A simple question

Copperfield finally has a light-bulb moment when advising a patient not to have a private health MOT

As you're already eight words into this column, I can safely assume you're a regular reader - so I don't need to reiterate my frequently expressed view that private health screens are an evil misapplication of medicine exploiting the vulnerabilities and bank accounts of the public, creating an unholy mess for the NHS to sort out, and that all those involved deserve horse-whipping. Good. Because that's not the issue. The real problem is explaining all this to patients.

It causes me enormous problems. If a patient asks me, 'Is it worth getting a private health MOT, doc?'

I spend the first two minutes fighting my gag reflex. That only leaves eight more to give private health screens the verbal kicking they deserve.

And that's tricky, like trying to explain to a Labrador why it shouldn't chew cables. I try paraphrasing what I wrote in the first paragraph, but the patient just sits there, glassy eyed and slack-jawed.

I allow for the fact that the average Essex punter only understands sentences including the word, 'pizza'. 'Imagine you're ordering a pizza,' I explain. 'But instead of asking what you want, they just chuck ingredients in a pan and hope for the best. You might end up with a big bill and...' I'm struggling. '...er...a dog's dinner.' I look for a reaction, but he's still glassy eyed and slack-jawed. And now drooling.

So I try another tack, aware that I'm starting to sound desperate. 'OK, think about your car. You take it to the garage when there's a problem, like you come to me when you have a symptom.' He nods. Contact. 'But you wouldn't just take it in when it's running fine and ask them to do a load of tests, would you?' Excellent. Except that, as he points out, you would. It's called an annual service.

'Yes, true,' I say, trying hard not to start shouting. 'But bodies are much more complicated than cars, so you can't really compare them.' Why did I, then? Why is this so difficult? I can explain about viruses, the concept of cardiovascular risk and even how CBT works, which I don't actually understand myself. But I can't get across why private health screens are crap.

'It's just that these tests make no sense in people with no symptoms,' I say, scrabbling for an explanation. Scrabble. Games. Jigsaws. 'It's like...it's like having the pieces to a jigsaw without knowing what the picture's supposed to be.' This works, I think, even though it doesn't mention 'pizza'.

'But they found my mate's prostate cancer with a blood test.' Oh joy. Now he wants me to explain PSAs, which is about as rewarding as punching myself repeatedly in the groin. I mumble, bumble and bluster. I talk about lead time, false positives and negatives and, incredibly, I even hear myself say, 'Wilson's criteria'.

He interrupts me, now slightly impatient. 'Look, doc, do you think it's worth getting a private health MOT or not?' Just for a moment, I consider killing him, which would at least help answer his question.

Then I have a light-bulb moment. 'No,' I say.

Dr Tony Copperfield is a GP in Essex