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Views And Reviews Primary Colour

Helen Salisbury: Should I persuade patients to have mammograms?

BMJ 2019; 365 doi: (Published 03 April 2019) Cite this as: BMJ 2019;365:l1409

Rapid Response:

Re: Helen Salisbury: Should I persuade patients to have mammograms?

The short answer to the title question is “No! Definitely not.”

The setting of a GP/patient consultation is not the right place for a doctor to raise the question of screening, [1] an intervention that should surely only be promoted by Public Health to citizens who are asymptomatic of the disease in question. The 10 minute consultation is neither the right time nor enough time to adequately or properly address the issue.

A trusted doctor should be one who guides his/her patient to reliable information and encourages them to contribute to a well-considered shared, but individual decision that respects BOTH party`s rights to self-determination according to their own values, individual circumstances and preferences. No interference of State!

The limited consultation time is short enough anyway: it should not be used by the doctor to promote public health issues: a reversal of a true doctor-patient relationship. His/her patient will have taken the initiative to make the appointment and should be free to raise those issues which concern them, without imposition of public health promotion. Especially where the conscience of the doctor is troubled, both by being offered a payment to raise a Public Health Authority issue that is directed at citizens, not patients, and especially when they are uncertain of the value of the intervention – in this case the harm benefit ratio of breast screening? The power of Public Health to blackmail by payment incentive and override the judgement of individual doctors is insidiously corrupting the Profession, crushing its judgement and professionalism, as Seamus O`Mahony has so eloquently written about. [2] Overdiagnosis with resultant wastage of resources stem from this reversal; a sad consequence of this uncalled for activity.

[1] Helen Salisbury. Should I persuade patients to have mammograms? BMJ 2019;365:l140

[2] Seamus O`Mahony. Can Medicine be Cured? The Corruption of a Profession. An Apollo Book. 2018.

Competing interests: No competing interests

05 April 2019
Hazel Thornton
Honorary Visiting Fellow, Department of Health Sciences
University of Leicester
"Saionara", 31 Regent Street, Rowhedge, Colchester, CO5 7EA