Alarmed: Dr Martin Scurr was less-than-impressed with the treatment he received
your NHS GP when you are ill, says the letter from Bluecrest Health screening, ‘but you may also appreciate that many serious health conditions don’t show any warning signs’.
The letter continues by telling me about a Mrs Smith from Oxfordshire, who is ‘so grateful for the Bluecrest check — it picked up the fact that I’d had a heart attack without me knowing it. I’m now being treated to help me avoid another one’.
Like me, many of you might have received a similar mailing from Bluecrest, offering screening appointments in your area. These are typically held in hotels or conference centres. With over 1,700 such clinics across the UK, Bluecrest are one of a number of commercial organisations that market health screening.
For a basic screening (price £129), I was offered checks to assess my risk of heart disease and stroke, my liver and kidney function, energy, muscles and bones. I’d get a gout check, diabetes check, a full lipid profile (cholesterol etc) and a metabolism check.
If I took up the offer within 28 days, I’d have my body fat percentage measured for free, ditto height and weight, my ten-year heart disease risk and (because I’m over 50) lung function.
And for £70 extra, I’d get a full blood count. Bluecrest explained: ‘With blood disorders early detection is critical; many issues can be cured but treatment is required straight away.’
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I imagine that many people would think this was money very well spent. But is it?
When the NHS was created in 1948, there was little concept of health screening, ie checking to unearth previously undetected conditions — a sort of stitch in time saves nine approach.
Fast forward 30 years to when I started out as a GP trainee in Barnes, West London. By then we were conducting smear tests and looking at cholesterol levels, blood pressure and smoking history as risk factors in heart disease, but there was little appetite for NHS health screening as we, too, were under the cosh financially.
Yet even back in 1972, Sir Richard Bayliss, physician to the Queen and the consultant under whom I trained, published an article in the British Medical Journal questioning screening.
His view was that the most important information comes from the conversation with the doctor, when a patient’s medical history, their family history and lifestyle help identify the genuine risk factors. Anything else — blood tests, X-rays, physical examination — is secondary.
Sceptical: Back in 1972, Sir Richard Bayliss, physician to the Queen and the consultant under whom I trained, published an article in the British Medical Journal questioning screening
Even now, with technology such as MRI or CT scans, it is the conversation with the doctor that is important; and subsidiary to that, simple tests including weight, blood pressure and a physical examination.
So when I received my Bluecrest letter, my initial reaction was to ignore it — but I know some of my patients have received this mailing, or similar, and curiosity got the better of me, so I booked myself in.
The ‘clinic’ itself was in the basement of a seaside hotel in Lowestoft, Suffolk, the examination room a meeting room converted for the day with a few items of equipment, including a tray with blood taking kit and an electrocardiogram (ECG) machine to check heart activity. There were also scales similar to those you can buy on the High Street and a portable examination couch.
The technician conducting the check-up had worked in the ambulance service as a trained driver, and although utterly professional, it seemed he was working according to a script — and that meant straight into the tests.
Indeed, I was astonished that there was no interest in my medical history, which meant Bluecrest had no idea I’d been a kidney donor, that I had undergone abdominal surgery for intestinal blockage, that I had a history of sarcoidosis (an inflammatory disorder mainly involving the lungs), or that I’d undergone eye surgery three times in the past year.
This had implications for my tests. For instance, the steroids I took for a year could affect my blood sugar levels or blood pressure; the sarcoidosis caused 12kg weight loss (which affected my BMI, but more of that later).
Nor was I asked about my family history or my occupation, which might be relevant in terms of risk factors for future disease. The screening tests themselves, dressed up to look very grand in the printed material, were so lightweight it was embarrassing for me as a medical practitioner.
Not thorough: Dr Scurr was astonished that there was no interest in his medical history
I was asked to remove my shoes and socks (I volunteered to take off my jacket, heavy with phone, keys, wallet and diary) and my height and weight were measured.
Electrical contacts were placed under my feet to calculate my body fat percentage. Bluecrest states proudly that they give you a free body fat percentage, height, weight and BMI calculations, but anyone can do all this at home.
I then had to lie down and roll up a sleeve and trouser leg to have my blood pressure measured via cuffs applied to an arm and a leg — a pretty simplistic measure of the health of your arteries.
My heart rhythm was checked by attaching an electrode to each of my four limbs. In GP practices we use 12-lead ECGs, with six leads on the chest, so the Bluecrest version is a bit pathetic really.
Finally, a blood test was painlessly and efficiently obtained from my arm. I was excluded from the lung function test as the technician asked if there was any reason I shouldn’t blow hard into the tiny spirometer, and I explained I’d recently undergone eye surgery, so this test was postponed for six months. For an extra £49, I was offered a PSA blood test for prostate cancer which I declined.
As Good Health readers will know, it’s a controversial screening test because of the high risk of false positives; it can also lead to over-diagnosis and over-treatment. None of this was explained. And my view is that offering it requires careful counselling — well beyond this technician’s level of training I thought.
The screening took 30 minutes in all, and you’re meant to receive the full report of your results within 21 days. Mine arrived just one day short of the six-week mark — the kind of delay that might cause anxiety. (What could be amiss? Were Bluecrest obtaining further specialist opinions?)
The results themselves are presented with an introductory text about each, marked by a green, amber or red flag, followed by advice about what to do next.
The good news is that I don’t have gout, though I suspect I might have guessed this from the lack of symptoms. Also, I had no red flags (ie, results well outside the normal range). But I did have six amber flags that triggered recommendations either to see my GP or undergo a repeat test in six or 12 months.
Mass audience: Thousands are encouraged to buy into the private health screenings, which usually take place in packed conference centers
In fact, not one of those amber flags was worth a jot to an informed medical practitioner. All had to be seen in the context of my own history, weight and age — yet for the uninitiated, every one of those amber flags could be a reason for sleepless nights.
One of the ambers was for my kidney function, with abnormal levels of eGFR. My levels were between 60 to 80, denoting a mild reduction in kidney function — if I was a young adult, that is.
I called my colleague, a kidney specialist, who not only said my level was better than his, but that levels decline after the age of 60. He said a better test of kidney function is a urine test for protein — easy and cheap to do. So why no urine test in a Bluecrest screen?
Another amber was for heart rhythm. It seems I had ‘a slight abnormality’, a so-called right bundle branch block, and again I was recommended to see my GP. However, I’ve had that variation all my adult life, first noted when I was a medical student: so it is normal for me, not an abnormality.
Another amber was for my blood count, showing a platelet count (the blood cells that help clotting) at 148 thousand per cubic millimetre, just below the normal range of 150 to 400 thousand. Given that I am healthy, with no bleeding tendencies, no bruising and well in every respect, it can safely be ignored, like going 31 miles per hour in a 30 mile zone. Another example of how lab results must be compared with the patient’s history.
I had similar tiny increases in my total cholesterol and ‘bad’ LDL cholesterol levels: again not an issue in a man who is very lightweight with the blood pressure of an 18-year-old, but sufficient to gain another amber flag, so more for my GP to go through.
Another amber flag was raised for my total iron binding capacity — a measure of the iron-carrying proteins in the blood. It was minimally below normal, other tests showed my iron itself was normal.
More worry for the uninitiated, and another topic to take up GP time. My BMI was low, another amber flag but not surprising given my sarcoidosis. But the flag came with patronising advice about the need to maintain a healthy body weight. And to see my GP. Quite apart from whether health screening saves lives, it is beyond doubt a screen such as this will raise the workload for overburdened GPs and prove unsettling for the worried well. My view is that these lightweight check-ups are a waste of money.
The important thing to protect your health is to stick to the following: take regular cardiovascular exercise, eat at least five items of fruit or vegetables daily, cut back on salt and sugar, avoid smoking, and stick to alcohol intake guidelines. And if you have symptoms, see your GP. Simple.
A spokesman for Bluecrest said the service ‘is about long-term prevention of illness’. ‘Rather than creating unnecessary work for GPs, our work aims to help reduce the financial burden on the NHS in treating long-term chronic conditions such as diabetes.’
The company has recently taken steps to make recommendations more personal, he said, and has a 24-hour GP helpline for clients to discuss their results.
Article source: http://www.dailymail.co.uk/health/article-4597558/The-health-screen-rip-personal-MOTs-worth-it.html