Due Diligence in Community Health Screening

In our "more is better" culture it is hard for people to understand that more tests do not equal better health. Physicians feel it necessary to order tests for multiple reasons; defensive medicine, patient requests, belief that it will find early, more treatable disease. Good examples of the latter is the controversy over the PSA test and yearly mammograms. In our community it is common for people of all ages to get "Life Line Screening"(the most well-known) or screenings done by other companies. It is offered at health fairs, as a perk for employees and their spouses, and at many churches. In my experience, most of the individuals undergoing these tests have almost no risk factors for the tests being run and many are too young for them.

Recently a middle-aged patient of mine came in with the results of her community screening in hand, done by a company called Stroke Prevention Plus. The first thing that I noticed was extremely high systolic blood pressure readings done by a technician looking for peripheral artery disease. This patient is a normal-sized woman who works out regularly. She's never had a systolic blood pressure over 120 in my office much less 160. On the day I saw her it was up a little--125.

The oddest thing about the results was a black and white "photo" stuck with a piece of scotch tape in the middle of the page. It was from an ultrasound. In the middle of the photo was an arrow pointing to the edge of a black shadow and in the upper left-hand corner were the letters "L thyroid". There was no identification on the photo whatsoever. Among the sheets that were mailed to her was a non-specific "Jane Doe" letter about "incidental findings" that could occur with the testing she had undergone. Nothing was addressed specifically to her. 

My interpretation, looking at the little photo and the arrow, is that the radiologist noticed a cyst on her left thyroid while interpreting the carotid ultrasound. I am speechless that she would be notified of a possible abnormality in such an impersonal and unprofessional manner. What if it is a cancer and she ignored it or wasn't smart enough to understand the significance of that photo? What if she thought everyone got a photo like that attached to their result sheets?

Does the company, Stroke Prevention Plus, think that they did their "due diligence" and are absolved from further followup of these abnormalities by this notification? Since they've performed over seven million health screenings, and no doubt monetarily flourished in the process, do they feel it unnecessary to inform a patient in a CLEAR manner what they "incidentally" found? Do they feel that they have done the patient a favor because they could have ignored the results? What an odd decision on the company's part! I'm thankful this patient is well-educated and understood that she should talk to me. I worry about other people who are not so capable.

 This post was modified 6-12-2012 to reflect the fact that this patient was screened by another company whose forms directly resemble Life Line's. Life Line has better protocols in place for followup. This does not negate the fact that there is no scientific support for screening such as Life Line in the general population, aging or otherwise, quite the opposite. http://www.minnpost.com/second-opinion/2012/03/buyer-beware-direct-consumer-health-screenings, http://www.sciencebasedmedicine.org/index.php/ultrasound-screening-misleading-the-public/, http://www.kevinmd.com/blog/2011/06/examining-evidence-community-health-screening.html.