Dr Muir Gray's account of screening ignores possible harmful effects of screening healthy people.1 Some of these are obvious, such as the example he cites of perforation of the bowel during colonoscopy. Others are much harder to recognise. For instance, it is difficult to believe that the emphasis on finding disease could not be having an effect on the nation's consciousness of health and suffering. The implicit message is that life is fraught with dangers called diseases, and it's doctors that can help you dodge them. We already live in a health-obsessed, or rather disease-obsessed, over-medicalised culture: any conversation overheard in the high street will tell you that. Combine this with the boredom and stress that also characterises our society and you have a potent cocktail for anxiety focused on disease. We are then in danger of mistaking life for an obstacle course — a process of dodging diseases by having health checks. This is hardly healthy. How much screening and the whole risk factor story contributes to this we cannot know: Dr Muir Gray does call for better knowledge. In the meantime, if we must screen for some of the obstacles on life's journey, it behoves us to place at least equal emphasis on helping people towards a life well lived. Perhaps you ask: is that our job? If our first priority is to do no harm, then it must be.
- © British Journal of General Practice, 2004.
