The message that prevention is better than cure has been drilled into us ever since we were children. This is one of the reasons that executive health checkups have become so popular. The promise is that they will help your doctor pickup medical problems early, so that these can be treated more effectively.
Unfortunately, even though the logic is very appealing, the sad truth is that health checkups are good only for doctors, testing centers and hospitals, but not for patients !
Let's look at why health checkups are being promoted so aggressively. The checkup is great way of converting well people into patients and for creating a constant stream of customers for the healthcare system.
It's a mathematical certainty that if you run a sufficient number of tests , you are bound to find abnormalities. The customer gets worried when the lab result is abnormal, and then hurries off to his doctor to get expert advice as to whether it is serious or not. This means that once you find an abnormality, the person is lured into the healthcare system, and the vicious cycle starts.
The equation is simple: Abnormality = more tests = more consultations = more treatment, much of which is unnecessary.
Let's consider a 40-year-old asymptomatic woman who goes for a deluxe super-duper health checkup at a local five-star hospital. Because she has opted for the Platinum scheme, the doctor does a vaginal ultrasound scan to check her ovaries. She may find a small ovarian cyst, which is when the games start. Ovarian cysts are very common in women and most 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 soft-sell is that this is done by "minimally invasive" surgery, so that there is no cut and can be done on a day-care basis. Also, the insurance will pick up the tab, so there are no financial damages!
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 advice 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 snowballed 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 do 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 then 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.
Marketing health checkups is very profitable for the new corporate lab chains, because they can sell this to all comers — they don't have to wait till someone falls in, which means the number of potential customers is huge! High volume business can be very attractive, because it keeps the machines humming.
The tragedy is that large compnaies are unwittingly compounding the problem by offering a mindless battery of tests for all their employees as part of their corporate wellness programs, without realising the harm they are doing.
Routine tests, such as electrocardiograms, chest X-rays and full blood screening, have been proven to provide little benefit for the healthy individual. This has been documented by the US Preventive Services Task Force.
Ironically, the "higher" the executive's post , the more the tests the Health Package offers (Diamond Packages provide 70 tests, versus Gold Packages which provide 40, for example), and this makes it more dangerous, because of the greater chance of finding some problem or the other! Unfortunately, in this patient population (healthy people who are undergoing tests for screening only), the vast majority of abnormalities are unlikely to be of any medical importance . They are called False Positives. However, the abnormal result is flagged and will create a lot of anxiety, and the doctor will then happily order further tests to try to determine the significance of the abnormal test result, often resulting in a Catch 22 situation, where a healthy person has been "converted" into a patient. "Welcome to my parlour, said the spider to the fly" would the best way of describing how the medical system seduces patients with the help of these health checkup schemes.
Now I am not saying that all screening is bad — it's just that it should be used intelligently and selectively. If we continue trying to use a one size fits all approach, we will end up in the sad situation where we are forced to treat a laboratory report rather than a person. While this may be good for the bottom lines of laboratory chains, it's bad for the poor patient and a lot of medical resources get wasted as a result of all this unnecessary testing.
Dr Aniruddha Malpani is a leading IVF specialist