16th Nordic Congress of General Practice.Copenhagen, Thursday 14th of May 2009.

Preventive medicine.Oral presentation- session 08

“Couldn’t you have done just as well without the screening?”

• Karen-Dorthe Bach Nielsen, Ebeltoft, Denmark.• Lise Dyhr, Copenhagen, Denmark.• Torsten Lauritzen, Ebeltoft and Århus, Denmark.• Kirsti Malterud, Bergen, Norway.

Karen-Dorthe Bach Nielsen, General Practitioner.Ebeltoft, DenmarkE-mail: karen-dorthe.bach.nielsen@dadlnet.dkHomepage: www.elh.dk

• Health screening in general practice

• Benefits from the screening

• As it is perceived by people with low cardiovascular risk score.

• Qualitative study

“Couldn’t you have done just as well without the screening?”

One part of a qualitative interview project about beliefs and attitudes related to health screening in general practice.

No, thank you!High risk Low risk – this presentations

The basic population for the qualitative interview-project.

• The Ebeltoft Health Promotion Project.• A multiphasic health-screening project in general

practice. • 904 Danes.• Men and women.• 30-50 years.• Baseline, 1, 5 and

15 years.

Screened for – among others:

• Risk factors (BP, bs, cholesterol, smoking)• Hb, ecg• Hight, weight (BMI)• Hearing,sight• Liver-, lung- and kidney• Urine tests

A calculation of cardiovascular risk score

• Sex• Family members with AMI < 55 years• BMI• Blood pressure • Cholesterol • Ciagrettes/per

• Low/Moderate• Increased/High

• Written feed back.• “You are in a low risk of having a coronary".

8400 Ebeltoft

“Couldn’t you have done just as well without the screening?”

• Men (7) and women (15) = 22 screened • 36-50 years, • Written feed back – twice – 1 year apart:

“You are in a low risk of having a coronary".

Family members with AMI < 55 years, cigarettes/day,

sex, BMI, blood pressure, cholesterol.

Low risk

Interview – audio taped

• Why participate …

• Your test results ……

• Used it how and/or for what …..

• Your health ……….

• Your opinion on health promotion …..

• Focus on how persons with an low cardiovascular risk score perceive the benefits from, the health screening.

“…… just as well without the screening?”

Preconception: Hard-hitting message

Results – summary: • Confirmed their feeling of being in good health• This acquired peace of mind were important• Eliminated worries • Confirmed lifestyle up to now• No guarantee • Price:

– Further examination– Unfulfilled expectations

“…… just as well without the screening?”

Considered them self healthy (1)

The results • Not present i their everyday life• But in the back of their mind

Rembered• Nothing seriously wrong• Each - paid attention to specific factors

Low risk

Considered them self healthy (2)

• Cholesterol– debated in the media– ... could easily be high

• Lungfunction – got out of breath when exercising

• Liver count – enjoyed a glass of wine

Low risk

Considered them self healthy (3)

• Not surprised at all

• Before the screening – felt healthy

• Expected the result to be allright

Low risk

Couldn’t you have done just as well without the screening?” (1)

• No!

• Prompt!

• Sharp!

• A little hurt!

• Surpriced

• How dare you ...?

Low risk

Couldn’t you have done just as well without the screening?” (2)

• No reason to believe that there was anything the matter BUT:

Sinks more in when an expert give his opinionConfirmed own judgement Approaces the age of 50 - greater risk

Low risk

• 45-year-old nurse.. "I expected my health would prove good, but you also know that the margins are so small, my blood sugar could easily have been 7 and then what? … even though there weren’t any symptoms yet. It’s hard to say you can just opt out …. and believe in your own judgement…you partly can…but superfluous, no, I don’t think it is…” .

No more worries (1)

• A good feeling– Nice, lovely, a relief, a reassurance

• Good to get rid of worries– Cholesterol, – Fitness, – Family health problems– Additional problems to chronic illness

Low risk

• A cheerful 38-year-old woman: “I just thought it would be terrible, I weigh too much and sit on my backside day in day out. I’ve never had anything the matter, but people in my family have died of cancer or coronaries. I was at no risk or low risk. I think that was lovely, I wouldn’t mind going again... “

• “Woman with neck-problems..... instead of using energy on speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.”

No more worries (2)

• Put emphasis on the acquired peace of mind

• Now - no need to make changes– Go on smoking– No further exercise

• An endorsement - serve and eat the right things

Low risk

Price to pay for the reassurance (1)

• Risk of being over-complacent

• Not necessarily remain healthy

• Could be something the matter elsewhere

Low risk

Price to pay for the reassurance (2)

• Haematuria – further examintions• False sense of security

• “... it gave me reassurance to be part of the project, where I sort of felt, oh good, now something’s happening ... ... so since then I’ve felt that this health project has given me a false sense of security ... but of course things can arise in the meantime, but...to put it crudely, I expected that I would be kept an eye on ... as if it was a form of safety net ...”

Low risk

Promices:

• Before the screening– Aware of the possibility of bad results– If something wrong - it should be put right – If results were normal in spite of too much

sugar, pastries or wine – I`ll take up a healthy lifestyle

Low risk

Considerations:

Positive:The acquired peace of mind

Feeling of relief

Conformation own sense of being healthy

Worrying?:Young people – knowing they are healthy –need an experts conformation.

Low risk

.... the endDead certain tests

You can damn well piss off again! I've just sacrificed both time and money on a whole bunch of tests...and they all showed I was 100% healthy!

More and more Danes undergo preventive health tests, while the number of tests on offer, both traditional and genetic, are rapidly increasing

Ugeskr Laeger. 2007; April, 169: 1637-1744.

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“Couldn’t you have done just as well without the screening?”

• Karen-Dorthe Bach Nielsen, Ebeltoft, Denmark.• Lise Dyhr, Copenhagen, Denmark.• Torsten Lauritzen, Ebeltoft and Århus, Denmark.• Kirsti Malterud, Bergen, Norway.

Karen-Dorthe Bach Nielsen, General Practitioner.Ebeltoft, DenmarkE-mail: karen-dorthe.bach.nielsen@dadlnet.dkHomepage: www.elh.dk