GPs order three times as many diagnostic tests as 15 years ago, study finds
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5093 (Published 29 November 2018)Cite this as: BMJ 2018;363:k5093
Why has there been such an increase in diagnostic testing?
I think we should take seriously the interaction between a) diagnostic tests that evoke a sense of anticipation of more secure future personal health and b) the human individual whose sense of himself or herself is intimately bound up with cultural expectation and norms.
This interaction is between:
- Tests that seem to possess a mystical power to secure life itself, in other word tests that are fetishised as commodities that are intensively and freely marketed and available for exchange; and
- The human being whose very identity and values, beliefs and behaviour, as a well person, is unsettled by the availability of tests, and whose identity as a moral citizen (doctor, parent, citizen etc.) relies upon following cultural norms.
And there is no doubt that screening by testing the asymptomatic has now become a cultural norm: regarded as a ‘good thing’.
The power of a fetishised test to unsettle and capture the identity of us all is leading to increasing harms to healthcare services as well as to the health of the asymptomatic, (or say minimally symptomatic) especially.
EBM ‘shared decision making’ (SDM) practice sustains this harm because it assumes that a person’s identity, values and preferences can exist and be identified, as if they are independent: a) of the way commodities are over valued; and b) of the way tests incite fear and lead to a compulsion to agree to testing, even when presented with ‘balanced pros and cons’ as if the process is ‘fair’.
Perhaps, as a start, screening tests should come with a very clear health warning, as with cigarette smoking: that “Having a diagnostic screening test when you are well can seriously damage your health.”
I have explored these issues in detail in my recently published book:
New Book by Owen Dempsey: