Nick Summerton is not afraid to take the contrarian view. And with ‘Better value health checks – a practical guide’, he’s happy playing what many would see as devil’s advocate.
That much is clear simply from the title: after all, if he can guide us in the direction of better value in health checks that implies they must be of some value in the first place.
Which will have health-check naysayers – and there are plenty of them, including me, and we tend to wave big EBM banners and adopt the smug expression of those who pity the unenlightened – gnashing our teeth in disbelief.
Dr Summerton acknowledges this. He’s a GP himself, after all, and so recognises the frustrations that health checks can cause – especially those glossy, scattergun, private ones which get dumped in our laps. But he wears other hats and has a wealth of experience covering areas such as public health, NICE and screening which make him very well placed to have a broader, more considered view.
Health checks stir up deeply held convictions about the individual’s philosophy of medicine
And this certainly comes through. Whatever your stance on health checks, it’s indisputable that this is an exhaustive, authoritative and meticulously researched account. It outlines the challenges and opportunities of health checks, suggests an ideal structure for the ‘better value’ check-up and then gives detailed information about health checks system by system, from cardiovascular to sexual health and all stops in between.
There’s no doubting the erudition but there’s also no hiding the tendency of the author to give health checks the benefit of the doubt. For example, in ‘Do health checks work?’, there’s an evangelical suggestion that the lack of evidence of benefit is due to shortcomings of the research, or the fact that the health checks under scrutiny should have been done differently to demonstrate their (evident?) value. This underlying enthusiasm is perhaps unsurprising given that, as early as page one, Dr Summerton is voicing his disappointment that the NHS health check does not include an ECG or ABPI.
Ultimately, and perhaps predictably, the conclusion is that the health check debate is too polarised and that an individually tailored approach rather than a thoughtless test-fest might keep everyone happy. I doubt that. I think health checks stir up deeply held convictions about the individual’s philosophy of medicine: it boils down to whether we’re adherents of ‘First do no harm’ or ‘I will save you’.
And I have another problem with the title. I just don’t see it attracting readers, even when ‘value’ is seen in its broadest sense – and the tangential use of ‘value’ might even put off those with a genuine interest in the subject. It left me wondering if this was simply a peg on which to hang a personal interest. Which would be a shame, because the result may be that his book ends up as something worthwhile with no market – the very opposite of health checks, some might say.
Dr Keith Hopcroft is a GP in Laindon, Essex
Better Value Health Checks is published by CRC Press