Wednesday, November 24, 2010
Whole body screening may harm people with illness and disability
I'll be staying close to home for Thanksgiving. But if I did have plans to travel by airplane for the holiday, I think I'd be apprehensive about the new screening procedures implemented by the Transportation Safety Authority (TSA).
My concern is not with the scanning machines. The level of potential radiation exposure, even by the back-scatter units, is almost immeasurably low relative to what's in our everyday environment. Rather, I'm worried about screening errors--false positive and false negative results--and about harms, physical and/or emotional, that patients and people with disability may experience during the screening process.
Even with these new machines in full-future swing, it's easy to imagine that an imperfectly-trained, inexperienced or just plain tired screener might miss an irregularity, especially in the context of a steady stream of passengers rushing to catch their flights. These operators might miss seeing the weapons despite the visual "information" available, right in front of their eyes.
The solution, to maximize the scanners' value and our unwanted exposures, would be through careful training and testing of the examiners. Ultimately, though, we can't get around the fact that they're human and sometimes nearing the end of a shift; we can reduce but not eliminate these kinds of screening errors.
My second concern is with the potential harm to patients and people with disabilities. Patients may be harmed physically, if screeners mishandle a pump or other device. A pat-down person might, for example, press too hard on a breast cancer patient's implant or expander and rupture that. Emotional trauma may be very real, and lasting. Most TSA screeners aren't accustomed, as are doctors and nurses, to seeing people's medical baggage--colostomies, stumps and other disfigurements that are usually concealed under a person's clothing.
There's been a lot of attention to one case, that of a 61-year-old man with a history of bladder cancer whose urostomy bag ruptured during an airport pat-down. The man described his urine spilling all over, and feeling humiliated. I think this a very understandable reaction. A person who's experienced significant illness with residual scars and deformities, may be unnerved by a stranger's brusque pat-down and look-over.
This is not a civil rights issue. After all, we don't have to travel on airplanes. In my opinion, no one has the right to board a public vehicle without full screening if that's what the TSA advises for public safety. Rather, I accept that one aspect of having a medical condition is that sometimes you have to put up with things other people don't experience. Nor is it a patient empowerment issue, in the sense that this is not about educating patients so they can better participate in their health decisions.
The matter is to what extent we can accommodate the needs of people with health issues and disabilities. Unfortunately, in a cost-cutting, fear-laden environment, patients' emotional needs may be shortchanged.
What would help, clearly, is better sensitivity and training of TSA staff, as was suggested in response to the urostomy incident. But given the huge volume of travelers and enormousness of our complicated transportation system, it seems unlikely we'll get a satisfactory solution among all staff at all airports, at least not in time for Thanksgiving.
This post originally appeared at Medical Lessons. Elaine Schattner, ACP Member, is a nonpracticing hematologist and oncologist who teaches at Weill Cornell Medical College, where she is a Clinical Associate Professor of Medicine. She shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology and as a patient who's had breast cancer.
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