As a rural family doctor I have to factor in travel costs when referring my patients for specialized services. Costs of travel include not only transportation expenses but time from work and home. Increasingly patients are being forced to travel again and again after having tests.
A good example is breast screening which causes many false alarms. For every woman who has a lethal breast cancer caught in time for a cure, several more have cancers diagnosed that would never have caused them problems. They and their daughters will have their lives changed needlessly. Additionally, overdiagnosed rural women (and their drivers) will have hours on the road, days and often nights away from work and family and are at increased risk of being involved in a motor vehicle collision. In more remote communities women are being flown out for screening.
Mammograms are easy to count and government can point with pride to numbers which show they are working on cancer “prevention”. Physicians are paid to meet targets to increase those numbers. Unfortunately the costs are high and often hidden.
Cancer screening is early detection, not prevention. At a seminar I attended on how to persuade patients to go for screening mammograms, a physician asked, “What if the money spent on transporting their women for breast cancer screening and followup was instead spent on building and maintaining sports facilites (walking tracks, arenas) in remote communities? Wouldn’t that truly prevent disease and premature deaths?”
I say yes.