Q&A: DR PIXIE MCKENNA
Pixie McKenna, general practitioner at The London Clinic, on why it is important that we get better at preventative medicine
Interview: Viel Richardson
Portraits: Orlando Gili
How would you define preventative medicine?
I would define preventative medicine as medical interventions or actions undertaken to prevent the development of future disease. These can be illnesses such as cardiovascular disease, diabetes, or joint damage through excess wear and tear. It is about maintaining the health of the whole body. As doctors, preventative medicine is our primary aim. We want to stop you getting ill in the first place, or at least stop a symptom developing into a more serious illness.
As a society, what are we like at preventative medicine?
Extremely bad. There are some people who turn up for the free screening programmes offered by the National Health Service, like the cervical smear, mammogram or general blood test, but they are in the minority. We really need to get the message out to a much wider pool of people about just how important it is.
Why are we so bad at it?
I think it comes down to the fact that as human beings, we are frightened—often we do not want to find out if something is wrong. There is also a lack of knowledge, with people not realising that a symptom they dismiss as general aches and pains might be an early warning. If something is persistent, you should get it checked out. There is the British ‘stiff upper lip’ attitude of putting up with ‘niggles’ and getting on with things—I can’t stress enough that this is the wrong approach when it comes to your health and can have serious long-term consequences.
You are launching a ‘health MOT’. What does it involve?
Essentially, it’s a series of questions and age-appropriate tests to establish your overall state of health. We look at medical history—including family history, which is a hugely important part—and any current problems. We go into real detail, so we can get a really accurate picture. Depending on your gender and age, there are tests we routinely carry out, but we will also check out any issue a patient is worried about or areas the MOT itself suggests may be appropriate. Also, if someone has a big event like a triathlon coming up, we can add a performance-based aspect to the MOT and offer subsequent advice.
What if you have a known illness or condition?
One of my mottos is, beware the existing diagnosis. The temptation for both the patient and the doctor who knows them is to put new symptoms down to known conditions, but one illness doesn’t preclude another so you should still have regular screening tests for things other than your known conditions. If you let us know about any conditions when booking that is helpful, and if you are seeing a specialist who has asked for a specific test, we can arrange for it to be done alongside. This makes it more convenient for you.
You mentioned age-appropriate tests. What does this mean?
Age-appropriate screening is a key part of preventative medicine. Women should start smear tests at 25, mammogram screening at 40, and everyone should start testing for blood in stools by 50. Sometimes we get young men asking to have their prostate examined because their grandfather died of prostate cancer, but it has no predictive or preventative value below a certain age, so it would be wrong to do the test—at best it is a waste of time and at worst, several early tests can give them a false sense of reassurance that it won’t happen.
What should the patient do in preparation for the MOT?
Have a think about anything that may be concerning you. If you think it would be helpful, write them down. It is easy to forget things in the middle of a consultation when a lot of information is being given to you. The main thing is, don’t leave with a doubt in your mind. Always ask if you have a question and if you forget, we are very amenable to answering an email or a call. Also, never assume anything. If you want to know if a test has been done or a symptom considered, ask.
What happens after the consultation?
At the end of the consultation there is time for the patient to air their feelings about the process. Every GP knows of what we call the ‘door handle conversation’: as they have their hand on the door handle to leave, a patient often says, “Can I just ask?” and that often turns out to be the real reason for their visit, so we give them time to talk things through after the consultation is over. They then get their results by phone or email, as well as a written report laying out the results. Crucially, we explain the significance of each result not only in terms of their personal health, but also in terms of where they sit in relation to the general population.
The report also includes recommendations going forward. It could say, “everything is great, see you in 12 months”, or there may be something regarding exercise or addressing a vitamin deficiency with supplements. There may also be something that requires further investigation—I might not like the look of a mole I have seen, for example, so refer the patient to a dermatologist.
Does this service affect the patient’s relationship with their GP?
It is something that runs alongside your usual GP relationship. Patients will often talk to me about things that they might not want to raise with their own doctor. This is a big issue in the area of sexual health. Because the GP may know and even treat the person’s partner, people can be very reluctant to talk to their GP about these matters. A service like ours removes that issue, making people much more likely to raise any concerns. It matters because, as we all know, some sexually transmitted diseases can have serious consequences if not dealt with.
It is best practice for us to inform your GP of any findings, but the final decision about what information we share lies with the patient. However, if we detect something serious like heart disease or find that you need long-term blood pressure treatment, we would urge you to engage with your GP in order to move forward and manage the situation.
What are the advantages of being based in a hospital?
It gives us access to facilities and staff. If we do the test at 8:30am, we could potentially have your results by lunchtime. If during the consultation I decide that a particular test like a mammogram is needed, we can often make that happen on the same day if the patient has time. We also have access to world class physicians and consultants. There have been times I have had a small query and have called a surgeon or consultant to get another opinion over the phone. It is great to have that level of colleague support as a GP. It also means that the consultants we refer patients to are people that we trust and see on a regular basis around the hospital.
What would you say to people who have not been to a doctor in years, as they have only suffered minor illnesses?
I’d say a health MOT is a very good idea. Absence of clear symptoms does not mean an absence of disease—especially in the case of something that may be developing slowly and can strike in the future. Once you are past the age of 50 things start to not work so well, so you need to hit that decade really match fit. From 40 onwards, you should be getting to know how your body is doing and getting it into good shape.