Published: February 7, 2013 - 3:00AM
Why? Well, if you have symptoms, you go to your GP and leave it to them to listen to your history, examine you, request investigations and reach a decision. This process is known as diagnosis. A full health check when you feel well is not diagnosis. The procedure is known as ''screening''. There are few screening tests where the advantages of diagnosis and treatment outweigh the disadvantages, and it is likely your doctor has already checked for these: for example, in women, a smear test, in middle years a mammography, and for both sexes blood pressure readings.
People with dementia have difficulty finding their way around hospitals. Even the walk from your bed to the toilet and back is fraught with avoidable dangers: shiny floors, bad signage, distracting noise, poor lighting and colour contrast between floors and walls, invisible grab rails that blend into the decor, taps that don't look like taps, sinks with no plugs … So you wet yourself, or fall, or get into the wrong bed, or get shouted at for moving. If I had to go, I'd want my family to stay with me as much as possible.
I have experienced many situations where a woman's first labour has not progressed according to plan and, in some cases, become an emergency. I would never have my first baby in a setting where there is no immediate trolley access to medical obstetric care.
PSA is a ''simple'' blood test to check for prostate cancer. Know what it stands for? Prostate Specific Antigen. Or rather, as many doctors will tell you, Persistent Stress and Anxiety. Prostate cancer is far more common and, usually, less serious than most people realise. In elderly men, it's virtually a state of normality. Most of these prostate cancers are dormant and harmless, and are something men die with, not of. Having a PSA may end up giving you information you would have been better off not knowing. That's if you can trust the result: it's notorious for inaccuracies, with false positives, false negatives and an inability to distinguish between harmless prostate cancers and the less common aggressive types. Sure, in theory it could save your life. But in practice it could well lead to worry, unpleasant biopsies and unnecessary surgery.
Doctors treat a wide range of conditions, but often we don't quite understand the therapies that we're offering, and why or how they work. Twelve years ago, I had colitis. One of the treatments is steroids but, as a doctor, I knew steroids are one of those treatments we apply to many illnesses without really knowing why they work. We know they're an anti-inflammatory, but all you're doing is masking the problem, and there can be side effects in the long term: steroids can make your skin more fragile, they can affect your connective tissue, they can change the shape of your face. It's one thing taking something if you know why it's working, but I wasn't prepared to go down that route. At that point, my lifestyle wasn't great. I was busy and not eating well. I started eating less sugar, fewer carbohydrates and anything processed. Not only did I get better, but, since then, I've hardly had a cold.
While I've had a colonoscopy, I'd never have a virtual colonoscopy - a CT scan of the abdomen to find polyps and early cancers in the colon. It's likely the radiologists would stumble on something else that has nothing to do with colon cancer - small abnormalities on the liver, kidney and lung, things that typically start a cascade of tests that may even lead to surgery. I would also never take medicines to lower my blood sugar for a haemoglobin A1c of 7 per cent. A long-term study of 50,000 diabetics in Britain found that trying to lower A1cs below 7.5 per cent increases the overall death rate. I'm not sure we should even call an A1c of 7 per cent ''diabetes'', but I'm very sure I wouldn't take medicines to lower it. Instead, I would try to lose weight and exercise more, and be open to medications to lower blood pressure and cholesterol. I'd never undergo advanced medical imaging when I felt well. Studies of total-body CT screening have found 85 per cent of healthy 50-year-olds to 60-year-olds have some abnormal finding, and the average patient has 2.8 abnormalities. That's a lot of follow-up tests and biopsies. While I'll gladly be scanned if I'm in an accident or develop acute abdominal pain with vomiting, I'm not getting scanned when I'm well.
Having just had my gallbladder out, and with the complication of leaking bile afterwards, I wouldn't have any operation or procedure without first reading the guidelines for the condition, looking at the complication rates and the risk of doing nothing. I would ask the surgeon how many of these procedures he or she carries out a year, and about their complication rate. I'd also Google them and ask other doctors for opinions. I would always ask what someone is doing to me and why. If I was in pain, I would ask what they were prescribing me, how much, how often. I would always read my discharge summary from hospital because they are often inaccurate. I would suggest trying to stay out of hospital as much as possible and having only tests that doctors will act on. I would go to a teaching hospital: they are likely to be the safest if anything goes wrong.
Not only is stripping painful, with large scars that have a higher chance of infection, but a year later 23 per cent of people have the same vein growing back. After five years, 83 per cent do. So it is painful and doesn't work in the long term. With pinhole laser methods, we have complete closure of the vein in 97 per cent of people a decade later. Also, general anaesthetic means you don't move, increasing the risk of deep vein thrombosis, plus you can't tell the surgeon it is hurting, so nerves can be damaged and this is found only when you wake up. If I had liver metastasis - when a tumour has gone to the liver - I would not have chemotherapy unless I was assessed by a liver surgeon first. If the metastasis is in only one side of the liver, then removal of this area surgically can cure it. The five-year survival after surgical removal of such tumours is far better than chemotherapy.
They are addictive and it can be very difficult for people to wean themselves off them; the side effects can include falls, confusion, sleepiness in the daytime and the feeling that increasingly higher doses are needed to achieve the same effects.
Evidence for them working isn't strong. I also often wonder if the valiant efforts we make to keep our terminal-prognosis patients alive make any sense. But I notice that colleagues say the same thing until they or their loved one gets a terminal prognosis, after which they want everything done.
Elderly patients, or those with a chronic debilitating condition such as heart failure, should consider it, but there is not much evidence that it is of benefit in healthy young people.
Surgery should never be undertaken for ''soft'' reasons. It's not that surgery is so terribly dangerous that I would worry about death. Mainly it's the worry of infection.
Several years ago, I volunteered with Medecins Sans Frontieres and spent six months in Angola. I'd expected poverty, but it was the arrival of kids suffering from severe illnesses that should never have occurred - illnesses easily prevented elsewhere, like measles, or tetanus - that saddened me most.
Now, practising in the West, I often meet parents who are reluctant to vaccinate their children despite the wealth of evidence regarding safety. Many of these diseases are now on the rise again. I can't help but wonder if vaccines have become a victim of their own success; that if we, too, had to queue for hours, surrounded by families who'd also been affected by these illnesses - illnesses that can disable and even kill - then we might not take them for granted.
I would never dismiss an alternative therapy without understanding how it works. It's taken me years of medical experience to realise that just because a therapy doesn't have evidence behind it doesn't mean it can't help some people. As doctors, we are trained, rightly, to seek scientific evidence of the effectiveness and safety of a given therapy. But conventional modern medicine can't help everyone. Despite a lack of research funding, there is a growing body of evidence of the effectiveness of a range of alternative therapies. A recent example was that yoga can help reduce pain and increase mobility in those with osteoarthritis.
They are based on an 18th-century practice of diluting particular compounds in water or alcohol to the point where the solution is so weak as to contain no trace of the original compound at all. Homeopaths believe that water has a ''memory'' of the curative substance that then has a beneficial effect. For me, the key word is ''believe''. Homeopathy is a faith-based medical system that, in the minds of its faithful, does not require any scientific evidence of effectiveness to be beneficial. If homeopathy is effective, then most of what we have learnt in the fields of medicine, chemistry and physics since the 18th century must be incorrect. I find that implausible.
This involves prolonged hormonal medication for three to four weeks, making the ovaries initially menopausal followed by higher doses of stimulation. This method of stimulation is associated with higher risks of ovarian hyperstimulation syndrome, which carries serious health risks. We can avoid these complications thanks to recent developments in making IVF safer, cheaper, more successful and accessible. Advances in endocrinology, ultrasound and embryology have made ''drug-free IVF'' (natural IVF and IVM) more successful and allowed development of safer ''mild IVF'' protocols requiring fewer drugs in a natural cycle. Why take drugs in higher dosages if you can have a baby with no, or fewer, drugs?
Down the microscope, doctors can't always tell the difference between ''dangerous'' and ''OK to leave alone''. So it is possible to find things ''too early'' that are not really life-threatening. The independent review of breast cancer screening published last year in The Lancet helpfully distinguished biases, uncertainties and some bad science. The latest quantification is that of every 10,000 women screened every three years from the age of 50 to the age of 70, about 43 fewer will die from breast cancer. About 700 will be given a cancer diagnosis and a lot more will be frightened by being recalled for further tests.
Although most women who are told they have cancer by screening are grateful, I wouldn't be sure if my life had been ''saved'' or if I'd just become an extra cancer patient. It appears that for every 15 women who are ''screen-diagnosed'', three will still die of breast cancer (so screening doesn't save their lives), eight will still live (so screening brought the diagnosis earlier, but treatment would have worked anyway), one will not die of breast cancer (so screening prevents this cause of death) but three extra will become ''cancer victims'' (so screening leads to having surgery and/or radiotherapy/chemotherapy that would not have happened in her lifetime). Screening can only be credited with one woman not dying of breast cancer, but all 15 have to be treated once something is found. It's complicated. Some women will take these odds. But I'm happy to wait until I have symptoms.
I would never undergo major abdominal surgery if I had little chance of getting off life support afterwards. I have operated on too many people at the end of their lives for emergent reasons, only to see them never get off life support and cause angst among relatives, who have to decide when to pull the plug. I would avoid surgery at all costs.
Guardian News & Media
These are the opinions of individual doctors. Consult your GP if you are concerned about your health.
This story was found at: http://www.dailylife.com.au/health-and-fitness/dl-wellbeing/the-treatments-doctors-say-no-to-20130207-2dzvn.html