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Preventive medicine. Oral presentation- session 08. 16th Nordic Congress of General Practice. Copenhagen, Thursday 14th of May 2009. “Couldn’t you have done just as well without the screening?”. Karen-Dorthe Bach Nielsen, Ebeltoft, Denmark. Lise Dyhr, Copenhagen, Denmark.

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16th nordic congress of general practice copenhagen thursday 14th of may 2009

Preventive medicine.

Oral presentation- session 08

16th Nordic Congress of General Practice.Copenhagen, Thursday 14th of May 2009.


Couldn t you have done just as well without the screening
“Couldn’t you have done just as well without the screening?”

  • Karen-Dorthe Bach Nielsen, Ebeltoft, Denmark.

  • Lise Dyhr, Copenhagen, Denmark.

  • Torsten Lauritzen, Ebeltoft and Århus, Denmark.

  • Kirsti Malterud, Bergen, Norway.

Karen-Dorthe Bach Nielsen, General Practitioner.

Ebeltoft, Denmark

E-mail: [email protected]

Homepage: www.elh.dk


Couldn t you have done just as well without the screening1
screening?”Couldn’t you have done just as well without the screening?”

  • Health screening in general practice

  • Benefits from the screening

  • As it is perceived by people with low cardiovascular risk score.

  • Qualitative study



The basic population for the qualitative interview project
The basic population for the qualitative interview-project. and attitudes related to health screening in general practice.

  • The Ebeltoft Health Promotion Project.

  • A multiphasic health-screening project in general practice.

  • 904 Danes.

  • Men and women.

  • 30-50 years.

  • Baseline, 1, 5 and 15 years.


Screened for among others
Screened for – among others: and attitudes related to health screening in general practice.

  • Risk factors (BP, bs, cholesterol, smoking)

  • Hb, ecg

  • Hight, weight (BMI)

  • Hearing,sight

  • Liver-, lung- and kidney

  • Urine tests


A calculation of cardiovascular risk score
A calculation of cardiovascular risk score and attitudes related to health screening in general practice.

  • Sex

  • Family members with AMI < 55 years

  • BMI

  • Blood pressure

  • Cholesterol

  • Ciagrettes/per

  • Low/Moderate

  • Increased/High


  • Written feed back. and attitudes related to health screening in general practice.

  • “You are in a low risk of having a coronary".

8400 Ebeltoft


Couldn t you have done just as well without the screening2
and attitudes related to health screening in general practice.Couldn’t you have done just as well without the screening?”

  • Men (7) and women (15) = 22 screened

  • 36-50 years,

  • Written feed back – twice – 1 year apart:

    “You are in a low risk of having a coronary".

    Family members with AMI < 55 years, cigarettes/day,

    sex, BMI, blood pressure, cholesterol.


Interview audio taped
Interview – audio taped and attitudes related to health screening in general practice.

  • Why participate …

  • Your test results ……

  • Used it how and/or for what …..

  • Your health ……….

  • Your opinion on health promotion …..


“…… just as well without the screening? and attitudes related to health screening in general practice.”

  • Focus on how persons with an low cardiovascular risk score perceive the benefits from, the health screening.

Preconception:

Hard-hitting message


Results summary

“…… just as well without the screening? and attitudes related to health screening in general practice.”

Results – summary:

  • Confirmed their feeling of being in good health

  • This acquired peace of mind were important

  • Eliminated worries

  • Confirmed lifestyle up to now

  • No guarantee

  • Price:

    • Further examination

    • Unfulfilled expectations


Considered them self healthy 1
Considered them self healthy (1) and attitudes related to health screening in general practice.

The results

  • Not present i their everyday life

  • But in the back of their mind

    Rembered

  • Nothing seriously wrong

  • Each - paid attention to specific factors


Considered them self healthy 2
Considered them self healthy (2) and attitudes related to health screening in general practice.

  • Cholesterol

    • debated in the media

    • ... could easily be high

  • Lungfunction – got out of breath when exercising

  • Liver count – enjoyed a glass of wine


Considered them self healthy 3
Considered them self healthy (3) and attitudes related to health screening in general practice.

  • Not surprised at all

  • Before the screening – felt healthy

  • Expected the result to be allright


Couldn t you have done just as well without the screening 1
Couldn’t you have done just as and attitudes related to health screening in general practice.well without the screening?” (1)

  • No!

  • Prompt!

  • Sharp!

  • A little hurt!

  • Surpriced

  • How dare you ...?


Couldn t you have done just as well without the screening 2
Couldn’t you have done just as and attitudes related to health screening in general practice.well without the screening?” (2)

  • No reason to believe that there was anything the matter BUT:

    • Sinks more in when an expert give his opinion

    • Confirmed own judgement

    • Approaces the age of 50 - greater risk


  • 45-year-old nurse.. and attitudes related to health screening in general practice."I expected my health would prove good, but you also know that the margins are so small, my blood sugar could easily have been 7 and then what? … even though there weren’t any symptoms yet. It’s hard to say you can just opt out …. and believe in your own judgement…you partly can…but superfluous, no, I don’t think it is…” .


No more worries 1
No more worries (1) and attitudes related to health screening in general practice.

  • A good feeling

    • Nice, lovely, a relief, a reassurance

  • Good to get rid of worries

    • Cholesterol,

    • Fitness,

    • Family health problems

    • Additional problems to chronic illness


  • A cheerful 38-year-old woman: “I just thought it would be terrible, I weigh too much and sit on my backside day in day out. I’ve never had anything the matter, but people in my family have died of cancer or coronaries. I was at no risk or low risk. I think that was lovely, I wouldn’t mind going again... “


  • “Woman with neck-problems..... instead of using energy on speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.”


No more worries 2
No more worries (2) speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.”

  • Put emphasis on the acquired peace of mind

  • Now - no need to make changes

    • Go on smoking

    • No further exercise

  • An endorsement - serve and eat the right things


Price to pay for the reassurance 1
Price to pay for the speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.” reassurance (1)

  • Risk of being over-complacent

  • Not necessarily remain healthy

  • Could be something the matter elsewhere


Price to pay for the reassurance 2
Price to pay for the speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.” reassurance (2)

  • Haematuria – further examintions

  • False sense of security

  • “... it gave me reassurance to be part of the project, where I sort of felt, oh good, now something’s happening ... ... so since then I’ve felt that this health project has given me a false sense of security ... but of course things can arise in the meantime, but...to put it crudely, I expected that I would be kept an eye on ... as if it was a form of safety net ...”


Promices
Promices: speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.”

  • Before the screening

    • Aware of the possibility of bad results

    • If something wrong - it should be put right

    • If results were normal in spite of too much sugar, pastries or wine – I`ll take up a healthy lifestyle


Considerations

Considerations: speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.”

Positive:

The acquired peace of mind

Feeling of relief

Conformation own sense of being healthy

Worrying?:

Young people – knowing they are healthy –need an experts conformation.


The end

? speculating about God knows what…. then you find out that actually you’re quite all right. I can use that to focus on the things that aren’t all right and use my energy there…in other words get rid of my worries about certain things and use my energy on something else.”

.... the end

Dead certain tests

Ugeskr Laeger. 2007; April, 169: 1637-1744.

You can damn well piss off again! I've just sacrificed both time and money on a whole bunch of tests...and they all showed I was 100% healthy!

More and more Danes undergo preventive health tests, while the number of tests on

offer, both traditional and genetic, are rapidly increasing


Couldn t you have done just as well without the screening3
“Couldn’t you have done just as well without the screening?”

  • Karen-Dorthe Bach Nielsen, Ebeltoft, Denmark.

  • Lise Dyhr, Copenhagen, Denmark.

  • Torsten Lauritzen, Ebeltoft and Århus, Denmark.

  • Kirsti Malterud, Bergen, Norway.

Karen-Dorthe Bach Nielsen, General Practitioner.

Ebeltoft, Denmark

E-mail: [email protected]

Homepage: www.elh.dk


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