Last Tuesday, the Bangor Daily News ran a front-page article (or advertisement?) for Life Line Screening, a for-profit Cleveland-based outfit that travels around to offer diagnostic screening tests to anyone willing to pay. On the face of it, this might seem like a noble idea – perform a series of noninvasive tests to detect potentially serious diseases and then tell those individuals with abnormal results to contact their local doctor to take care of the situation.

What could be the harm in this apparently well-intentioned activity? Well, as a physician with 23 years of experience in primary care, let me count the ways this is poor medical care to patients:

First: These tests will be done without regard to clinical risk factors, meaning that the overwhelming majority will be negative. The article quoted the chance of finding an abdominal aneurysm as one per 300,000 Mainers, which means a lot of dollars for the people doing the testing and a very low yield for that particular condition. One of the first lessons taught in the education of primary care physicians is an epidemiological concept called Bayes Theorum. This allows doctors to select patients who would be likely to benefit from a particular test from those who will simply be throwing their money away.

Second: What are the qualifications of the individuals running these tests? I wouldn’t send a relative to any hospital lab that wasn’t certified for quality by the Joint Commission for the Accreditation of Healthcare Organizations. Whenever someone has a test done at Eastern Maine Medical Center or St. Joseph Hospital you can be sure that the interpreting physician has his or her credentials reviewed on a regular basis, and participates in a rigorous quality assurance program. Does anyone know the credentials of the folks in the traveling show? What are their false-positive and false-negative results and do they share their error rates with the public?

Third: No test is completely “risk-free.” I’ve known a patient who suffered the very stroke that these tests were designed to prevent and it was caused by the pressure of the ultrasound transducer on the carotid artery. Does this mobile van have a protocol to manage any medical problem that might arise while patients are being screened? You can bet that the radiology departments at our local hospitals do. And they have physicians who are on site to manage the complication, not call an ambulance to send the unwitting victim down the road to the nearest emergency room.

Fourth: It’s another nail in the coffin for primary care. This last concern may be difficult for some to grasp, even the surgeons quoted in the article failed to acknowledge this problem. Combined with insurance company policies that inordinately reward those who do procedures over primary care, Internet sales of prescription drugs and the growing proliferation of urgent-care centers, this misplaced consumerism is a serious detriment to primary care.

Encouraging patients to bypass their local family physician to get screening tests done is one more change in the direction of medicine that tells many of us who have dedicated their professional careers to primary care that we are not really needed in this “marketplace” of medicine. Like the corner grocery store or the home delivery of fresh milk, primary care is being pushed out by forces that favor an “industrial model” of medicine over the lifelong development of a trusting relationship between a patient and his or her physician. Making rational screening recommendations is the responsibility of every primary care doctor and if you remove yet another tool from our black bag, it will be closer to being empty.

Analogous to the battle between local merchants and national big-box chains that import cheap goods from sweat shops, the sponsors of this program have unwittingly chosen to send local health care dollars to Cleveland rather than support local resources. Many primary care offices are nonprofit and the vast majority are only one month’s receipts ahead of economic ruin. Our own colleagues in specialty practices have little understanding of the challenges facing primary care – even the transcription costs necessary to send them a letter discussing a patient may be near impossible for us to afford.

The final irony of this article concerns the sponsors’ statement that patients with abnormal findings will be “urged to contact their physician as soon as possible.” What is left unspoken is the expectation that this physician will interrupt whatever other clinical activity he or she was doing, begin arranging either additional tests or a consultation to a surgeon’s office, and do all of this as “a free service” that will not require a visit in that primary care office. What they don’t realize is that the continued promotion of activities that devalue primary care will bring the day closer when a patient calls their local doctor and this time the phone is unanswered because it is no longer in service.

William A. Sturrock, M.D., is chief of Family Medicine Service at Eastern Maine Medical Center.