Professor Greenhalgh makes a valid point about the pitfalls of opportunistic screening in general practice.1 There will always be patients who find opportunistic health checks intrusive and entirely superfluous to their consultation with their GP. However, as Dr Greenhalgh points out herself, proactive care of this kind is often based on robust evidence and contributes significantly to practice income too. Allowing patients to entirely opt out of participating in these health checks could therefore have serious long-term clinical and cost implications.
There are also practical problems in implementing any ‘opt-out’ systems. Presumably any decision to opt out of routine health checks would have to be based on informed consent. But such informed consent would surely have to be regained at fairly regular intervals in order be ethical and fair. If a 50-year-old woman, for example, opts out of ever receiving letters inviting her for annual blood pressure or urine-dip screening, is it ethical to regard this consent as indefinite and not re-offer the screening as she ages, her cardiovascular risks increase, or if her social circumstances/medical comorbidities change?
There are also other advantages in sending ‘unsolicited mail’ to our patients that Dr Greenhalgh overlooks. For example, such offers of screening, even if they are declined, can serve to remind infrequent attenders of the existence of their GP and encourage attendance for other problems.
Dr Greenhalgh refers to a few of her patients ‘who have negative attitudes towards proactive care’ and one patient in particular who felt that ‘her biometric data in the absence of symptoms are none of anyone’s business’.1 Surely it is our role as primary care clinicians to challenge attitudes of this sort and, so far as it is reasonable, encourage all patients to participate willingly and actively in taking responsibility for their long-term health, rather than allowing a select few to opt out of health checks on a default basis.
- © British Journal of General Practice 2013
