Beware the worried well

By BBC Doctor Colin Thomas

Health checks are good for you, or at least that's what you could be excused for thinking if you look at the plethora of advertisements for well person checks.

The premise is that well people should be informed about their health - and quite right too.

But I'm not convinced that health checks add anything significant to health, in fact in certain circumstances they might actually detract from overall health and contentment.

Such checks are big favourites of a category of patients we might refer to as the 'worried well'.

This encompasses patients who are constantly concerned about their health, sometimes referred to as the 'inverse care law' which states that those patients who use healthcare the most actually need it the least.

You can tell who fits into this category because they always ask what their blood pressure is each time it is taken, and are overcome with worry if it isn't plum normal.

The following case shows how a happy and contented person can be transformed into a 'worried well'.

I have a friend who a few years ago was offered the opportunity of a yearly prostate specific antigen (PSA) screening blood test.

He assumed it would be a good thing to do, but the potential pitfalls were not explained to him at the time.

He now assures me that had he known what he was in for he would have politely declined.

Things went wrong

All went well the first few times he had it checked, however the third time the PSA value was slightly raised.

He then realised that this test was not so much a yes/no as a no/possibly/probably, and once a borderline reading occurred then more nasty surprises were in store.

He was advised that he needed a prostate biopsy, which, gentlemen, if you consider the anatomy for a brief second is quite an eye watering experience.

To his subsequent annoyance he discovered that a prostate biopsy would not necessarily put the matter to bed because a small tumour on one side of the gland might be missed by taking the biopsy from the other - and yes you've guessed it - he would need to have more regular blood tests.

By this time he was frantic with worry. In some respects he felt that once he had started the process he should carry it through, but the prospect of the same worrying time every year or so was too much for him to bear.

The spectre of a biopsy would probably hang over him every time, so he decided, in consultation with his GP, to walk away from the whole process.

And in what I thought was an inspired observation he said "You know Colin, PSA actually stands for prolonged stress and anxiety!"