Guest Post: Prostate screening shouldn't be a primary care initiation rite

Dear Dr. Lin,

For the past two years, I have been searching for a primary care physician who will not require that I undergo prostate cancer screening as a condition of accepting me as a new patient. Usually physicians don't admit this directly when I ask them in the initial interview; sometimes, they actually agree with me that the PSA test and digital rectal examination are neither necessary nor beneficial. But something strange and frustrating happens after I leave each office: these physicians decide that they require screening after all and send me a letter, telling me in a short sentence that they won't or can't accept me as a new patient.

One primary care physician tried to "sneak in" a digital rectal examination when all that I needed was pre-operative clearance, assuming that I wouldn't object! After I objected, he claimed that he had forgotten my preferences. It didn't end there. He went on to bill Medicare for prostate cancer screening and refused my four requests to correct the error. He finally withdrew the charge when I threatened to notify my insurance plan of possible fraud.

Variations of the same story occur each time I meet a new primary care physician. I am getting very concerned because I need refills of certain prescriptions. Do you know any open-minded primary care physicians in eastern Massachusetts who are familiar with the harms of prostate cancer screening and could take me on as a new patient? I would be forever grateful.

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The above post is a lightly edited version of an e-mail that I received recently from a resident of Massachusetts. If you would be willing to accept him as a patient, or could refer him to a primary care physician in his area, I would be happy to pass on any recommendations.