The Last Word: on screening clinics

June 21, 2013 § Leave a comment

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-screening-clinics

“So, for $292, I can be up-to-date on how my body is functioning.” 

My patient – let’s call him Fortunato, a trusting character in a 19th-century horror story – had received an amazing offer: a personally addressed letter recommending a complete check-up at a screening clinic. It sounded too good to miss so he called the phone number. 

Fortunato said the first four tests would cost $199 but it was less than $100 more for another five. He figured this was a bargain. Perhaps even an Incredible, Once-In-A-Lifetime Bargain! 

Trapped like a roo in a spotlight — or an Italian nobleman in a catacomb — Fortunato supplied his credit card details over the phone. Research does actually suggest it will be easier to sell overpriced, unnecessary products to destitute pensioners than to rich doctors.  

The tests weren’t yet done when Fortunato told me his story, so I suggested he try to get his money back. I spoke my mind about the screening clinic but did not commit libel. Bad-mouthing is instead classified as slander. Slander is as serious as libel but hard to prove unless, say, the offender stupidly writes about it. 

Fortunato could recall little about what he’d just purchased but returned this week with the advertising letter. The outfit was called ‘Screen For Life’ — coincidentally, Edgar Allan Poe’s fictional Fortunato did indeed scream for life. From his initial description, I’d thought he’d booked a complete body CT. Instead, he was getting an incomplete body ultrasound.  

I felt partially responsible for Fortunato’s predicament because I’d been keeping his natural paranoia at bay with antipsychotics. Trust is the key to all relationships. Fortunato has paranoid schizophrenia — but trusted the company. I don’t — but didn’t. 

Apparently being trusting increases oxytocin levels and makes life worth living — although trusting nobody at least keeps your surprises pleasant. To paraphrase my favourite writer, Anon: “Trust God. The rest, virus scan.” 

One wonders, before taking payment, do Screen For Life telephone operators counsel patients on the complexities of false positives, false negatives, incidentalomas, over-diagnosis and iatrogenic harm? Perhaps information on population screening tests is provided from last month’s NPS Medicinewise News? And patients would presumably be asked what tests they’ve already had?  

As it happens, Fortunato sees GPs for more than just fortnightly antipsychotic injections and financial advice. He also has type 2 diabetes that necessitates regular monitoring of his cardiovascular risk factors. Fortunato had already had many of the tests booked at the screening clinic. And these had been bulk-billed at no cost to him. 

Fortunato ultimately cancelled his screening tests and, to the company’s credit, received a full refund. This news created the same pang of anxiety I feel when I so effectively explain the problems of PSA testing that patients don’t get it done. Would Screen For Life have discovered something important? Is Fortunato now the opposite, Sfortunato? 

I explained to Fortunato, as I do with many patients, that to negotiate life is to negotiate probabilities. Poor decisions can end well and sensible decisions can end badly but it’s best to keep the odds on your side.  

I therefore told Fortunato that he was right to cancel the tests. He is not wealthy and has better uses for his money, like food and rent. 

Another Italian, Niccolò Machiavelli, once said: “Wisdom consists in being able to distinguish among dangers and make a choice of the least harmful.” He could have made a great doctor.

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