Wednesday, December 8, 2010

What kind of role model are you for your children?

I have been having a heated discussion with my grown daughter about my refusal to have a routine mammogram and as a result, she has accused me of being a poor role model to her and her brother. This has left me thinking about what message I want to give my kids about how to make informed decisions about their healthcare.

Routine mammograms
How this all started was when my daughter posted a comment on her Facebook account saying how cross she is with me because I will not have routine breast mammogram. She has seen one of my best friends die of breast cancer so she feels I am really stupid for not engaging with a screening process that she feels will reduce my chances of dying of breast cancer.

Cochrane review
But I have made the decision not to have routine mammograms at this stage because I am not convinced about the validity of routine testing, and I am very concerned about the risk of false positives and the effects of being over-treated. I am low risk of breast cancer and have taken on board what the latest Cochrane review has said about routine mammograms.

Role model
My daughter feels I am a poor role model because I have refused a screening program... I am giving her the message that it is OK to ignore tests that have the potential to improve one's health.

What I want to model is how to question healthcare practice and make informed choices about my care. But I do not know if I am doing a very good job of that.

How do you talk about the issues of healthcare and screening to your children? What sort of role model are you? Do you encourage your children to ask critical questions about healthcare practice?



M-H said...

I'm curious as to your reason for not having the routine mammograms. Do you feel your risk is so low that they are not needed? I don't do all the preventative things that are recommended these days, and regularly get told off by conscientious registrars at my GP practice when I can't see my usual doctor. But I do have the breast squish and the cervical cancer check. Problem for me is that I'm adopted, so have no clue what my family history might be and how to rank the importance of tests.

Moira said...

Certainly Cochrane provides food for thought, however, the metaanalysis doesn't always touch the heart! I understand the aims of EBM but do question its assumptions, finding its reliance on a particular hierarchy of knowledge somewhat limiting. Two very dear friends were both recently diagnosed with invasive carcicinomas (breast). Both detected by routine mammogram screening - both the first call at 50 and both pre clinical detection. Now, maybe one or both are in the 30% who are being overtreated but they both feel scared but relieved that it was "picked up very early". We continually make risk assessments within our own situation and that changes over time. I teach about health promotion but enjoy wine, good food and little exercise. My idea of good food is certainly not what the average nutritionist would describe as 'good' I am quite sure! I rarely visit my GP, partly because I don't want to be told what I know! ie lose weight! We contextualise risk assessment for ourselves in our situation and should do so - using all available data. However, I'm with your daughter:)

Sarah Stewart said...

Hello M-H and Moira

Thank you both for your comments - I know we are all of that "certain age" so it's interesting for me to see your view points.

M-H - I feel that my risk is low enough that I do not want to run the risk of being over-treated. I may change my mind on that as I get older. I think it is a personal, relative thing that we decide on ourt own individual contexts.

Moira - I know the Cochrane meta-analysis is not the be all and end all. I also know women who have either had their cancer missed by mammograms or been over-diagnosed. And also know women who have found their lumps by them or their partners feeling the lumps. So I guess it's all contextual.