Do More Screening Tests Lead to Better Health? Choosing Wisely

Dr. Mike Evans is a staff physician at St. Michael's Hospital and an Associate Professor of Family Medicine. He is a Scientist at the Li Ka Shing Knowledge Institute and has an endowed Chair in Patient Engagement in Child Nutrition at the University of Toronto.

Written, Narrated and Produced by Dr. Mike Evans
Illustrations by Liisa Sorsa
Directed and Photographed and Produced by Nick De Pencier
Editor, David Schmidt
Story/Graphic Facilitator, Disa Kauk
Production Assistant, Chris Niesing
Director of Operations, Mike Heinrich

©2015 Michael Evans and Reframe Health Films Inc.

[gregmartin]

I'm a big fan of these videos. This is an extremely important topic. Keep up the good work Dr Evans!

[mateus.boaventura]

Excellent text and excellent animations! Thanks for the didactics.

[bdogmusician]

I would also note that Texas Governor Gregg Abbott put into place Abbott's law which has helped advanced lab companies as he himself had a relative pass away even though there was advanced testing that couldve helped diagnose the problem earlier and/or prevent the loss but his PCP refused to do it for fear of losing money as part of his agreement with an ACO

[kmjmw]

I agree that certain testing should be limited depending on the patient. However, I also agree that thorough testing does build a better relationship between physician and patient. If the patient feels like they are being well taken care of it will improve their attitude and overall experience when visiting a physician. For example, if a patient has gone through various testing, there is a good chance that they will listen to their doctor if he or she recommends making changes to improve life quality whether or not the tests came back positive or negative.
It also depends on the patient to a certain extent. Some people will want full testing done and others might not want to in fear of a false positive because at the time they feel fine. It comes down to relationships and communication. A great physician will know how to cater to their patients and make decisions that will not only keep them healthy but also produce the best level of well-being.

[lamininerelatedvideos]

I am now your fan, Dr. Evans.... Thank you so much for this wonderful information. Will be following your posts.

[bkharpal]

Thanks you Sir for a very informative and thought provoking article

[lizmcbride]

I personally feel the more screening tests, the better. Screening tests help to catch early signs of health issues and they are great for providing peace at mind for patients. Early detection, along with treatment, can produce better outcomes and lower the risk of dangerous or severe complications. In the case of mammograms, women who receive false positives and have invasive procedures and further tests should be more relieved than upset when they find out they do not have cancer. I would much rather be safe then sorry. As for women who received false negatives, they would've most likely received a false negative if it was a normal screening test or if they were looking for breast cancer specifically. It is certainly unfortunate that many tests have false negatives and false positives, but not giving screening test at all won't make those issues disappear AND it will put symptom-less people with major diseases at high risk of not detecting them early enough.

[rachelperkins]

I agree that preventative health and teaching patients how to care for themselves properly is more efficient than taking the time to do so many screenings on a regular basis that have ample room for false positives. Not only do these tests cost a lot, but receiving a false positive can cause unneeded stress and panic in patients. If someone is at a high risk for developing cancer, heart disease, diabetes etc., I think there should be relatively regular screenings to make sure all is well, but it is also the patient’s responsibility to take care of themselves and also monitor their own health along with the help of their doctor. To create a better working and more accurate health system, patients must be willing comply to doctors orders for preventative health measures, and doctors must be willing to get to know their patients’ histories and risks for developing certain ailments.

[emilyjohnson]

I am doing a case study for health care ethics. In our case studying we are talking about the newborn screening tests on infants when they are born. I looked into it and the case of the one test could save only 4 lives in a year on average. Its not always a hundred percent that the test will be accurate. that being said, sometimes there is misdiagnosis. In certain cases, people become overly stressed for something that they might not even have. In other cases, people could receive negative results for something that should be positive. Overall though, theres nothing wrong with screening tests. Early detection saves so many lives.

[emilyl]

I think this issue is very important in healthcare right now. Especially since the new recommendations went into place for women getting mammograms. However from previous knowledge and the information provided in this video I do think screening should not be increased, unless there are previous risks, or knowledge of family members that have had diseases that could be passed on, or of course if the person chooses to have them done based on personal beliefs. There are so many false positives that can occur, which can lead to unnecessary treatments that could put stress on a person. Unless these false positive problems are fixed with new technologies, I think screenings should either be lessened or continued as they are now. I do see how recommended screenings by a doctor can improve the patient-doctor relationship, however I think this can be done in other ways too. If we start focusing on prevention more and lifestyle changes, many of these diseases the screenings check for would probably decrease.

[Nat-us]

I have always been an advocate of health screening tests, but after hearing some of the drawbacks mentioned in this video, I am not so sure anymore. Obviously I understand that there are certain screening exams that are important like Pap smears and mammograms and colonoscopies, but I thought that more screening exams equaled better health. I had not taken into consideration the impact that more screening exams might have on the patient’s mental health. Now that I think about it, I can recall various instances in which my own family members have been worried and had a lot of anxiety before and after having a screening test done. I also did not really realize how common it is for these tests to give false negatives or false positives. I think that by not overdoing it with screening exams, practitioners are upholding the medical ethics principle of non-maleficence, in which healthcare providers strive to not cause harm. In the case of a young woman with a lump in her breast and an abnormal mammogram finding, it could lead to more invasive tests just to prove that she did not have anything. While I understand that it is very important to get breast lumps looked at by a healthcare provider, I can only imagine the emotional anguish someone must feel while going through all these steps and the anxiety they experience while awaiting results. I certainly believe that periodic routine exams are essential for catching and treating disease early on, but there is a balance that needs to be achieved. I really like that in the video he emphasized the importance of lifestyle factors. Living and encouraging a healthy lifestyle is the best medicine because it can prevent so many diseases. I also like that he emphasized that those with certain risk factors should be screened more frequently due to a higher likelihood of developing a disease. I can’t help but wonder if this would cause even more worry for patients as they await results because they know they are more prone to have a disease. Multiple people in my family have had colon cancer and I know that getting a colonoscopy is a very stressful event for my mom and my uncles because of it. Like I stated previously, it seems like there needs to be a balance when it comes to medical screens and it is up to the physicians to decide what will be most beneficial for their patients. I also think that reassuring and comforting the patient throughout the process is also really important. Learning how to be compassionate and a good communicator can help ease any fear that patients might be experiencing while awaiting results from a medical screening test.

[ariana]

I understand why doctors would lessen the amount of tests patients are receiving because of all of the false positives and inaccurate reading they are receiving, but I believe each patient is different. Like DocMikeEvans said each patient needs there own set of testings. If a patient has a high risk of breast cancer in their family, of course they should be tested more regularly than a patient who does not have high breast cancer in their family. I believe each patient should be treated as an individual, if the testings make the patient more comfortable and worry less, than they should stick with the regular screenings and testings. If the patent does not have any symptoms or any family genetic make up for the disease, and have a good peace of mind about not getting tested, then they should be able to chose to have less testings. With this kind of communication, patient-doctor relationships will become stronger. Communication is key, and it matters how the patient feels. If they believe they have control over their bodies, and can work along side their doctor they will feel more comfortable with decisions made.

[paramedicpete]

Has anyone ever told you Mike, that you sound a bit like Bill Murray?

PS. Great videos!

[Prabulous]

I have a contrarian view. I believe tests are important to establish a baseline...to me that's just a common sense scientific view. I've run into countless situations were the Dr doesn't know what's normal for me and compares me to the average... And has provided bad advice. Family dr refuses to do physicals so I pay for my health elsewhere. Life is too important to let policy and statistics drive my health care... particularly when the health community keeps changing it's mind on what's right.

[lilyw]

I agree, you shouldn't be getting tests done if you are at low risk. These screenings can cause more harm the patient especially if they are misdiagnose. Ther is no reason to be tested for things if they don't even apply to you.

[reclusejoxie]

Wow, super cartoon video, I love it.

[kaitlynlipinski]

I personally think that the amount of tests patients receive should be lowered. There are to many unnecessary test done that in the end may end up just scaring patients. Such as the Breast cancer test mentioned, there are false positives to many tests and in some cases patients are such low risks for diseases that unless there are symptoms the test isn't needed. If there is a family history or and indications then the doctor should definitely recommend these tests, but other than that I agree with the vide more is not always better. Between false positives and even in some cases a misdiagnosis these tests can be causing more harm than good to the patient. The stress from waiting for results to a wrongful diagnosis of something such as breast cancer can turn a patients life upside down. The specific tests mentioned all have a good amount of false positives, so until the tests are more accurate they should not be done unless they are completely necessary.

[delicee]

I believe that the amount of screening should no be increased. Many can result in false positives causing patients to undergo unnecessary procedures. However if one does have family history of a disease know to be passed on, the test required to check for this disease should be given.

[wednesdayschild]

I am not sure those vitamin trials are good. There is a big difference in quality. Food is not fresh.

[bdogmusician]

I disagree when it comes to more testing. Obviously you wouldnt want a PSA test when you are 26 but you should consider an NMR, GGE, TGE or VAP test (no longer available) if you have family history of heart disease or diabetes as a basic lipid panel is inaccurate 65% of the time. Also with just a TSH or Vit D 25 OH you're getting a small portion of a MUCH bigger picture. If you are a doctor that just needs time for a 5-8 minute consultation so you can reach your bonus with your ACO then basic screening makes sense at the expense of your patient. Imagine saving a life with more testing versus trying to convince people that there's nothing wrong. You risk more credibility and risk more financial benefits from your patient who could've been helped with an LP(a) or HDL2b or ApoA1 test. Now your patient is dead and you passed on multiple years of flu shots, referrals, testing, etc. You shouldn't look at it as just being financially beneficial but also rewarding as a care giver.I love your videos and I find them very informative as well as greatly well made. But I will say that Canada yanked Vit D testing which has been linked to heart disease in multiple studies so its probably better if you don't find it necessary in most cases.