Screening Boom

While Health Screenings Proliferate, the Number Of People Getting the Right Ones Isn't Keeping Up

Orlando Sellers found out he had high blood pressure while posing as a patient for a videotape being made by the Department of Veterans Affairs.

"I didn't know. But when the doctor took my blood pressure, it was extremely high -- 189 over 112," said Sellers, a 58-year-old human resources specialist at the VA Medical Center in Washington. "He said, 'That's high, let me check it again.' It was the same."

Despite strong evidence that tests like a blood pressure check every two years are worthwhile, barely 50 percent of U.S. adults receive the diagnostic and preventive screenings that many medical experts recommend. Several factors explain why many Americans remain unaware that they have hypertension, colorectal cancer, high cholesterol and other lethal conditions: the proliferation of recommended tests, doubts about the value of some once-standard exams and time demands that keep many doctors from performing systematic screening.

What to do? Experts say people should find a doctor who will schedule screenings as they become due -- or they should take over the scheduling themselves.

Too Much of a Good Thing?

The merits of early detection and prevention of disease became especially clear in the 1950s and '60s, when childhood immunizations nearly eradicated a number of diseases, including measles.

This success has had an ironic side effect: "As we have more entrenched screening, the risks seem less imminent, less of an immediate threat," said Amy Compton-Phillips, Kaiser Permanente's physician director for care management in Rockville. As a result, "it's harder to convince healthy patients that a screening is important."

Today's physicians are encouraged to screen patients for literally hundreds of conditions and diseases. This advice comes from specialists, from groups such as the American Cancer Society and from such respected standard-setters as the U.S. Preventive Services Task Force, a panel of experts that evaluates many components of primary care. The American Academy of Family Physicians endorses most of the task force's 20 or so screening recommendations -- and adds about 30 more. (For details, see http://www.ahrq.gov/clinic/uspstf/uspstopics.htm and http://www.aafp.org/x24996.xml .)

A further complication: The task force sometimes downplays screenings -- like breast self-exams and the prostate-specific antigen (PSA) test for prostate cancer -- that the medical establishment once supported enthusiastically.

The Doc and You

The annual physical, long associated with a standard battery of tests that almost always produced a bill of good health, has fallen from favor in an era of managed care, evidence-based medicine and too-too busy physicians.

When David Sobel, a Kaiser Permanente physician, started practicing medicine 25 years ago, the routine exam was, well, routine. "Patients were tested annually -- chest X-ray, EKG, blood tests," he says. "But what it did was falsely reassured people and distracted them from the real things, much bigger things that have an impact on health, like stopping smoking."

Kaiser Permanente now stresses a preventive medicine package that varies based on each patient's age and sex. People with chronic conditions such as diabetes and hypertension get extra monitoring. "The notion that one size fits all is not appropriate," Sobel said.

This individualized approach calls for patients to play a larger role in their own care. Since learning of his high blood pressure, Orlando Sellers has enrolled in a pilot version of My HealtheVet, an Internet-dependent program that allows him to react quickly when he senses he may have eaten too much chocolate, fried food or soda.