On the face of it, health checks can seem like a bit of ‘no brainer’. If you accept an invite from your doctor to attend for a ‘health MOT’ (the MOT is the annual test of car road-worthiness in the UK), then the thought is this will help ‘catch something early’, and allow earlier and more effective management. It sounds good in theory, but do health checks actually do any good?
This week saw the publication of a study that aimed to assess the impact of NHS health checks [1]. The researchers compared in outcomes general practices that undertook screening, with those in patients from practices where health checks were not routine. The researchers focused on five conditions: high blood pressure, heart disease, kidney disease atrial fibrillation (a type of heart rhythm disturbance) and diabetes.
This 3-year study found that the rates of these conditions was no higher in screened patients than in those who received normal care. In other words, health checks did not pick up an additional health issues that would not have been picked up in the normal course of events. By the way, in this study the total number of screens performed was 16,669. Think of all the time, effort and resources that went into these screening endeavours, only for them to prove to be a complete dud.
More important than this finding, I think, is the impact of health checks not on the apparent prevalence of a condition, but on actual health. Do health checks translate into a reduced risk of disease or death?
The impact of health checks on health outcomes was assessed by researchers from the so-called Cochrane Collaboration (specialising in performing ‘meta-analyses’ of health interventions) [2]. The review pooled together the results of 14 studies where the health outcomes of people who underwent a health check were compared with those of people who didn’t.
Here are the results:
Risk of death from cancer – no benefit
Risk of death from cardiovascular disease – no benefit
Overall risk of death – no benefit
The authors concluded that:
General health checks did not reduce morbidity [illness] or mortality, neither overall nor for cardiovascular or cancer causes, although they increased the number of new diagnoses. Important harmful outcomes were often not studied or reported.
Yet, despite this, the NHS Choices website continues to promote health checks and makes quite grand claims about the ‘expected’ benefits in terms of lives saved and cases of disease prevented. The NHS Choices does not provide the evidence that backs up these claims (which, remember, run counter to the evidence presented here).
Should you get an invite for a health check, it’s perfectly legitimate to attend. It’s also perfectly legitimate, though, to ask your doctor for the evidence that supports this initiative. It’s high time we doctors were made more accountable for the recommendations we make and services we offer, including those sanctioned by our Government.
References:
- Caley M, et al. The impact of NHS Health Checks on the prevalence of disease in general practices: a controlled study. BJGP 2014;64:625 e516-e521
- Krogsbøll LT, et al. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012;345:e7191.3
A few months ago I broke my arm. Because I am female and 55+ the red flag went up on the computer system and I was sent for osteoporosis testing.
I knew there was no way I was at risk but I was tested anyway. A royal waste of everyone’s time. As my daughter says, ‘they probe and probe until they find something wrong’.
There are too many statistics and not enough consideration is given to individuals. The cost of needless testing could be diverted to cope with some of the scandals in the care of those already ill.
I agree Noelle, this is possibly the biggest failing of medicine the looking until they find something syndrome and the one size fits all approach to fixing illness. I might also add to that, the creation of normal conditions as illnesses & the total disbelief in the power of the body to heal itself given the correct therepeutic doses of vita-nutrients. Disease only happens when the body’s cellular structures break down supporting these structures by natural means and drugs in the short term( where necessary), should be what they are aiming for. Then that would mean treating patients as individuals in a holistic manner, something the one size fits all approach to diagnosing and treating disease cant do.
Wouldn’t you need to look at all-cause mortality for this to have meaning?
Your final sentence, John, is the clincher for me. Thank you. GP accountability to patients is the key to their performance and our trust. So often my GP has said I recommend/urge you to take whatever because it is in government/NHS guidance without him/her questioning the scientific evidence behind it. I would like to see all such guidance referenced to the independent clinical trials or ‘whatever’ ie anecdotal so-called evidence. We pay for the service, after all, so why are we so reticent about demanding politely what the hell supports they advice? We need to build a GP-patient partnership based on integrity and accountability. Then, just maybe, lifestyle and wellbeing will take its rightful place and help tackle the obesity epidemic which threatens the health service.
I try and avoid going to the doctor unless absolutely necessary (having been an NHS employee both as a diagnostic radiographer years ago and more recently a support secretary in a hospital, I’ve very wary of ‘getting into the system’). We moved house last year and had to register with a new GP and were invited to have a ‘new patient checkup’. My partner was weighed and measured (BP) by 2 trainee Health Care Assistants while the nurse went off to check his urine. These 2 girls hardly seemed to know what they were doing (chatting to him all the while and I suspect not having the cuff in the correct place/level with heart etc) and my partner’s blood pressure was deemed by the nurse on her return to be very high (“Oh my goodness, I think we’d better repeat that – you may be called in to have a 24-hour blood pressure monitoring done”). Naturally this reaction did nothing to help my partner’s blood pressure come down for the 2nd check! On our return home I borrowed my (93-year old) mother’s blood pressure monitors (both of them) and we proceeded to check our blood pressures in the comfort of our home and, lo and behold, all perfect.
Incidentally, my mother had always had low blood pressure but at the surgery was deemed to by hypertensive and given medication. After this she had 2 episodes of syncope at home and also had unusual ECG rhythms when checked by the paramedic. Eventually with home monitoring the GP agreed that she never had hypertension – most likely ‘white coat syndrome’). A year later she died of a heart attack – I wonder if the drugs may have had anything to do with that as she was always very healthy and was never on any drugs before then…..
As for myself, the 2 HCAs had no idea how to use the scales (the type with the sliding weights) and I had to more or less weigh myself and tell them the result!
Needless to say, when we were asked, as 56 year olds, to attend for a health check, neither of us jumped at the chance, particularly as one of the tests was for cholesterol levels – I could just imagine the arguments that would’ve come about when we would’ve been offered statins (for no reason at all) and then refused them!
Myself and my parents all suffer with ‘white coat syndrome’ – I can feel the stress and panic the second I set off for a doctor’s appointment, and putting an uncomfortable cuff around my arm does nothing to alleviate this! Thankfully we have an understanding doctor who lets us record our BP at home and bring the readings in – very useful for me since I’m on the pill!
Me too with the white coat hypertension. I always have to talk my way out of a further evaluation. At home I’m almost always fine. But put me in the doctor’s office and strap that cuff on me, and my BP is always elevated. I’ve tried counting, doing sums, humming to myself, no help. The only thing that ever does any good is to imagine myself floating in a warm pool. Or to imagine watching fish in an aquarium.
I remember one time when I ended up in the ER overnight to check out some epigastric pain. When I arrived, my BP was ~116/80. By the time I’d been there for about 12 hours, with the cuff set to self inflate every 15 minutes, startling me every time by going off with a loud buzz, and inflating to ever higher cuff pressures so that my arm felt like it was being squeezed in a vise, all because the staff kept resetting the upper limit to keep the alarm from going off, my final BP was a lovely 194/120. So now I have a medical record showing a disastrously high BP. I love this system.
During winter, when my father resides in Florida, once a week his friends from the neighborhood will get together for lunch. One of the friends is a retired doctor. A number of months ago during one of the lunches, the retired doctor discussed his former profession with mention on routine tests. What caught my father by surprise and he still talks about today was mentions on how it would annoy him (the doctor) when patients showed up, expecting him to do everything. He enjoyed patients that took an active roll in caring for themselves, with some basic knowledge on keeping healthy. In line with your article – he went into discussion about many typical routine tests being unnecessary. To make a long story short, it was a lunch my father seems to have enjoyed greatly. He brings the talk up from time to time.
PS Please excuse the typos 🙁
When I reached the age of 60 I took up the offer of the MOT. It found high cholestorol and the next think I was sent off to ahve a cardiogram. & it stressed me and freaked me out. It felt that having got to that age feeling pretty healthy & energetic I was suddenly being told you’re old and expect to have something wrong. The cardiogram was fine, and unnecessary. The practise had targets and financial rewards for doing all this. That is medicine by numbers. They get that for getting people onto statins. As far as the cholestorol test, they gave me a horrid & poorly designed handout with diagrams of blocked arteries and risk calculations of stroke etc. Same effect – stress. A breezy doctor explained on the phone they could ‘pop’ me on a pill ( meaning statins). I started looking into it… eg info on this site, and have avoided cholestorol tests ever since, though a doctor added one onto a blood test without asking my permission, however it showed sufficient good cholestorol so they have left it. Its left me feeling distrustful, compounded by the practises incompetent administration.
Isn’t there a strong possibility that healthy ‘health conscious’ people are more likely to go for regular health checks than those who take little interest in their health until they are already suffering from cancer or cardiovascular disease?
By accident one of my private blood tests also tested my cholesterol levels. I took the results along to one of the GP’s at my practice as I was interested in getting it recorded on my records that my white cell count was normal.
The GP looked at the total cholesterol level and panicked.
Only when she plugged the individual figures into a formula did she work out I was not at risk from heart disease at all. I have a high HDL level.
My previous NHS blood test only gave total cholesterol levels so if I’m invited for a health check in a couple of years time I will refuse.
I have to keep an eye on a couple of nutrient levels anyway and getting the NHS to test them is near impossible. I had to be in pain for over a year before a nurse believed and did comprehensive blood tests on me, as the GPs at my old practice decided I was making things up.
As previous post I had one of these letters ‘inviting’ me for the health check, needless to say I haven’t taken up their offer. I am a very fit 65 year old who enjoys open water swimming, cycling and going to the gym. Doubtless they would want to prescribe the usual cocktail of meds, which I cannot see benefitting me. Thanks largely to this website and books by Margaret McCartney, Malcolm Kendrick and yourself Dr Briffa, I shall carry on as normal. Getting a timely appointment with a GP is almost impossible – of late, I have used private GP services just to get seen and sorted. Thank you for the as always excellent and informative newsletters.
Very interesting results. I instinctively shy away from responding to invitations to attend health screens. (These are getting less like “invitations” and more like “mandates” all the time – a friend of mine was literally hounded by the medics to go and have blood tests. Doctors, at least in the UK, are supposed to fulfill government quotas – so many of their “at-risk” patients on hypotensives, so many on statins (a figure which seems to increase all the time), so many over-60s screened for colon cancer, >95% of the panel with vaccinations up to date, etc. etc.). For years doctors have been criticised for not concentrating enough on disease *prevention* – so what do they do? Certainly not focusing on diet and lifestyle issues (about which they have no training whatsoever). No – they call you in for tests, and just get you on the drugs earlier!! It’s a travesty of what should be being promoted. But it’s the logical endpoint of handing over responsibility for our health to people who are trained to dish out drugs.
What is not mentioned in the study, and which I think would be fascinating to look at, is the sheer amount of worry and distress caused by being called in for tests and having to wait for the results, and then possibly being called for further tests and interventions and all the worry and distress associated with that. All over the country at this very moment there are probably hundreds of thousands of people who can’t eat and can’t sleep because they’re worrying about something that they didn’t even think about before being called in by the doctor. And now, it seems, all for NOTHING.
Apart from the bit about colorectal cancer screening.
For those of us who are having regular colonoscopy examinations, and if necessary polyp removal and biopsy, the NHS check on the biopsy – while longer than necessary due to cuts and outsourcing of lab work – is very welcome as there is potential for cure (remission) if cancer is found.
The rest I agree with.
Fair enough Stephen. But on the subject of cancer screening, here’s a very interesting piece about doctors’ lack of understanding about statistics and probability, and how it can lead to unnecessary worry and distress in “patients”:
http://www.bbc.co.uk/news/magazine-28166019
I’m very interested to read the above comments as I was thinking these problems only belonged to my own doctors’ practice. I too avoid going anywhere near as much as possible but very occasionally it does becomes necessary. Are they interested in the presenting problem? Not likely…..instead they start checking through their computer screen to see whether all the boxes are ticked on the medical record. I think these government pressures are a disgrace and totally undermine the doctor-patient relationship. Unfortunately the doctors at the practice I attend are unwilling to communicate or answer my remarks. That makes me inwardly fume and they then try to take my blood-pressure! The last time this happened the reading went up to 236 because of my annoyance and frustration! The doctor was visibly frightened and asked if I was stressed. Silly question but since she asked, I let her know in no uncertain terms. The digital reading whizzed rapidly down as I vented my annoyance and returned to the normal it has always been. Does anyone have any ideas for (politely) asserting themselves with their GP in these situations? I would dearly love to know.
I had a follow up cholesterol test from 3 years earlier which came back as ‘borderline high’ so was called in for a health check. I wish I’d never gone. The HCA took my blood pressure and almost fell off the chair as it was 163/96. Pityingly she looked at me and said “Well you’ve had 70 good years” as if it was all downhill from now on and I might as well book in for a care home. I informed her I was actually 29years, not 70! She put me down for a 24 hr monitor which I duly had and that was a little lower but still high enough for them to put me on meds. I felt furious – really resentful that the surgery gets paid a bonus for causing me unnecessary stress.
What was worse was that it turned me from a person who led a healthy lifewith a healthy disregard for illness into a person who sees problems around every corner
There may be benefit to some elderly in having higher blood pressure-to get blood where it is needed, and to others for reasons that are being studied. Show this to your doctor.
http://archinte.jamanetwork.com/article.aspx?articleid=1217205
http://psychcentral.com/news/2013/05/04/how-would-high-blood-pressure-benefit-teens-adjustment-quality-of-life/54465.html
This is all about “defensive medicine” and advising to avoid litigation.
All is made clear in the book by Gigerenzer, Gerd (2014-04-17). Risk Savvy: How To Make Good Decisions (p. iii). Penguin Books Ltd. Kindle Edition.
Medicine is particularly examined in Chapters 9-10
http://www.bbc.co.uk/news/magazine-28166019
may also be of interest.
Hippocrates had it so right over two thousand years ago:
“Let food be thy medicine and medicine be thy food.”
“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”
“There are, in effect, two things, to know and to believe one knows; to know is science; to believe one knows is ignorance.”
In fact,most of his quotes are so, so true, especially in today’s “we believe we know” opinion leaders’ driven medicine…
https://www.goodreads.com/author/quotes/248774.Hippocrates
My 67 year old father was called for these health checks last year.
He was given a clean bill of health.
A few weeks later he suddenly died from a massive cardiac arrest.
My faith in these tests is low to say the least.
My gp told me my cholesterol level was 5.2 last year and I am due to have a repeat test next month.
But – I am also following a low carb diet as per escape the diet trap – and will be interested to see what my results are.
Did your doctor find out your HDL & triglycerides levels? If s/he didn’t then knowing total cholesterol level is useless.
@ Bec
The tests are largely box ticking exercises and the only thing they’ll do for the majority of people is cause undue stress and anxiety. For those given a “clean bill of health” it’s largely down to chance whether that is actually true. I’m sorry that your father passed away.
What your cholesterol number happens to be is also likely irrelevant. The oh so qualified “health care assistant” may as well measure the number of times you blink in a minute and relate this measure to your star sign. What matters ultimately, are outcomes. What are the outcomes of intervention “x” or “y” or “z”. If the outcomes are not demonstrable (which is after all the whole point of “evidence based medicine”) then why the intervention? It’s nonsense.