Tuesday, September 4, 2012

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.


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.


  1. I am amazed. What are these doctors thinking? I would never "require" prostate cancer screening for my patients. I am in Maryland, so I can't help. There must be at least one family physician in Waltham with a shred of good sense.

  2. I've heard similar stories about patients who were "fired" by their Ob/Gyns for declining screening mammograms, or patients being discharged from pediatric practices for refusing vaccinations. In my mind, there are two ethical issues here: 1) Our professional obligation to care for patients even if they don't agree with our preventive care recommendations; 2) the weight of the medical evidence that PSA testing produces net harm to patients. So, essentially, these physicians are firing patients for declining a harmful intervention. Outrageous.

  3. I spent the past 10 years on birth control pills, and was unable to find a doctor who didn't require annual paps in the large city I live in. I'm average risk with a spotless record of negative findings on all their tests. The ironic part is that none of them were concerned about my high blood pressure, they made it out like the exam was something you had to "pass" to get the prescription.

    I became fed up and stopped taking birth control pills for this reason.

    I also had to leave my obgyn because she insisted on a baseline mammogram once I hit my 30s. As an average-risk woman, this one baffles me.

    As a woman, it's frustrating to be treated by primary care doctors mainly in the context of my reproductive system.

    1. I'm having the same problem. I won't undergo any intimate invasive exams, but have high blood pressure. Even though heart disease is the number 1 killer of women, but they don't care. If you don't give them access to your female parts, they refuse to treat you for anything else.

  4. My niece was fired by her LA doctor with a letter saying she wouldn't have any patients who didn't get mammograms.

    Yes, I think it's unethical.

  5. Of course it's unethical. It's also completely predictable. Follow the money: http://dinosaurmusings.wordpress.com/2013/02/18/and-so-it-begins/ ‎