We strive to help our patients achieve healthy targets, but, wonders Wendy Johnson, how does this emphasis on detecting deviations from the norm affect our quality of life?
This has been a truly momentous week as my first grandchild, a beautiful boy named Arthur, arrived. Thankfully both mother and baby are doing fine, but we have not been without worries during the pregnancy and the first few days of the infant's life.
My daughter of course availed herself of the usual screening tests on offer – and what a lot there have been! Apart from all the blood tests, there were numerous scans and an array of neonatal tests. But she was often given conflicting information, and it was hard to interpret the significance of the various findings. There were suggestions of size discrepancies, then she became concerned when told that her placenta was "too low" – fortunately all later proved to be completely normal. Within a few hours of his birth, young Arthur had failed his hearing test - happily to pass with flying colours the following day. At this very vulnerable time such warnings of "abnormality" create enormous anxiety for the entire family.
This got me thinking about the current emphasis on health checks and screening, and how these affect our outlook on life. One of the central features of the primary care white paper Our Health, Our Care, Our Say is medical check-ups at critical points across the lifespan, and education to raise awareness of the risks of disease.(1) Where health was previously regarded as the normal state, and illness an exceptional and transient departure from it, increasingly it seems that ill health has become the norm.
Today we rarely meet anyone who is "normal". We strive to help our patients achieve ever-lower blood pressure and cholesterol targets, and prescribe more and more drugs to help them reduce their cardiovascular risk. Yet the quest for the ideal of perfect health, as defined by the World Health Organization as "a state of complete physical mental and social wellbeing", is clearly unattainable.
How does this emphasis on detecting deviations from the norm affect quality of life? As health awareness has grown, rather than promoting wellness, illness has increased.
Growing numbers of people report feeling ill, numbers of consultations with health professionals have grown rapidly in the past few years, and rates of sickness absence from work have risen.
It has been argued that health promotion policies foster a climate of fear about health issues, as people worry about succumbing to disease as a result of deficient lifestyles.(2) Health can only be achieved through intense vigilance against health risk and willingness to submit to regular professional intervention.
Of course screening can have enormous value – a neighbour has just successfully completed therapy for an asymptomatic cancer identified entirely as a result of routine screening. She is hopeful for a complete cure and grateful for that screening opportunity. However, the negative effects of screening can be significant and lasting. I believe we need to be much more sensitive about the way that we explain test findings to our patients, and be aware of the possibility of inducing health anxiety.
2. Fitzpatrick M. How health promotion makes people ill. Br J Gen Pract 2006;56:231.
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Your comments: (Terms and conditions apply)
"Our bodies are like cars, with the heart being the engine. To get the best performance out of a car it requires consistent regular servicing not to mention care in handling. We need to remember this particularly more so when screening is available free to all" - Name and address supplied
"Oh, how I agree. My area of renal care has been 'subcontracted' to an outside agency and everyone who has been seen by their very vigilant nurse has been told they only have 30, 40, 50% renal function. They have not been advised that at age 65 this can be expected. Many have informed their relatives they have not long to live, most have been unnecessarily worried in my view" - Name and address supplied
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