How useful is a check-up
Medical screening
More and more people are willing to pay more than €1000 for a medical screening, even if there are no complaints at all. The question is what it will bring. And who will benefit from it.
You feel healthy. However, sometimes doubt sets in. Would it really be all right inside? After all, you get older one day. And you hear so much. From diseases that are discovered too late. An explosive growth of diabetes. That sporty man who suddenly dropped dead.
There is a good chance that you recognize yourself in this. The free kidney check from the Kidney Foundation to detect hidden kidney damage with a home test was requested by more than 275,000 people within a week. GPs are increasingly seeing people at their consultation hours who – even if they have no specific complaints – would like to be thoroughly examined. And Prescan, a company that brokers total body scans in Germany, sees the number of customers who readily pay €1400 to undergo a comprehensive screening is growing every year; already more than a thousand people a year.
The countless providers of medical check-ups like to make a comparison with the MOT for cars. Why would you have your car checked every year, but only go to a doctor if something is really wrong?
However, it is not that simple. The human body turns out to be a lot more complicated than a car. Moreover, it takes us quite a bit of effort to deal rationally with our own health.
A chance of 1 in 90,000
“We assess the risks and dangers surrounding our health very differently from other risks, such as a traffic accident, fire or crime,” says Tjeerd Tijmstra. He is a medical sociologist at the University Medical Center in Groningen and has been researching the psychological effects of health screening for more than twenty years.
“I once presented an imaginary situation to young mothers: a test is coming up that can detect a serious illness in two newborn children every year, which can then be treated well with medication. All newborn children would have to be hospitalized for 24 hours, for a chance of 1 in 90,000. Many mothers turned out to be willing to do so. They stuck with that when I said afterwards that the chance of an accident on the way to that recording is just as great. People don’t reason rationally when it comes to their health. What if it is your child who can detect that disease early?”
Unintended Consequences
The Dutch Association of General Practitioners (NHG), the scientific association of general practitioners, considers virtually any screening without a specific medical reason to be ‘undesirable’. And the Health Council, which advises the government, also mainly sees objections. Screening can have unintended consequences. People who lead an unhealthy life can see a good test result as a reason to continue living on the same footing. And it often gives a false sense of security. There is no single diagnostic method to recognize all syndromes in a body.
Someone can suddenly feel like a patient because of the outcome of an examination. For example, a man over 70 can have prostate cancer without knowing it. He doesn’t notice it and will probably never notice it because this form of cancer only grows slowly. A ‘accidental’ discovery of this cancer during a screening can then cause a lot of unnecessary unrest. Who still manages not to feel like a patient? And what if something is found for which no treatment is possible?
A Rotterdam study has shown that people over the age of 60 with a certain brain abnormality that can be seen via an MRI scan, developed dementia more often than others. Most people, eight out of nine, didn’t get it. But without an effective therapy, the question is what the health gain is if you get tested for this.
At the corner of the street
These objections are shared by many doctors. Nevertheless, general practitioners deal differently with patients who come to them without complaints for an extensive examination. General practitioner Cees Meijer from Voorschoten is one of the doctors who will listen to patients if they ask for a thorough examination.
“There is increasing attention for healthy eating, plenty of exercise and the advance of chronic diseases,” he says. “Of course, more people will come to you with the question: how am I doing? I will not quickly refuse an examination, even if there is no immediate medical reason for it. If you want to be able to monitor someone’s health properly, it is also nice as a doctor to have measured values. As general practitioners, we are the linchpin of healthcare. I would be annoyed if my patients did not come to me for such examinations.”
According to him, nobody benefits from the current immense range of investigations on the corner of the street or scans for no reason. How do you still see the forest for the trees? That is precisely why he believes that a general practitioner should take these questions from patients seriously.
Warranty to the front door
Peter Aalstein, general practitioner in Capelle a/d IJssel, is firmly convinced that there is always something behind the request for an extensive examination without immediate complaints. For example, uncertainty, or fear because they have read something or because someone in the family has died of a serious illness.
Aalstein: “It has become a business to grab shoppers off the street for a free test for cholesterol, for example. For me it is crucial: in whose interest is it that something is done? Is it a need of the patient himself or is a need created? Sometimes I also make the comparison with a car. Then I ask people: ‘Do you also always think in a car: I could be killed halfway through?’ Oh no? Why then on the road of life?”
If you point out their insecurities to people, the tenor of the request changes, he notes. In addition, he cannot give more guarantee than to the front door: “Even a healthy athlete can suddenly fall down with a cardiac arrest. It is also possible that a check-up shows that someone is in good shape and therefore signals that you should go to the doctor are downplayed. Three months later, that person feels something and thinks: well, it must be nothing serious, I have just been approved.”
He is clearly not in favor of researching people without concrete complaints, but he will nevertheless assess per person what he does with such a request. “It is quite possible that I examine someone with psychological complaints extensively for reassurance. But if I really feel that someone wants a check-up for no reason, I give the phone number of a testing institute in the area because I don’t think they belong in health care. Then it is no longer about a patient, but about a consumer.”
Hypochondriac society
It seems to be an individual choice whether or not people want a check-up and how much money they are willing to pay for it. According to medical sociologist Tjeerd Tijmstra, this is too simplistic thinking and this topic directly touches on a much larger question: do we learn to deal with uncertain factors in life or are we moving towards a hypochondriac society? “We must stop thinking that we came to Earth with a rickety body. We know what to do and what not to do to get reasonably healthy somewhere between 80 and 90.
Of course there are people with bad luck, people with a hereditary predisposition. But it now seems as if we are suddenly dealing with an enormous number of disease threats. As we get older, our bodies deteriorate; there is a limit to what you can avoid. Two-thirds of people are dependent on long-term care at the end of life; it is an illusion that you can prevent that with screening.”
Sources):
- Plus Magazine