Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
It is easier said than done to simply deny following up private screening results.<1><2> What if patients have already had these tests done, bring these results to their GPs, and expect something to be done? Some of these tests may still be in their experimental phase that most clinicians may have never heard of. These tests and their indications may not be validated by the NHS or FDA and have minimal clinical values.
Then GPs may be left with the following options: 1) deny doing anything with these test results that significantly affect their rapport with patients; 2) google what these tests are that can lead to patients questioning their doctors' competency; or 3) reluctantly follow up these private screening results. Neither of the above would lead to good outcomes. In addition, some patients may still be dissatisfied with the service and go to the busy emergency department for rapid referrals.<3>
As soon as patients walk into a doctors' office and bring up their health concerns, doctors owe patients a duty of care. Perhaps, rather than simply denying their health concerns and test results, we should establish strict policies to protect patient safety, such as banning these private screening tests being performed without a doctor's signature. A doctor's signature indicates the legal responsibilities to act accordingly to the results.
At the end of the day, doctors are taught to take a history and examine patients before ordering investigations and treatment. If all that matters is a test result, what is the point of taking a history and examining the patients? If patients choose these private companies to be their primary health providers, it is only fair that GPs can also choose to deregister these patients from their practices, as the therapeutic relationship is already compromised.<4>
References:
1. Mahase E. Private screening: GPs shouldn't have to deal with results, says RCGP. BMJ. 2019;366:l5707.
2. Iacobucci G. Private health screening: NHS must not be left to "pick up the pieces," say LMCs. BMJ. 2019;364:l1289.
3. Yeung E. Should doctors be asked what they need from patients? BMJ. 2019;366:l5111.
4. Yeung EYH, Mohammed RSD. Learning from the Canadian experience of capping GP consultation rates. BMJ. 2018;361:k2550.
Competing interests:
I have been paid for working in primary and secondary care, but not for writing this letter.
Private Screening: “GPs should not follow up” BMJ 2019:366:l5707
I agree with Dr McCartney that the selling of tests and imaging direct to the public should not to be encouraged but I would like to be reassured that if a privately funded health check reveals disease, she is not suggesting the withholding of NHS treatment. It seems odd that 87% of cases seen by NHS doctors following private “screening” were considered unreasonable and yet 75% needed further investigation.
I note that the paper was accepted without debate and based on anecdotal data and is likely to fuel division between private and NHS services where generally there is good rapport and financial benefit for the NHS.
More fruitful research would be to determine why patients had to pay for the 13% of cases that deserved the attention of the NHS.
Not following up private screening results: easier said than done
It is easier said than done to simply deny following up private screening results.<1><2> What if patients have already had these tests done, bring these results to their GPs, and expect something to be done? Some of these tests may still be in their experimental phase that most clinicians may have never heard of. These tests and their indications may not be validated by the NHS or FDA and have minimal clinical values.
Then GPs may be left with the following options: 1) deny doing anything with these test results that significantly affect their rapport with patients; 2) google what these tests are that can lead to patients questioning their doctors' competency; or 3) reluctantly follow up these private screening results. Neither of the above would lead to good outcomes. In addition, some patients may still be dissatisfied with the service and go to the busy emergency department for rapid referrals.<3>
As soon as patients walk into a doctors' office and bring up their health concerns, doctors owe patients a duty of care. Perhaps, rather than simply denying their health concerns and test results, we should establish strict policies to protect patient safety, such as banning these private screening tests being performed without a doctor's signature. A doctor's signature indicates the legal responsibilities to act accordingly to the results.
At the end of the day, doctors are taught to take a history and examine patients before ordering investigations and treatment. If all that matters is a test result, what is the point of taking a history and examining the patients? If patients choose these private companies to be their primary health providers, it is only fair that GPs can also choose to deregister these patients from their practices, as the therapeutic relationship is already compromised.<4>
References:
1. Mahase E. Private screening: GPs shouldn't have to deal with results, says RCGP. BMJ. 2019;366:l5707.
2. Iacobucci G. Private health screening: NHS must not be left to "pick up the pieces," say LMCs. BMJ. 2019;364:l1289.
3. Yeung E. Should doctors be asked what they need from patients? BMJ. 2019;366:l5111.
4. Yeung EYH, Mohammed RSD. Learning from the Canadian experience of capping GP consultation rates. BMJ. 2018;361:k2550.
Competing interests: I have been paid for working in primary and secondary care, but not for writing this letter.