Health screening - is it worth it?
I once sat down to start an expensive private health check with a city executive and he asked me a question that has lingered at every one I’ve done since. “Look doc”, he said, “The company are paying for this so I don’t care what the answer is here, tell me honestly, with this range of tests are you actually going to find anything out?”
The easy answer was that I didn’t know, but it was possible. However I elaborated for him along these lines: it is very possible to find out lots of highly valuable health data with a variety of tests, but in my opinion the vast majority of health screens offered are unlikely to pick up anything surprising or insightful. Therefore in most cases the answer to my title above is, I believe, “probably not.”
The vast majority of people could compile relatively accurate lists of healthy behaviours, unhealthy behaviours, make a few deductions from their personal medical history and family history and come up with a good idea of whether they were healthy or not. A health screen needs to achieve more than you could on your own.
To be useful a health check needs to achieve two things:
Identify changes you can make to reduce your risk of developing diseases (particularly the biggest killer, heart disease, but also things like dementia).
Identify as early as possible disease that are more treatable at an early stage, like cancer.
The NHS does this to some extent with health checks and cancer screening. Some years ago there was a push for ‘over 40 health checks’ in the NHS (on which many of the current privately available checks are based). Obvious questions about smoking, alcohol, weight, and some simple blood tests were well-intended public health measures. When you roll out small improvements across a whole population of course the sum of the difference you make is quite large (and the savings for treating disease can also be large). However as an individual you really want to know that YOU are the one that is going to benefit. Few people discovered anything they didn’t already know or suspect.
Most people are aware that the NHS offers cancer screening tests. Programmes are well established for cervical, breast, bowel cancer; they haven’t changed much over the years, although they have saved huge numbers of lives.
The NHS offers advice on private screening, which in a nutshell says “be careful and don’t get fleeced”. I am completely on board with this sentiment. When I set up Lisle Medical I considered not offering health screens because they often lack value. However that is a weakness of the process because there are now tests available that very effectively achieve the two main aims outlined above. With my city executive patient’s question in mind I sought a way to add real value.
When my father in law died of cancer last year 7 weeks after diagnosis and 3 months since being one of the fittest 76 year olds I’d ever met I had an overwhelming sense that I had let him down by not detecting this for him. Of course I couldn’t have known that the man stacking logs outside my house was about to get a cancer of vanishingly rare levels of aggression, but the experience brought back a sense of injustice about screening tests and made me wonder if there was some form of health screen that would have helped. In compiling a screening report recently I decided it was time to change the offer.
This is what Lisle Medical wants to offer: we cannot stop your demise in a freak yachting accident, and nor can we predict the hideousness of every rare and fatal disease out there, but when you come for a health check you want the doctor’s best possible efforts at prolonging your life, and hopefully making most of that a healthy existence.
Atherosclerotic heart disease (the cause of most heart attacks and strokes) is ubiquitous if you live long enough but can be identified before it causes symptoms and minimised with various interventions.
Cancer affects a third of us but is treatable if you catch it early enough and is now detectable with groundbreaking new tests which boast very high levels of accuracy and sensitivity (read about the Trucheck Intelli test).
Neurodegenerative disease (particularly dementia) is a major feature of ageing in the modern world and a great fear of many, but we can work to minimise factors which might increase your risk.
Muscle loss and bone weakening happens if we’re not doing the right type of exercise and places us at risk of simple fractures in older age with awful mortality statistics attached to them.
The cumulative effect of poor sleep is a greater risk of the major diseases mentioned above.
I could go on. We know more and more about the factors that we can modify to prevent the diseases of old age and the evidence is constantly emerging. Lisle Medical has the luxury of agility in reacting to this evidence, of being able to offer the latest and best tests we feel are of most benefit to you and leave you to do the cost benefit analysis. I have carefully considered the major health threats we face, current best evidence, and the usefulness of the available tests and am redesigning packages of real value to your health from which you can choose. I will remain engaged with the latest evidence to ensure you are not being fleeced, and as the evidence changes so will the offer.
Returning to the man who triggered this thinking, we did the tests, he was moderately healthy and nothing was revealed, as expected. I hope he’s reading this and I’d be very pleased to revisit his health check now!
