Results From Screening Tests Can Be High In Anxiety
For years I've had a patient who is a gym teacher. As you might expect, he's pretty fit. Well into his 60s, he can do an impressive number of pushups, as he demonstrated one morning in our exam room.
He surprised me in a different way at an appointment several months ago. He pulled out results from medical tests that he'd had done at his church. He and many of his fellow congregants had each paid about $150 for screening tests that they were told could see if they were at risk for strokes, clogged leg arteries and other problems.
He'd had an electrocardiogram, which measures the heart's electrical activity. He'd also had ultrasound tests performed on the big arteries in his body — the ones on both sides of his neck that feed the brain (the carotids) and the aorta, the largest blood vessel in the human body.
The man was in good health. He didn't smoke, wasn't overweight and exercised regularly. I wouldn't have ordered these tests for him. They come with a risk of false alarms. And in my patient's case, there were no medically compelling reasons for them.
He was disappointed when the tests showed "mild carotid artery disease" on one side of his neck. As someone who prided himself on his health and fitness, he was disturbed to learn that his results indicated that he was at risk for a stroke.
Though his report described the risk as mild, all that mattered to him were the words "disease" and "stroke." By the time he came to see me, I had to work pretty hard to calm him down.
My experience with this patient and others like him led to me look at the website for Life Line Screening, the company that performed his tests. There I found testimonials from customers who felt screening had saved their lives, or at least uncovered problems before they became life-threatening.
A disclaimer acknowledges "there is debate about the importance ... of screening for vascular disease in general." The statement concludes with an admonition to "always consult with your doctor," as we are the ones who "know you best."
My opinion was that my patient could have done without the tests. The U.S. Preventive Services Task Force, which is the most unbiased source of recommendations on preventive care, recommends against carotid screening in healthy people, too.
So what is the evidence for Life Line's approach?
Dr. Stephen Brunton, a family doctor who's an advisor to the company, says Life Line's research distinguishes it from competitors and provides a counterargument to critics. "Our standards are wider, based on the data we've collected," he told Shots. Life Line has screened more than 8 million people over two decades, and willingly shares their data with independent researchers who have performed multiple analyses. The company's conclusion: vascular disease is more prevalent than conventional medical opinion suggests.
But there's another issue.
Life Line also has relationships with some 150 hospital partners, who stand to benefit from referrals of anxious customers like my patient the gym teacher for further testing and treatment.
The company says there's no conflict. "No money changes hands in these relationships," said Joelle Reizes, the company's communications director. "We partner with hospitals to answer the criticism that we leave patients 'hanging' after we provide them results." If a screening customer doesn't have a primary care physician, then a hospital partner can help link to one through their network.
Still, relationships between hospitals and screening companies have come under scrutiny, as Public Citizen, a consumer advocacy group, has criticized hospitals partnering with HealthFair (a competitor of Life Line Screening). Public Citizen recently sent letters to 20 hospitals in eight states asking them to sever ties with HealthFair, citing the "widespread consensus among medical experts ... that community-wide cardiovascular health screening programs are unethical and are much more likely to do harm than good."
In my practice, I strive to achieve the best results for patients using the best available medical science. I also try to minimize harm. As we often say, each patient is different. Some of us want every morsel of information about ourselves, while others prefer to know only what's necessary, or likely to inspire action. In the case of my gym teacher-patient, less would clearly have been more.
John Henning Schumann is a primary care doctor in Tulsa, Okla., where he teaches at the University of Oklahoma School of Community Medicine. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital