Interview: Ksenia Rabinovich
Amid the boom in healthy lifestyles gaining momentum and popularity of regular medical examinations among people who, in fact, do not care. The purpose of such examinations is to determine the state of health, as well as to identify dangerous diseases in the early stages, with the treatment of which it is better not to delay. We asked two doctors whether it is worthwhile to regularly conduct health checks, in which cases they are optional, and when they are completely contraindicated.
What is medical examination and checkup
Oncologist, Executive Director of the Cancer Prevention Foundation
Previously, in Russia, medical observation and treatment of certain groups of patients with a certain class of pathologies (tuberculosis, cancer, skin and venereal diseases) was carried out. Observation was carried out on the basis of institutions specializing in the treatment of these diseases - dispensaries, hence the word "medical examination". Now, it seems to me, the term was not quite correctly transferred to medical monitoring of the health of the entire population. In addition, this observation is no longer carried out in dispensaries, but in ordinary polyclinics. The idea of general medical examination is based on the following concept: early detection of a non-communicable disease improves the results of its treatment. In addition, the organizers of the medical examination 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. Checkup is a set of examinations, which, according to the plan, should reduce mortality from non-communicable diseases: primarily from cancer and diseases of the cardiovascular system. In fact, these concepts are almost synonyms, at least in the sense in which the word "clinical examination" is used in the order of the Ministry of Health, which regulates its implementation.
The difference lies in the approach: clinical examination is aimed at the entire population, and this is a program that is paid for by the state, and checkups are an individual decision of the patient. At the same time, there is no question of “check-up” of the entire country: check-ups are carried out mainly on the basis of commercial clinics, and the patient pays for them. As a rule, checkups and medical examinations offered by clinics and polyclinics in Russia are not individualized in any way (or very weakly individualized according to age and gender criteria). 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 go through some kind of "economy" or "super-elite-plus" option, which, as is clear of the titles, has nothing to do with medicine.
How to know if you need a health check
Cardiologist, Candidate of Medical Sciences, Associate Professor of the First Moscow State Medical University. I. M. Sechenova
I am convinced that the doctor, not the patient, should conduct the check-up. It is the doctor who determines the necessary and sufficient scope of examinations and only the doctor interprets them in the future. Of course, none of the diagnostic methods excludes false positive and false negative results, but here the question is rather in the selection of the correct examination method. Scientists around the world are looking for studies that are both sensitive enough to detect a disease and specific enough not to 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 receive a false diagnosis is a powerful psychotrauma.Regardless of the nature of the suspicion, symptoms or diagnosis, the most appropriate examination method should be prescribed by a doctor. If a patient himself goes to a clinic or laboratory, prescribing an examination for himself, then, with a high probability, he simply throws money away.
How to understand the expediency of a check-up in each specific 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 that can be significantly influenced. It is a waste of money to look for diseases that do not heal well 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 expensive and dangerous treatments. False negative diagnoses lead to false calm and lack of treatment. Another important factor is the likelihood of detecting the disease that you plan to find. If the likelihood that you are sick is lower than the risk of complications from the examination itself, then such an examination is not advisable.
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. The individualization of the checkup includes rather complex algorithms that are difficult to summarize in a simple answer to the question: "How can I be examined?" To do this, we have come up with a system that automatically answers this question to anyone. It is called SCREEN (Scientifically-based Cancer Risk Evaluation Engine). This is an online test in which you answer a number of questions rather quickly and, if necessary, refine the answers. Based on the test results, SCREEN offers you a list of necessary examinations and their frequency in accordance with the recommendations of the largest international societies, adapted for use in Russia.
What is included in planned cardiac examinations
Many of our patients are very fond of prescribing echocardiography on their own, based on the belief: "Ultrasound will show what is wrong with my heart." In fact, echocardiography is a very highly specialized examination that answers very specific questions: is there a heart defect, is there heart failure. It is not used for routine screening of people without indication. Healthy people will get more trouble and worries from echocardiography than benefit: for example, many people can be found to have mitral valve prolapse or bicuspid aortic valve - completely innocent variants of the norm with which a person is born and lives for many years. But, having discovered these features, the patient begins to worry, go to doctors and try to cure what does not need to be treated.
In the case of diseases of the cardiovascular system, examination by a therapist, that is, by a general practitioner, measuring blood pressure, body weight, glucose levels, and lipid metabolism indicators are much more effective methods of early diagnosis. These are simple and very cheap studies that 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 end up even finding something that doesn't really need to be treated. This behavior can be a sign of anxiety-hypochondriacal 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 to coronary heart disease, so routine examinations, such as blood pressure monitoring, blood glucose measurements, and so on, will certainly not harm them.
Is it worth it to regularly make an oncological check-up?
The concept of the benefits of early detection of cancer is true only for some population groups and only under special conditions: adherence to the quality of examination, quality control of subsequent treatment, and a number of other factors. It is sheer insanity to use the same set of surveys for large groups.In addition, it is noticeably harmful to those who do not need the examination. It's the same with genetic tests. Do you have many relatives with 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, you should first consult a medical geneticist: he will tell you what exactly and by what method to analyze. Otherwise, the survey is tantamount to looking for a needle in a haystack: you will find a lot of unnecessary, but whether you find a needle is not a fact.
Clinical examination or check-up is important, but you should always remember about the balance of harm and benefit. Yes, there are many people who will benefit from a preventive examination, but there are also many who will benefit from it more. These are mainly people who have a 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 total "check-out" for you.