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The business of medicine

Nowadays, everywhere you look,you are besieged with adverts for private healthcare companies. For ‘just a small price’, you can be screened for a variety of illnesses you didn’t know you had, and by doing so regain a sense of control over your own health. I mean, after the seasonal excesses of Christmas, just who wouldn’t that appeal to? Who wouldn’t want the best that ‘modern medicine’ has to offer?

So it struck me, when I heard a radio ad for a private diagnostics company that offers at-home STI testing, in addition to ‘cancer screening’ with results delivered to you online, that the long-cherished concept of ‘the patient and his physician’, whilst not being made redundant, is rapidly evolving into a more consumer/provider role in 2016 and we’d all better wake up and smell the coffee.

These private diagnostic companies are part of a growing web-based medical services movement that is cutting out the middle-man, ie, clinicians, when it comes to patient care. 

Using direct, consumer-orientated language — the phrase ‘removing barriers’ in particular — invokes themes of health justice, equality and patient autonomy. Obviously, the consumer is king, even when it comes to healthcare, and the concept is pretty much a no-fuss, no-muss one. So what’s the problem? You could argue that any initiatives that encourage those who may not have previously attended a health specialist for STI testing or ‘health screening’ for reasons such as inconvenience, cost, or simply embarrassment should be applauded. The testing is validated and — we are told — follow-up is provided. Well, the problems surrounding private healthcare screening are multifold for patients, their doctors and possibly even society.

These private diagnostic companies are part of a growing web-based medical services movement that are cutting out the middle-man, ie, clinicians

Most GPs can easily recount the scenario of the patient who comes into them with a furrowed brow clutching a PDF printout of an ECG, carotid Doppler, a cholesterol, PSA, etc, having been told that they should ‘follow-up with their GP’. They of course, have been told that by whatever private screening company had rolled into town that week and positioned themselves triumphantly in the middle of the local shopping centre. ‘Get checked! This test could save your life!’ the posters scream, attracting curious punters who think that they would probably like a test that could add years to their life, whatever it is.

This type of medical entrepreneurship is the ultimate in capitalist picking of the low-hanging fruit, and what’s more, it’s perfectly legal. These companies offer ‘screening services’ yet pretty much fail to comply with any of the basic principles that responsible health screening programmes are based on. They don’t appear to counsel, to delve into and research the patient’s medical history, or interpret the results for patients, and most crucially of all, their follow-up policy is, largely, to get somebody else, namely the humble GP, to do it. Our patients are not patients to them; they are simply customers.

 These mobile screening units are not the only ones making a profit out of people’s natural health anxieties and curiosities. Turn on the radio and you’ll hear ads for all sorts of ‘the best’ services at private healthcare facilities, while you walk into some pharmacies and you can get ‘allergy tests’, among other screening services. In an age where the mood is that of increasing patient autonomy and empowerment, this is a pretty alluring message. The only eligibility criteria for seeking the medical treatment you want (versus what you might actually need, or not need) is a valid health insurance policy or a pre-loaded credit card.

Despite measures to float and dangle the concept of universal healthcare and insurance to the electorate, the reality is our health system continues to operate on a two-tier basis; the tier of those who have, and those who have not. Nobody can blame private hospitals for wanting to increase their revenue and generate profit, but when many well-trained doctors and nurses are moving to work exclusively in the private sector, we are left with a public system that is utterly depleted and ever more teetering on the brink. This may be an environment that suits some, but not the majority of our ageing population.

I personally have no issue with patients having a natural curiosity about the quality of their overall health and challenging me about potential diagnoses, but it is my ethical and professional duty to provide them with responsible information, to prescribe (or not prescribe) appropriately and to perform the right test, at the right time, for the right patient, and to refer for the right treatment if required. Never to over-treat. Of course the delivery of healthcare is ever evolving, and there can be real benefits to patients embracing different technologies to track and manage their wealth and wellbeing, but we should cast a critical eye on anything that appears to be purely commercial versus patient-benefit driven.

It is not just doctors, but politicians and policy-makers who have a duty of care to patients and society at large, in this instance. It’s high time those with power used it to regulate not just the healthcare professionals who work on the front line day after day, but those whose interests in your health are purely ‘just business’.

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