Clinical examination: Is it necessary to undergo regular medical examinations
Against the boom of a healthy lifestyle Gaining momentum and popularity of regular medical examinations among people who, in essence, nothing bothers. The purpose of such examinations is to determine the state of health, as well as at early stages to identify dangerous diseases, the treatment of which is better not to delay. We asked two doctors whether it is worthwhile to regularly conduct health checks, when they are not necessary, and when they are completely contraindicated.
What is a clinical examination and checkout
Previously, Russia conducted medical observation and treatment of certain groups of patients with a particular class of pathologies (tuberculosis, cancer, skin and venereal diseases). Observation was conducted on the basis of institutions specializing in the treatment of these diseases - dispensaries, hence the word "clinical examination". Now, it seems to me, the term is not quite correctly transferred to the medical observation of the health of the entire population. In addition, this observation is made not in clinics, but in ordinary clinics. The idea of a general medical examination is based on this concept: the early detection of a non-communicable disease improves the results of its treatment. In addition, medical examiners hope to identify, for example, precancerous diseases, the treatment of which should prevent cancer.
Now, along with the concept of clinical examination, the concept of "check-up" is actively used, and in fact it does not differ from medical examination. Chekap - is a set of surveys, which is intended to reduce mortality from non-communicable diseases: primarily from cancer and diseases of the cardiovascular system. In fact, these concepts are almost synonyms, in any case, in the sense in which the word “clinical examination” is used in the order of the Ministry of Health, which governs its implementation.
The difference lies in the approach: a clinical examination is aimed at the entire population, and this is a program that is paid for by the state, and check-ups are an individual decision of the patient. At the same time, there is no talk of "chekapizatsii" the whole country: the check-ups are carried out mainly on the basis of commercial clinics, and the patient himself pays for them. As a rule, the check-ups and medical examinations that Russian clinics and clinics offer are not individualized (or very poorly individualized - according to the criteria of age and sex). Moreover, often a check-up is a position in the price list, which is not subject to any changes depending on the patient, except that in some clinics they offer to undergo some variant of “economy” or “super-elite plus”, which, as is clear of the titles, has nothing to do with medicine.
How to figure out whether to check health
I am convinced that the doctor should conduct the check-in, not the patient. It is the doctor who determines the necessary and sufficient scope of examinations and only the doctor treats them further. Of course, none of the diagnostic methods exclude false-positive and false-negative results, but here the question is rather in the selection of the correct method of examination. Scientists around the world are engaged in the search for such research, which at the same time will be sensitive enough to detect the disease, and specific enough to not get false results.
An example of such a method is the determination of antibodies to HIV. Today, the techniques are very sensitive and quite specific, because in this case, to get a false diagnosis is a powerful psychotrauma. Regardless of the nature of the suspicion, symptoms or diagnosis, the most appropriate method of examination should be prescribed by a doctor. If the patient himself goes to the clinic or laboratory, prescribing himself an examination, then, with a high probability, he simply throws money down the drain.
How to understand the feasibility of the check in each case? It makes sense to conduct a health survey depending on what you want to find. You need to look for something specific - something that can then be cured or what can be significantly affected. It is a waste of money to look for illnesses that are poorly treated at any stage. In addition, any diagnostic intervention can be harmful - for example, in the form of false-positive or false-negative diagnoses. False positives are followed by unnecessary further examinations, and often costly and dangerous treatment. False negative diagnoses lead to false peace and lack of necessary treatment. Another important factor is the likelihood of finding a disease that you plan to find. If the likelihood that you are ill is lower than the risk of complications from the examination itself, then such an examination is inappropriate.
The conclusion is this: it is necessary to determine the risks of the disease before looking for it, and this depends on a number of factors. Individualization of the checkout includes quite complex algorithms that are difficult to state in a simple answer to the question: "How can I be examined?" For this we have invented a system that automatically answers this question to anyone who wishes. It is called SCREEN (Scientifically-based Cancer Risk Evaluation Engine). This is an online test in which you quickly answer a series of questions and, if necessary, clarify the answers. According to the test results, SCREEN offers you a list of necessary examinations and their frequency in accordance with the recommendations of major international societies adapted for use in Russia.
What is included in the planned cardiac examinations
Many of our patients love to prescribe their own echocardiography, based on the belief: "Ultrasound will show that I have a heart." In fact, echocardiography is a very highly specialized examination that answers very specific questions: is there a heart disease, is there a heart failure. It is not used for routine surveys of people without evidence. Healthy people will get more trouble and feelings from echocardiography than benefits: for example, many people can find mitral valve prolapse or bicuspid aortic valve - completely innocent versions of the norm with which a person is born and lives for many years. But, having found these features, the patient begins to worry, go to the doctors and try to cure what is not necessary to treat.
In the case of diseases of the cardiovascular system, a much more effective method of early diagnosis is an examination by a therapist, that is, a general practitioner, blood pressure, body weight, glucose, and lipid metabolism. These are simple and very cheap studies that allow you to determine the risk of cardiovascular disease and the need for further action.
There is a category of people who begin to regularly go to doctors and independently do computed tomography, magnetic resonance imaging (MRI), endless ultrasound examinations. They spend a lot of money and ultimately even find what they really do not need to be treated. Such behavior can be a sign of anxious-hypochondriac neurosis, which is based on a pathological fear of getting sick. Such disorders should be treated by psychotherapists. On the other hand, these patients are not immune from coronary heart disease, so routine examinations, such as monitoring blood pressure, measuring blood glucose and so on, will definitely not harm them.
Should I regularly do oncological checkup
The concept of the benefit of early detection of cancer is true only for some groups of the population and only under special conditions: compliance with the quality of examination, quality control of subsequent treatment and a number of factors. Applying the same set of surveys to wide groups is an obvious insanity. In addition, it is noticeably harmful to those who do not need a survey. With genetic tests the same. Do you have many relatives who have cancer? Few relatives who were sick, but they got sick at a young age? This means that the probability of a malignant mutation is high. But in this case it is worthwhile to first go through the consultation of medical genetics: he will tell you exactly what method to analyze. Otherwise, a survey is equivalent to finding a needle in a haystack: you will find a lot of unnecessary things, but whether you find a needle is not a fact.
Clinical examination or checkup is important, but you should always keep in mind the balance of harm and benefit. Yes, there are a lot of people who will benefit from a preventive check-up, but a lot of those to whom it will do more harm. These are mainly people who have low risk of disease. For example, more than half of those tested in our system do not receive any recommendations or receive one or two. And no you total "checkup".