Ethical issues related to health checksBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4787 (Published 30 July 2014) Cite this as: BMJ 2014;349:g4787
- Dee Mangin, David Braley Nancy Gordon chair in family medicine1
It is not just the lack of benefit or the harm to patients—who are frightened by their “high risk” and will never think of themselves as healthy again.
It is the waste of resources as governments encourage, and sometimes pay, clinicians to screen healthy patients for cardiovascular risk, producing tonnes of paper with guidelines, recommendations, and rainbow coloured risk charts.
It is also the harm to health systems, many of which struggle with service sustainability and rising costs. With the mounting pressure and strain on primary care services and providers, the opportunity costs of spending time on checks with no evidence of benefits and potential for harm creates an issue of distributive justice. Although largely overlooked in the summaries that underpinned recommendations on risk assessment, primary care studies of cardiovascular risk screening have shown the enormous resource requirements and lack of meaningful benefit to patients.3 4 5 These finite resources are then unavailable or available in a less timely way for patients who would benefit from medical care.
It seems futile to tackle the health outcomes of lifestyle issues that are linked to socioeconomic disparity and environmental constraints through individual clinical care. Adverse drug events are now leading causes of death in developed countries. Greater population health gains would probably come from attending to political and social drivers of poor health, as well as creating healthy environments and a regulatory and clinical environment that provides truthful, transparent information from trials and supports doctors and patients in truly assessing the medication risk-benefit balance. The therapeutic imperative in medicine means that we are good at rushing to do things that might “save lives” but not good at not doing, or undoing.
Cite this as: BMJ 2014;349:g4787
Competing interests: None declared.
Full response at: www.bmj.com/content/348/bmj.g3680/rr/701965.