Presenters or Patients? A Crucial Distinction in Individual Health Assessments
Individual health assessments (IHAs) for asymptomatic individuals provide a challenge to traditional distinctions between patient care and non-medical practice. They may involve undue radiation exposure, lead to false positives, and involve high out-of-pocket costs for recipients. A recent paper (Journal of the American College of Radiology 13(12): 1447–1457.e1, 2016) has criticised the use of IHAs and argued that recipients should be classified as ‘presenters’, not ‘patients’, to distinguish it from regular medical care. I critique this classificatory move, on two grounds: one, it is conceptually suspect. Two, it obviates the medical ethics framework for IHAs, potentially exposing recipients of IHAs to lower standards of oversight and protection. Responsible regulation of IHAs will be easier to ethically justify if those seeking IHAs are considered patients and not merely presenters.
KeywordsIndividual health assessments Asymptomatic screening Computed tomography Medical language Medical ethics
- Brewer, Noel T., Talya Salz, and Sarah E. Lillie. 2007. Systematic Review: The Long-Term Effects of False-Positive Mammograms. Annals of Internal Medicine 146 (7): 502. https://doi.org/10.7326/0003-4819-146-7-200704030-00006.CrossRefGoogle Scholar
- Chin, J.J. 2001. Doctor-Patient Relationship: A Covenant of Trust. Singapore Medical Journal 42 (12): 579–581.Google Scholar
- Croswell, Jennifer M. 2010. Cumulative Incidence of False-Positive Test Results in Lung Cancer Screening: A Randomized Trial. Annals of Internal Medicine 152 (8): 505. https://doi.org/10.7326/0003-4819-152-8-201004200-00007.CrossRefGoogle Scholar
- Illes, Judy, Dylan Kann, Kim Karetsky, Phillip Letourneau, Thomas A. Raffin, Pamela Schraedley-Desmond, Barbara A. Koenig, and Scott W. Atlas. 2004. Advertising, Patient Decision Making, and Self-Referral for Computed Tomographic and Magnetic Resonance Imaging. Archives of Internal Medicine 164 (22): 2415. https://doi.org/10.1001/archinte.164.22.2415.CrossRefGoogle Scholar
- Malone, Jim, Maria del Rosario Perez, Eva Godske Friberg, Mathias Prokop, Seung Eun Jung, Jurgen Griebel, and Steve Ebdon-Jackson. 2016. Justification of CT for Individual Health Assessment of Asymptomatic Persons: A World Health Organization Consultation. Journal of the American College of Radiology 13 (12): 1447–1457.e1. https://doi.org/10.1016/j.jacr.2016.07.020.CrossRefGoogle Scholar
- World Health Organization. 2009. Conceptual Framework for the International Classification for Patient Safety. http://www.who.int/patientsafety/implementation/taxonomy/icps_technical_report_en.pdf?ua=1.