Many GPs will have a nagging unease about screening and the relentless medicalisation of the population. Hazy half-remembered snippets about Wilson's criteria and false positives are brought into stark focus in Margaret McCartney's book, The Patient Paradox. Few are spared her withering gaze: the national cancer screening programmes and the private screening industry are pilloried. She alights briefly on Big Pharma but, with barely a pause, the PR-savvy celebrity-driven campaigns of Big Charity are taken to task. The treatment of hypertension and the use of statins are questioned; even Mr Testicles (darling of the male cancer awareness scene) gets a kicking. However, this is not some spittle-flecked rant: the arguments are measured and well-referenced; the conclusions are distressing.
One of the problems with screening is its fundamental reasonableness. Intuitively, it feels right and a voice quoting evidence is drowned out by the clamour that ‘something must be done’. The paradox that should alarm GPs is that we are complicit in fostering an NHS where the healthy are prioritised over the ill. McCartney argues we need a National Sickness Service to address health inequalities. Looking at the collated evidence in this book I wonder how we have strayed so far from the true values of informed consent; GPs look like ham-fisted henchmen bullying individuals into population-based policy. McCartney suggests that GPs need to act as professionals ‘to liberate patients’. Read this book. But don't expect to be able to practice medicine in the same way again.
- © British Journal of General Practice 2012