The Benefits and Risks of Screening

Evidence is mounting that ever earlier detection and ever wider definition of disease is having some adverse consequences for healthy people. Diagnostic scanning of the abdomen, pelvis, chest, head, and neck can reveal “incidental findings” in up to 40 % of individuals being tested for other reasons (Orme et al. 2010). Most of these “incidentalomas” are benign. A very small number of people will benefit from early detection of an incidental malignant tumour, but many others will suffer the anxiety and adverse effects of further investigation and treatment of an “abnormality” that would never have harmed them (Moynihan et al. 2012).

Increased screening also brings more direct hazards. There is evidence from epidemiological studies that the organ doses corresponding to a common CT study (two or three scans, resulting in a dose in the range of 30–90 mSv) result in an increased risk of cancer. The evidence is reasonably convincing for adults and very convincing for children. However 75 % of physicians significantly underestimate the radiation dose from a CT scan, and 53 % of radiologists and 91 % of emergency-room physicians do not believe that CT scans increased the lifetime risk of cancer. It has been estimated that about 0.4 % of all cancers in the United States may be attributable to the radiation from past CT scans. Given the rapid increase in CT scans this estimate might in future be in the range of 1.5–2.0 % (Brenner and Hall 2007).

The Benefits and Risks of Information Technology

The revolution in information technology is having a massive impact on healthcare but also bringing new risks (Wachter 2015). Information technology can reduce risks to patients by providing effective and timely clinical decision support (Jones et al. 2014), improving coordination and communication, and may become a major driver of clinical performance and quality (Weiner et al. 2012; Classen et al. 2011). Various forms of tele-health facilitate and support people in their own homes (Baker et al. 2011; Anker et al. 2011). The massive introduction of IT in healthcare will probably be associated with a reduction of errors due to poor checking, poor readability, and poor traceability (Wachter 2015).

Information technologies are also making decades of stored data usable, searchable, and actionable by the healthcare sector as a whole. This information is in the form of 'big data', so called not only for its sheer volume, but for its complexity, diversity and timeliness. Analysis of big data can help clinicians and organizations deliver higher-quality, more cost-effective care. Big data can potentially lead to the development of an anticipatory health care system, where providers can create personalized evidence-based medicine, tailored to patients' personal preferences for how (Groves et al. 2013).

However such dramatic changes could have negative consequences for both the quality and safety of care if not properly organized, taught to professionals and patients, and accompanied by careful implementation and testing. New risks generated by these technologies are ethics (confidentiality), increased inequalities between regions and social categories, and paradoxically a reduction of direct contact between patients and professionals (Taylor et al. 2014).

Public information on safety will be increasingly available. Public reporting of safety and quality standards is expected to provide accountability and transparency thereby enhancing trust between patients, regulators, payers, and providers (Werner and Asch 2005). Alongside these benefits of public reporting, however, there are potential risks which include a potential loss of trust either in particular institutions or in healthcare more generally. Developing optimal data collection instruments and assuring adequate quality from participating centres are significant challenges (Resnic and Welt 2009). Although considerable efforts are being made to assess safety in a scientific way that allows comparison between hospitals and other facilities, the views expressed on social media could be a much more important determinant of a hospital's reputation.

 
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