Friday, June 18, 2010

How a health checkup can be bad for your health

We all know that prevention is better than cure, and this is one of the reasons that executive health checkups have become so popular. They promise to help your doctor to pickup medical problems early , so they can be treated more effectively.

Unfortunately, even though the logic is very appealing, the sad truth is that in real life, health checkups are good for hospitals and diagnostic centers, but not for patients ! In fact, most doctors never do a health checkup for themselves , because they know how useless they are !

So what is your doctor not telling you ?

Let's look at why hospitals promote health checkups so aggressively. The checkup is great way of converting well people into patients; and creates a constant stream of customers for the healthcare system.

How ?

It's a mathematical certainty that if you run a sufficient number of tests , you are bound to find abnormalities. Once you find an abnormality, then the person is snared into the healthcare system, and the vicious cycle starts.

Abnormality = more tests = more consultations = more treatment - more surgery, often unnecessary

Let's consider a 40 year old asymptomatic woman who goes for a deluxe super-duper health checkup at a local 5-star hospital. Because she has opted for the Platinum scheme, the doctors does a vaginal ultrasound scan to check her uterus. She finds a 4 cm fibroid and then advises the patient to undergo surgery to remove it. Since most patients are ( understandably !) reluctant to undergo surgery, the soft-sell is that this is going to be " minimally invasive" surgery done through a laparoscope, so that there is no cut and this can be done on a day-care basis. Also, the insurance will pick up the tab !

It's very common to do this for ovarian cysts as well. Cysts are very common in women; and most are functional and will resolve on their own. However , the doctor scares the patient into doing surgery, using a number of fear-inducing techniques, such as : it may increase in size; it
may burst; or, it may become cancerous. The sonographer is also a part of this scam, and magnifies the findings by highlighting them and by reporting the size in mm, instead of cm ( a 4 cm cyst is reported as a 40 mm cyst , to make it seem bigger !)

The truth is that you cannot make an asymptomatic patient happier - and if she has no complaints to start with, she most probably does not need any intervention at all ! The right advise would be masterly inactivity. However, few doctors have the maturity to advise this.

In fact, they tell the patient that thanks to this checkup, they have picked up a problem which could have snow-balled in the future. The amazing thing is that patients are happy when an abnormality is picked up ( they can justify the money they spent on the health checkup !). Most patients are very pleased that the problem was spotted before it became a major issue.

The truth is that most of these so-called abnormalities are not really problems at all - they are just incidental red herrings discovered with modern medical technology, which the patient would have happily carried to her grave if she had been unaware of them.

All this overtesting is leading to an epidemic of overtreatment. Is this going to change ?

No - it will just become worse as time goes by. Thanks to better technology , it's becoming easier and cheaper to produce high quality images of practically any nook and corner of the human body. However, better pictures does not equal better clinical outcome. A lot of these images will pickup problems, which are just anatomical variants, but which will be "treated" by over-enthusiastic doctors. There is too much money at stake !

Also, remember that if an "abnormality" is detected, it requires a very courageous doctor to advise against treating it with surgery ! In reality, it's s much easier for the doctor to advise surgery and "fix" the problem. After all, if he does the surgery, no one will object ( whether the surgery was needed or not is never discussed). Find a problem - fix the problem, is a common knee jerk response. It's also much more profitable for him !

However , if he advises against surgery and the problem worsens over time ( as it will in a very small minority of patients), the patient is quite likely to sue the doctor for not taking care of it when it was first pointed out ! Even good doctors will advise surgery to protect themselves, even when they know in their heart of hearts that this surgery is not in the patient's best interests !

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  1. Sudhir S.7:16 PM

    Hi Doctor,
    Interesting blog..i completely agree with your thought process of unnecessary investigation chasing. However, here we are beating the "Health Check-up" when the actual culprit is the "physician" who is providing the incorrect advice. It’s like penalising the "the murderous Knife” when the real “murderer” goes scot-free. It is like saying that all yearly car services are meant for garage’s profit & hence, should not be done. That would be inappropriate.
    We, patients, need to improve our health awareness levels & get ourselves acquainted with common health issues so that no doctor can invoke fear of death in us & take us for ride. I have seen health check-ups working too (just last week, one of my friend’s Father-In-Law (62 Years) went for a Health Check-up, had negative Trade Mill Test report, went in for Angiography, found multiple blocks which ever evaluated by two Cardiologists & then surgery was decided for.
    Improving our health knowledge & identifying right doctor (I don’t know how) are the solutions than just dropping the Health Check-up.

  2. Dear Sudhir,

    I am sorry, but why do you think the health checkup "worked" for your father in law ? Bypass surgery has never been proven to improve life expectancy at all ! It's useful only in a small group of men with ischemic heart disease ( for example, those with significant left main coronary artery disease). "Treating " a blockage seen on an angiogram by "surgically bypassing" it is gross overtreatment ! I do not think your father in law received good quality medical care - and I fully agree that being a better informed patient would have prevented this unnecessary surgical intervention !


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