I worked in a retail pharmacy that offered regular health screenings; vision, hearing, skin cancer, and so on. During one of the events, a dermatologist was very busy examining a long line of people wanting her to look at their “spots”. I overheard many of the conversations and most of the exams ended with the doctor stating, “we ought to do a simple biopsy and a lab test” – or something like that.
During a break, I asked the doctor why such a high percentage of the visitors needed further testing. She explained that most people are excellent at identifying that something isn’t “right” with their health. The screening is an opportunity to have someone take a look and support their personal diagnosis – or calm their fears. While the doctor told me she would rarely tell someone they actually had a cancerous spot, she felt very comfortable helping the person decide to move forward and do something more about their concerns.
Skin cancer affects approximately three million people – a little over 1% of the U.S. population. In the screening above, over 75% recognized their own suspicious spots and were referred for more testing. People came to the screening because they already thought something was wrong.
Hearing screenings are similar. The overwhelming majority of visitors tested poorly and were referred for more advanced testing. Approximately 2% of the US population suffer hearing loss and, again, more than 50% of the participants in the screening had measurable hearing changes.
Screening participants already suspect there was something wrong.
It’s clear that people know themselves and their bodies far better than any third party could. They know when “something just isn’t right.” While their personal evaluation might require attention, it takes a special effort to make that appointment with a doctor to validate those concerns. The person might conclude their concerns are just as likely that the doctor visit might show there’s nothing wrong and that the problem will go away on its own. That’s good news. On the flip side, it cost the person money and time.
Rather than waiting for a screening event – and there seem to be fewer of them these days – how might we learn to trust our own instincts and seek health advice when we think we have a problem?
The standard approach is to insist that everyone undergo an annual physical examination – even when nothing seems to be wrong. When done often, those regular exams are likely to find something that can be “fixed.” Instead of honoring the overwhelming success rate of self-diagnosis, our official approach is to encourage everyone to subject themselves to testing until something is discovered – and then return to the health system on a regular basis to keep up with the situation.
Simultaneously, there are numerous people who honestly believe they have a problem that routine tests don’t discover. That should be the trigger for medical intervention, not the battery of random tests ordered at every annual checkup.
Worse yet, the standard testing announces that the patient is wrong and that their health is fine – because some test results are “normal”.. This seems to be the situation when it comes to thyroid problems.
Millions of people – especially women – know deep down that something is wrong yet the gold standard test result (TSH levels, when it comes to the thyroid) is WNL (within normal limits). The doctor is happy that the test results are okay but the patient sad because they continue to feel like dirt and exhibit every symptom associated with low levels of thyroid.
That’s a dilemma. In one case, people who feel fine are poked and prodded on a regular basis until something is discovered that can be treated – usually for the rest of their life. At the same time, there are other people who know they’re sick but the lab tests don’t support it. One group gets treatments that make them feel worse, and the other group is denied treatments. Something is out of balance and it seems we need to do something. Quickly. My approach is empowering patients to trust themselves – even when the doctor disagrees.