Medical EducationPublic Health Education or Indoctrination?

2 Mins read

Ever heard of It’s a web site from the US Department of health and Human Services

Ever heard of It’s a web site from the US Department of health and Human Services

where you will find information and tools to help you and those you care about stay healthy.

Sounds like a laudable goal, right? Great! Now, help me! Here is the “help” that I found when I went to the page called “Colorectal Cancer Screening: Questions for the doctor”:

What do I ask the doctor?

It helps to have questions for the doctor written down ahead of time. Print out these questions and take them to your next appointment. You may want to ask a family member or close friend to come with you to take notes.

So far so good. But here is the list that follows:

  • What puts me at risk for colorectal cancer?
  • When do I need to start getting tested?
  • How often do I need to get tested?
  • What screening test do you recommend? Why?
  • What’s involved in screening? How do I prepare?
  • Are there any dangers or side effects involved?
  • How long will it take to get the results?
  • What can I do to reduce my risk of colorectal cancer?

Note the wording: “When do I need to start getting tested?” “How often do I need to get tested?” And these “needs” come well before the “why?” In fact, the “why” never really comes. The oblique “why” about which test is recommended is too little too late. The real “why” is why, or even whether, I need to get tested in the first place. I am happy to see a question on the dangers of screening, but again it leaves plenty of room for the clinician to minimize and patronize.

The list of questions is built upon one (erroneous) assumption: Everyone is bound to perceive the risk-benefit equation of colorectal cancer screening the same way. We know this is false, and each person needs to make an individual decision based in what we know today and according to the values he/she places on the outcomes. The way the questions are written, they simply reinforce the bullying attitude of the screening bias, making those who swim against this tide feel irrational and unreasonable. But may I point out that some of us spoke out against universal mammography screening even before it became the main-stream recommendation? So perhaps there are good reasons to be more cautious with screening for everything, even colon cancer.

Science evolves, our knowledge evolves. What we think we know today will be modified tomorrow. I take a strong exception to this dogmatic and one-sided formulation of how to have a discussion about testing whose risk and benefit profile may not (and should not) elicit the same unbridled enthusiasm from everyone. So please,, rethink your “helpful” questions so as to educate, rather than indoctrinate.

Hat tip to @DCPatient for pointing me to this page  

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