Monday, May 15, 2006

I've got your number

"It's 5.8." I say to Robert Snell, back for his cholesterol result and BP check today.
"?" He replies.

(I've got to develop a better inerrogatory look, they're all doing it now!)

"Well," I expound, "the ideal is supposed to be 5.0 or lower, though the UK average I believe is around 5.7 still."
"?" Still obviously none the wiser.

Now, I don't really mind, but Robert is intelligent and has access to IT, AND came to ask for a cholesterol test in the first place. So why ask for a test if you don't know what you are going to do with the result?

We rehearse the implications of a high cholesterol level and review his diet. Fat intake seems fine, and he is actually counting the calories in an attempt to loose weight. His blood pressure remains a little high on minimal medication, but even with this his cholesterol level does not (according to our risk calculator anyway) give him a significant increase in heart disease risk. Having adjusted his BP meds we agree there is no value in treating his modestly elevated cholesterol and he departs, I hope, reassured.

It's an emerging trend this. People see that nice lady on the telly telling them to get their cholesterol done, or, for blokes, their wives do and tell them to get it checked. Up they come to request the test with no real thought for what happens next. It's as though having the test will, totem-like, remove all fear of cardiac disease for ever after, almost regardless of what the result turns out to be.

I'm not at all sure that blokes in particular use the knowledge they gain at all, unless it's as carte blanche to pop in to the nearest garage shop for that pork pie on the way home, since they have now had the test. Now Robert doesn't actually look the pork pie type, and anyway Linda will doubtless subject him to the third degree when he gets home, and she will almost certainly know more about it than he does.

But now at least he "knows his number".


Happystance said...

I am particularly irritated by campaigns like this. The BBC recently carried an item about the health illiteracy of UK adults. People are derided for 'not knowing their numbers' but there is a distinct lack of education as to why these numbers might be important and what their implication is - beyond chowing down on a wholewheat breakfast cereal, snarfing a field of oat bran, or taking your statins (OTC or prescribed).

It seems as if patients can be derided as the 'worried well' by some commentators for seeking tests in the absence of symptoms and derided by other commentators for their 'health illiteracy'.

You were there to give advice to your patient. How many people are using DIY test kits? I'm really complaining about over-simplified health campaigns. Exposing us to data and encouraging us to collect it does not transform it into information that is of relevance to us.

Best - Tony

Doctor Jest said...

Tony-- Absolutely. The other one that gets me at the moment is a prosrate (sic) test. Most blokes, again I suspect mainly sent up by their partners, turn up for a test at age 50. It seems the idea is a test at that age will cover a lifetime.

It won't. Also we have no nationally agreed screening programme for prostate cancer, and if we did I doubt it would kick in at age 50.

greavsie said...

I became involved in a heart study at St Thomas's's's's's' a couple of years ago. All my numbers were on the good side but it took a lot of understanding as to what it all meant.

Although I know I can hold a litre of Lucozaid for 30 mins without wetting myself.

Doctor Jest said...

Dr Greavsie sir-- So that's why London graduates all call it Tommies, bit of a bugger to spell otherwise!

Are you quite sure the lucozade thing was part of a study. These lab types have weird senses of humour you know.

Oh, and how's the cough?

vegas said...

Then we should fight back - just put all of our patients on statins without checking their cholesterol levels. That should stop them whining.

Doctor Jest said...

Vegas-- I'm all for them putting it in the water, oh no, hang on there isn't any left is there, how about the bread, no wait, better yet, put statins in the Pork Pies. That should do the trick.