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Ancient wisdom, modern practice

By on July 31, 2012
It is curious that these days much medical activity is directed, not to the sick, but at people who are well.  The idea, it seems, is to detect disease at an early stage, before symptoms develop, so treatment can be started sooner and patients will, therefore, achieve a better outcome.  Is this really possible?  It makes intuitive sense, but in practice all it may achieve, apart from making money for doctors, is to cause anxiety for the people undergoing tests – who are thereby turned into patients.  This is something I try to avoid.  There must be tens of millions of people of working age in Japan, who are probably the healthiest section of the population, who undergo every year the apparently compulsory humorous sounding ningen dock (‘human dock’) examination.  Does it do more harm than good?  Are statistics compiled and published showing the cost-effectiveness, or otherwise, of these examinations?  

Let us take the case of breast cancer screening.  The current tendency, or one may even call it a fashion, is for patients to be presented with full information about the bene ts and possible harm (a word in medical parlance for some reason often used in the plural – ‘harms’) of the screening procedure, and then the decision is left to the patient.  While I am in favour of  patients being fully involved with all aspects of their care, I think this is passing the buck.  How can patients judge all the information and come to a carefully weighed conclusion on what is often a complex situation?  It is the doctor who is, or should be, expert in the matter.  Surely, it would be preferable for him or her, with of course appropriately detailed discussion, to recommend a particular procedure or treatment, or not.  The patient then only has to decide whether to accept the advice offered.  

Does breast cancer screening save lives, and if so, to what extent? And what of possible harm?  I quote from the medical literature:
 
[F]or every 2000 women invited for screening throughout 10 years, one will have her life prolonged and ten healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive ndings. (http://summaries.cochrane.org/CD001877/screening-for-breast-cancer-with-
mammography)

Would I recommend breast cancer screening, say, for a healthy 50 year old woman with no family or personal history of breast disease? Of course, a woman’s particular concerns and wishes must be taken into consideration, but in general my answer to this question would be ‘No’.

Perhaps we should keep more in mind the 2000 year old advice:
Those who are whole need not a physician, but those who are sick.  Matthew 9:12

Note: The above is for general information only and should not be taken as medical advice.  If you have concerns about your health, or the need for screening, please see your doctor.  

Dr Gabriel Symonds runs the Tokyo British Clinic, a general practice serving the foreign community since 1992.  Tel: 03-5458-6099  
www.tokyobritishclinic.com

About Dr. Gabriel Symonds

Dr. Gabriel Symonds was the director of the Tokyo British Clinic. The clinic closed down in May 2014 after serving the expatriate community for 20+ years. Dr. Symonds has retired and the Tokyo British Clinic is now closed. Dr Symonds will continue to live in Tokyo and may be contacted by e-mail over any questions concerning medical records or related matters: symonds@tokyobritishclinic.com He will be available from another address for: smoking cessation psychotherapy/counselling circumcision information Tel: (03) 5458-6099 www.tokyobritishclinic.com