1st June 2026

Newsletter Monday

Hello Reader,

A BBC article today reports that heart screening checks had identified almost 200 young women with previously undiagnosed heart conditions, including some at high risk of sudden cardiac death.

It caught my eye too, because I was talking to this charity a couple of weeks ago.

On the face of it, it sounds like a straightforward success story.

A simple test.

A serious condition.

A life potentially saved.

And of course, if you were one of the families affected, it would be difficult to argue that finding those conditions wasn’t worthwhile.

But healthcare is rarely as simple as the headline.

When I was talking to their representative at their stall, I asked what their bottlenecks were in rolling this out.

What struck me was that the biggest challenge wasn’t actually performing the screening.

It was what happens afterwards.

The public tend to imagine screening works like this:

Test.

Answer.

Problem solved.

In reality, it often works more like this:

Test.

Uncertainty.

More tests.

Probably a long wait.

More uncertainty.

Then, hopefully, an answer.

But not always.

The obvious normal results aren’t difficult.

The obviously abnormal results aren’t difficult either.

The challenge is the large group of people in the middle.

The ECG that looks a bit unusual.

The finding that might be significant.

Or might not.

The result that needs an experienced pair of eyes to decide whether it represents a potentially dangerous condition or simply a normal variation.

And that was exactly the issue we discussed.

There simply aren’t endless numbers of highly experienced cardiologists sitting around waiting to review loads of borderline ECGs.

If a national screening programme were introduced, somebody would need to review all of those uncertain cases.

Some people would need echocardiograms.

Some would need MRI scans.

Some would need repeat tests.

Some would spend weeks or months worrying before eventually being told everything was normal.

This is why screening programmes have to be assessed carefully.

Not because anyone doubts the seriousness of sudden cardiac death.

Not because anyone wants to miss cases.

But because every screening programme creates both benefits and harms.

The benefits are often easy to see.

The harms are usually quieter.

Anxiety.

False alarms.

Further testing.

Waiting lists.

Opportunity costs.

And money spent here that can’t be spent somewhere else. Funding is not unlimited.

Pattern Recognition

I see a version of this problem regularly in general practice.

Occasionally a patient will come to see me after speaking to a pharmacist, having been told that a symptom might represent a side effect of a medication.

Now, before I go any further, this isn’t criticism of pharmacists.

In fact, pharmacists are far better than I am at spotting dispensing errors, drug interactions and medication-related issues because that’s their area of expertise.

I am grateful when they call and say, “Did you really mean to prescribe that dose?” politely pointing out that I’ve put an adult on what is essentially a toddler dose of something.

But sometimes a possibility gets raised that is technically possible yet highly unlikely.

And because I’ve spent nearly two decades seeing thousands upon thousands of patients, my brain is comparing that situation with hundreds of similar cases I’ve seen before.

Pattern recognition matters.

Experience matters.

The question isn’t simply:

“Could this happen?”

It’s:

“How likely is this to be what’s happening here?”

That’s the same challenge these cardiac screening programmes face.

Medicine is getting better and better at finding things.

We can detect tiny abnormalities that would have gone unnoticed twenty years ago.

But finding something is only the beginning.

The harder question is deciding what it means.

The headline is simple.