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In a spin over screening

Phil's reeling from trying to ease his patients' fears prompted by Government 'health fascism'

Phil's reeling from trying to ease his patients' fears prompted by Government 'health fascism'

I have a number of patients who I think of as spinning plates; people who find life only just this side of bearable. They are crippled by anxiety, loneliness, depression, bereavement, inadequacy or just an inability to cope with 21st-century life. I run between them like a variety artist on stage, cajoling, reassuring and advising, keeping them spinning on their sticks and stopping them falling off and smashing. Keeping such patients off the floor is a fundamental part of our job (and one that can't be replicated by walk-in centres or nurse practitioners).

One of my spinning plates has fallen off her stick. She is an elderly spinster whose life is governed by fear. She lives alone and is terrified of, among other things, her neighbours, bird flu, terrorists, her nephew, passive smoking, dogs, cholesterol, blood pressure, buses and saturated fat. We have had, over the years, long discussions about every one of these shibboleths, and now I come to write them down I am struck by how many of them are media-generated medical irrelevancies. It makes me ashamed, it really does.

The cause of her dropping off her perch is yet another piece of pseudo-scientific nonsense. Like dozens of my patients, she has been co-opted onto a trial of bowel cancer screening. Like several of my patients, she has come up positive. It's entirely possible I was sent comprehensive details of this proposed trial – I will almost certainly have chucked them out unread. But I am positive I was not asked for permission for my patients to be included in this charade, because I most certainly would not have assented.

She was too upset to give me much idea of the mechanics of this new Government-fuelled intrusion into our bowel habits, but I assume she was asked to wipe her arse on some magic paper. The first three wipes were equivocal, leading to extreme anxiety, as were the second three, resulting in paralytic fear, and wipes seven to nine proved enough of an aberration to have her assigned to a specialist nurse next week – hence her distraught appearance as an emergency extra this morning. She has cancelled her holiday in Spain next week, at a cost of £500 to herself and the same to her friend who won't go without her, in order to see some bloody nurse who will ask her if she has eaten any black pudding recently, which she has.

Screening in the NHS, all of it, is an unscientific muddle. The Wilson criteria for an effective screening protocol are well known and sensible (although too long to be quoted here), so why do we have a breast screening programme that generates more pain, anxiety and morbidity than it prevents? Even that pales into insignificance when compared with the cervical screening programme, which costs four times as much and creates even more suffering, for a disease 10 times less common and with no effective treatment.Now we are proposing programmes for bowel and prostate cancers.

There is no evidence significant illness will be prevented, and no end to the anxiety and unnecessary medical intervention that will ensue. This is health fascism. Where will it end? When will the state stop poking its nose into our lives, and when will we as a profession start looking at the evidence and stop colluding?What are we actually here for?

It is not to make ourselves seem important and bugger about with people's lifestyles when we have no right and no evidence it makes any difference. Surely we are here to improve the quality of our patients' lives. When are we going to realise this is best done by leaving them alone to get on with.

Dr Phil Peverley is a GP in Sunderland and current MJA Columnist of the Year

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