Disease Screening Certificate

The essence of a disease screening certificate is a health risk warning certificate within a specific testing range at a specific time. It is neither equivalent to a "disease-free certificate" nor has universal disease diagnostic efficacy. All conclusions only correspond to the technology used in screening, the items covered, and the physical state at the time of sampling.

When I met Aunt Zhang at the free clinic of the community health service center last week, she clutched the wrinkled negative lung cancer screening certificate six months ago. She coughed and felt tight in her chest and refused to do a CT scan. She insisted, "My certificate says there is no problem, it's just a common cold." In the end, the nurse coaxed her to take a X-ray. Fortunately, it was just pneumonia, so it was a false alarm. I have experienced similar things in the past two years, sometimes 20 or 18. Most people misunderstand this thin certificate, which is more likely to miss a diagnosis than screening.

In fact, the industry has been arguing about how to write this certificate and how detailed it should be, and there is no unified conclusion for almost ten years. Public health experts always say that the content should be written as plain and simple as possible. It is best to leave a message like "This result is normal, it is recommended to re-examine in X year." Only when ordinary people can understand it can they be willing to come for screening. If it is full of professional terms and disclaimers at the beginning, those who are willing to come will be scared away. After all, the penetration rate of two-cancer screening in many third- and fourth-tier cities is just over 60%. The first priority is to increase the coverage rate. But the clinical doctors got a headache when they heard this. Last year, I had dinner with Director Li of the physical examination department of a tertiary hospital. He pulled out the complaint records on his mobile phone and showed me that a patient had a normal abdominal B-ultrasound, and the certificate stated that no obvious abnormality was found. Three months later, he was found to be in the advanced stage. Regarding pancreatic cancer, the family members brought the certificate to make trouble, saying, "Why did you get cancer when you said there was no problem?" - The detection rate of pancreatic cancer by ordinary B-ultrasound is less than 30%. This sentence was written in the small print at the bottom of the certificate. The patient's family said they did not see it. Who do you think they should ask for comment? Therefore, the clinical demands have always been: all limitations must be written clearly. Even if there are more words and it looks more scary, it is better than having disputes afterwards.

I saw this kind of pull and pull situation a lot when I helped organize files at the physical examination center in the past two years. The most exaggerated genetic screening certificate I have ever seen. The remarks page at the back is longer than the main text. The "Explanation of Test Limitations" alone lists seven or eight items, such as "only covers currently known disease-causing sites", "does not rule out the risk of disease caused by external environmental factors", "test results are only for scientific research reference, not clinical diagnosis basis". When the customer took it, his face turned green, saying that I spent 8,000 yuan to buy such a piece of paper that does not guarantee anything? In fact, this is not a shirking of responsibility by institutions. The ceiling of different screening technologies lies here: if you take a DR chest X-ray, there is a half chance that pulmonary nodules smaller than 2cm will not be detected; if you do a Helicobacter pylori serum antibody test, a negative test can only mean that you have not been infected or the infection has recovered, but it does not mean that you do not have active Helicobacter pylori in your stomach now; even the HPV genotyping test that everyone thinks is the most accurate only covers a dozen of the highest-risk subtypes, and not all subtypes that may cause cancer can be detected.

To put it bluntly, this certificate is like a snapshot taken when you went on a trip. It can only prove that you were smiling at the angle that the camera was pointed at the moment you pressed the shutter button. It cannot prove that you were happy all day long, and it cannot prove that you still have unfinished milk tea in the pocket that was not captured by the camera. Oh, by the way, there is another misunderstanding that many people make: they think that any stamped screening certificate is valid. In fact, this is not the case. Screening for infectious diseases such as hepatitis B and syphilis, which are required for employment and health certificates, are all nationally prescribed testing methods and thresholds. As long as they are issued by a formal institution, they have legal effect, and the employer You have to admit it; but the 99-yuan "one drop of blood" screening certificates you see in WeChat Moments, which are mailed in a wallet, often do not even undergo basic clinical cohort verification, and the detection rate is not as accurate as if you felt for lumps on your body at home. That kind of certificate is, to put it bluntly, just a sales gift and has no use.

To be honest, every time I look at the screening certificate for the elderly at home, the first thing I look at is never the last line of "no abnormalities", but whether the test items are in line with their physical condition, whether the technology used is accurate enough, and whether the suggestions in the notes have been followed. If you really feel unwell or have symptoms recently, even if you just got a negative certificate three days ago, you have to go to the hospital for further examination. Don't use the certificate as a disease-free gold medal like Aunt Zhang. It will cause problems more than the gain is worth the loss. After all, this piece of paper is just a tool to help you check risks, not health insurance, right?