This week we focused on the sociology of medical screening and its benefits and harms. The seminar touched on a range of issues relating to various aspects of medical screening. To start with we had many definitions of what screening is, with most describing it as a process of identifying individuals who may be at high risk of developing a specific condition or who may be in the early stages of disease with a view to intervening and reducing the risk of the disease developing/progressing further.
We had several posts that revolved around screening for others benefits, and who actually wins, is it the patient or a third party. A good example was screening blood products for transfusion and communicating (or in some cases not) the results of the blood screening back to the individual and steps that were taken following this. Here we can also talk about the idea of ‘privatisation’ of screening and how private healthcare might influence what tests are actually carried out and whether these are beneficial or even necessary.
When I think of screening I think of one test, done at a particular point in time, which is either positive or negative. But there are further implications, highlighted in several posts, about how one you are screened and a positive result is found, you may need to be followed-up with regular testing over months or even years to monitor progression of disease. What are the impacts of this long-term screening, and to what extent does it cause anxiety and stress to be going into hospital for regular testing when you feel physically fine and nothing is found on screening tests? Patients may feel they are playing a ‘waiting game’ and living in fear of developing the disease, purely through the process of being screened.
This leads nicely onto points made about how the process of screening itself can cause untold anxiety in a patient, causing an individual to become a ‘patient’ even though their screening tests may come up negative. When thinking of the recent publications on the true effectiveness of breast screening and the high numbers of women being treated unnecessarily, it is important to consider how specific and sensitive a screening test is when implementing it across the population/to targeted groups. Is screening a guarantee that an individual will or will not develop the disease? In many cases no, but as medical professionals how responsible are we for communicating these facts to our patients in a way that they will understand, to allow them to make informed choices about whether or not to have the test. And must we/do we always have to gain a patients consent for screening? A few posts discussed blood group screening as an example, particularly in pregnant women. Here, screening is done automatically to identify Rhesus D negative mothers. To what extent should this screening test be discussed with mothers and should mothers be given the option to opt out? Must all screening need consent or do the benefits of some tests so clearly outweigh the harms that it obviates the need for consent?
Finally we talked about the stigma of screening, and how this may affect how likely an individual is to undergo the test or discuss it with family. Is the stigma still applied even if the result is negative? In many cases screening will provide peace of mind to patients worried about developing specific conditions, and patients who are identified as being high-risk/in the early stages of the disease will be appropriately managed and will probably be thankful that the condition was identified early. But what happens when the anxiety around the test results themselves becomes a condition to treat. To what extent do individuals make themselves sicker by worrying about the results, and is this a case of risk itself becoming a condition to treat? A nice way to think about this is the ‘medicalisation’ of risk.
To sum up we discussed various issues surrounding screening, with potential pitfalls being highlighted but also the clear benefits being acknowledged. It’s interesting to end by considering how risk is actually communicated, as Sara mentioned in her post. Should we be focusing more on how to actually communicate risk to our patients in a way that influences healthy behaviour, and if so, what are the best ways of doing this with regards to different conditions?
