Why you shouldn’t always opt for every medical test available

Dr Mercer Rang called it the Ulysses syndrome. Like the Greek hero, the patient embarks on a journey of investigation into their health, going on many adventures, a long round of endless examinations, referrals and treatments. At the end of it all they arrive back home and realise they’re no better off than when they started – just traumatised by the process.

The point is that not all tests are useful. There can be physical and psychological damage from testing that’s not appropriate. So we need to be wary of gimmicks. As a GP and a clinical public health consultant, I have to sigh when I’m presented with another set of test results that don’t mean a great deal. Any test, no matter how obviously beneficial it might seem on the surface, needs to meet some sensible criteria. It’s all about what works. Some tests will help with health and wellbeing and some just won’t. Don’t trust the offer of any test without proof, without evidence from research, and a solid case for using it.

A good example is the test for cholesterol levels. They’re well-established, with plenty of research evidence of the nature of cholesterol and what high levels mean for health. We also know we can do something about it over time and reduce cholesterol levels, meaning less risk of heart disease and strokes. It’s useful.

But some others can be a problem. Full body scans sound comprehensive, important. Evidence, however, suggests that the harm from exposure to radiation may well outweigh any benefits. Ten years ago it was estimated that the unregulated access of individuals to CT examinations of the chest in Australia was responsible for at least 40 fatal cancers per annum.

Instead it would be more appropriate to focus on specific scanning when there’s a need or particular concern and when the harm vs benefits balance evens up. For example recent research from the United States has shown that low dose CT scanning in individuals at heightened risk of developing lung cancer due to their age (over 55 years) and smoking history reduced death rates from lung cancer by 20%. Interestingly it is also important to be aware that the simple chest x-ray – that is still offered by some screening organisations – will miss over a 1/4 of lung cancers even in people with symptoms such as a persistent cough.

The carotid ultrasound is another case where a test looks sensible and valuable for reducing stroke risk – but, based on a comprehensive review of the evidence, the United States Preventative Task Force recommends against screening for asymptomatic carotid artery narrowing in the general adult population as it can lead to unnecessary concerns and risky treatments. Nothing can be more damaging to wellbeing than constant anxiety about health problems – particularly if they’re illusory. Research has shown that `labelling` people with health conditions doesn’t help.

No-one would accept undergoing a medical treatment without there being a solid basis of evidence for why. So before accepting the principle of offering any tests for employees as part of a wellbeing strategy, it’s essential to ask: show me the published research evidence.

 This is a guest article written by Dr Nick Summerton, GP and Medical Director, Bluecrest Health Screening

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