Our health is precious, but do you really need the health test and medical treatment that can sometimes do more harm than good, says Dr Melanie Wynn-Jones
Is there too much testing?
The ideal health test is quick, cheap, reliable, convenient, doesn’t involve discomfort or risk and is unaffected by timing or other factors. But in reality, 5% of us fall outside the ‘normal range’ of any given test without necessarily being ill.
A health test may give conflicting or borderline results, or fail to detect disease in its early stages. And they can also trigger allergic reactions, accidentally damage us or slightly increase our cancer risk – radiation doses used in CT scans, for example.
NICE – the National Institute for Health and Care Excellence – recently told GPs to refer more people for a health test when symptoms could mean cancer. But hospitals don’t yet have enough equipment or people to do these quickly, and cancer symptoms don’t always tick the ‘right’ boxes.
Screening tests for people without symptoms, such as stool tests for bowel cancer and PSA blood tests for prostate cancer, can also miss some cases while wrongly detecting others. So make sure you report any symptoms, even if your result was negative.
Genetic testing could reveal worrying news or force you to face dilemmas such as should you have children or tell relatives. Will they want to know?
So we all – patients, doctors, NHS managers and politicians – face difficult choices. Do we take a health test whenever there’s a worry, despite the fact that surveys show that apparently healthy people may still notice several symptoms each week?
If we do test, some people will suffer adverse effects for no benefit, and waiting lists and costs may rise.
Questions to ask your GP
1. How safe is it to ignore this symptom? What’s the worst that could happen if I don’t have a health test now?
2. Are there any alternatives to try first (such as lifestyle changes) and for how long?
3. What does the test involve and what are the possible risks or downside?
4. What happens next if the result is positive or if it’s negative and/or my symptoms continue?
5. For screening tests, when will my next health test be due?
6. Is it worth paying for tests that are only available privately?
What about over-diagnosis?
British doctors recently expressed concern that over-diagnosis (where individuals are diagnosed with conditions that will never cause symptoms or death) can lead
to unnecessary or unpleasant treatment, increased anxiety, and/or wasted resources.
And the more tests we carry out, the more likely we are to detect ‘incidentalomas’
– symptomless conditions discovered accidentally during tests for other things. We don’t have enough research to tell us whether ignoring these could be dangerous.
For example, increased CT scanning has revealed that many people have unsuspected tiny lung nodules that don’t show up on ordinary chest X-rays. Current policy is to rescan periodically to see if they’re growing or changing; recent US research suggests this may be a safe way to decide which should be removed, but it will be years before we can be sure.
Diagnosing risk factors or conditions linked to serious diagnoses (such as pre-diabetes, where your blood-sugar levels are raised, increasing your risk of developing actual diabetes) may mean worrying about something that may never happen, but gives you the chance to take avoiding action.
However, not everyone wants this and a serious diagnosis could affect life or travel insurance, job prospects or relationships. Understanding just what your risk is isn’t always straightforward. For guidance, visit patient.co.uk and type ‘risk’ into the search bar for an explanation of ‘absolute’ and ‘relative’ risk.
Earlier diagnosis doesn’t always save lives either, and earlier knowledge that you
have something that can’t be successfully treated (such as dementia) doesn’t extend your life expectancy, it just extends the time spent living with the condition. However, it does give you longer to prepare and/or possibly benefit from new treatments.
Questions to ask your GP
1. How sure are you that I have this condition? Could it be anything else and would any more tests help?
2. What are the advantages or consequences of being diagnosed?
3. What could happen if I ignore it?
Do you need a health test or medical treatment?
We naturally want to feel better or be cured, preferably with minimal discomfort, rather than let nature take its course. Prescriptions have increased by 55% in the past decade, and many save lives or improve the quality of life. But by how much?
Research shows some of us would rather take a hypothetical pill for just a few weeks’ increase in life expectancy, while others wouldn’t – even for an extra 10 years.
Many of us feel pressured by media hype or loved ones to try anything and everything, but international researchers recently said that most people overestimate the likely benefits (and underestimate the likely harms) for many treatments and tests – more than half overestimated the number of breast-cancer deaths saved by screening.
Treatment can have a downside, too. Some drugs have disabling, sometimes fatal, side effects, while surgery may not be successful or may trigger blood clots, infection and other complications, even death.
A recent important change in the law on informed consent says we must be told about all available options, including their disadvantages (even if this might put us off).
Questions to ask your GP
1. What does this treatment involve – what are the possible risks or complications, and how common are they?
2. What are the alternatives available to me?
3. What will happen if I don’t have treatment or decide to postpone it?
4. Where can I find out more information?
So what should we do?
More care may not be better care. But there are still many uncertainties, and every case is different. Looking up symptoms on Google can help, but research shows symptom-checkers can get it wrong, so we should check with our doctors.
- Your doctor can help you access patient-decision aids to help you make choices about your care, and these have been shown to significantly improve our understanding about options.
- What we really need when we have a potential problem, is the best-available clear, unbiased and evidence-based information, and expert support to help us make more informed decisions and guide our own care.