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Full Disclosure on Life Line Screenings

Posted Jan 21 2010 5:50am
Recently I wrote a post fairly critical of the Life Line Screening program. People pay $200 for a battery of screening tests which they may or may not really need and are then left to sort out the results with or without the aide of a primary care provider. My largest criticisms of this program is the shotgun approach they take with the assumption all testing is good testing and lack of clear follow up plans.

A man in his mid to late fifties came to see me recently after getting this screening done. He hadn't been in to see me in over a year despite his history of high blood pressure. His medication use was spotty and he had been off his anti-hypertensives for several months since I wouldn't refill them anymore unless he came in for an appointment. In addition to this, he was a former smoker and had never followed through with getting his cholesterol and blood sugars checked as I had requested. All in all he was not the most health conscious of men, but hardly atypical for my practice.

For some reason he decided to do this Life Line Screening program when it came to the local motel one weekend. It wasn't clear whether his wife dragged him to it or whether something happened in his life to make him really take stock of it. When he showed up in the office with results in hand a few days later we were happy to see his bone density test was normal (a completely superfluous test for this individual), but he had an abnormal carotid artery scan. On their green-yellow-red interpretation scale this was in the red. There was a note on the paper written in hand that he should follow up with his primary care provider to discuss what this meant.

I placed my stethoscope on his neck to listen to his carotid arteries leading to his brain for bruits, a sign of turbulent blood flow caused by severe plaque build up. To my surprise they clearly could be heard on both sides, one of which was clearly harsher than the other. I told him my concern about these plaques in his carotids being dislodged triggering a stroke and convinced him he needed to urgently see a surgeon to have the screening ultrasound confirmed and surgery if indicated. Two days later he was in he OR having one side of his neck done after it was confirmed he had a critical stenosis in one of these major arteries.

Is this vindication for Life Line Screening? In all likelihood this patient would have had a major stroke if he had not had this test done, but instead of singing Lifeline's praises I would say this is more of a failure of primary care and personal responsibility. If this man had presented for routine follow up for hypertension as I'd asked, I would have picked this up then since it's part of my standard exam for patients with high blood pressure for people in their fifties and older, but he hadn't for whatever reason. If our office had better systems in place to hound people to come in who needed follow up perhaps we wouldn't have been off his medications for so long. In a well designed and organized health care system it is the Life Line Screening Programs and not the tests they run which are superfluous.

There, full disclosure.

The Country Doctor
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