TWO QUESTIONS FROM SARA

TWO QUESTIONS FROM SARA

by Sara Shaw -
Number of replies: 1

Well done on postings so far, some interesting and critical relfections on screening

Looking across your posts raised two questions:

Firstly, does screening for risk change what it means to be a patient?

While much screening (e.g. PKU) involves identfying a disease, there is a drive to screen for risk of disease (e.g. PSA). If you're identified as being 'at risk' does this mean that you are a patient or not? What does being 'a patient' now mean?

Secondly, and related to this, what are the implications for diagnosis and clinical care?

Might clinical diagnosis now include 'being at risk'? What does this mean for clinicians providing treatment and care?

 

 

In reply to Sara Shaw

Re: TWO QUESTIONS FROM SARA

by Storm Parker -

Medical screening as I understand it is testing apparently healthy individuals for a disease/illness or for being at risk of an illness. Its rise has changed how we view health and illness, with apparently healthy individuals becoming patients, and the whole population potentially being at risk.

I think that screening for risk does make someone a patient- for example metabolic syndrome (a disorder that is a risk factor for diabetes and cardiovascular disease) like pre-hypertension- is not a symptomatic disorder. However its diagnosis turns an individual into a patient as they now expected to comply with medical advice and take measures e.g. lifestyle changes.

The benefits are clear- diabetes and cardiovascular disease are potentially debilitating conditions, but there will probably be patients who despite being diagnosed with metabolic syndrome, would never have gone on to develop these conditions.

One study suggests that metabolic syndrome should be screened for in obese children (http://journals.lww.com/jpgn/fulltext/2009/09000/screening_of_metabolic_syndrome_in_obese_children_.11.aspx). This raises issues about the potential psychological harm of such a screening programme, such as stigma that may be associated with it and children’s responses to being screened on the basis of being obese, and about whether a child is able to comprehend the risk associated with metabolic syndrome and so the appropriateness of such a screening test.