to my patients.”
patients may not know if their screening test has caused them harm. This leads to the “popularity paradox” where a bad screening test creates many false positives, and much unnecessary treatment, but people end up feeling that they “owe their life” to screening when, in reality, they have been subjected to unnecessary treatments – and the resultant risks.
It is precisely because screening is a mixed bag of benefit and harm that no one should impose their own values onto another person. Yet at present, NHS screening programmes are judged by how many people attend, and not by how many people make an informed choice to attend – or not. Similarly, GPs are paid according to how many screenings are done, not by how well informed their patients are.
In addition, patients are often misled into thinking that invitations to NHS screening come from their trusted GP rather than where they actually come from – a central NHS Screening office. Apparently this increases uptake.
We need a debate about the cost-effectiveness of our screening sacred cows, but we also need a debate about how to give autonomous adults fair information about screening that respects their right to decline. Until patients are given unbiased information – including that screening can maim as well as help – we will continue to fall short of the ideal of patient consent, “no decision about me – without me.”
McCartney is a leading voice for rational, balanced discussion of screening tests and the tradeoffs involved therein. I’ve written about her work in the past:
Before the week is over, I’ll have two more articles on imbalanced screening test promotions.
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