Dear Source:
I read the article on the Fire Department's financial woes. One possible way to increase funding for the department is to eliminate or modify the physical examination that the fire department members are required to undergo yearly. A physical examination performed yearly may be useful in screening for treatable conditions. However, the Fire Department asks that extensive, yearly blood tests, EKG's, Chest X-rays are to be done on its members. I am told that this was something negotiated by the Firefighters union.
Many firefighters have their own personal physicians that can complete the physical examinations and determine what appropriate laboratory or other testing is necessary. By duplicating this physical examination/laboratory testing, money is being wasted.
The Fire Department has established a list of laboratory examinations that each member is to receive regardless of their health history. For example:
– PSA (prostate) testing: any male firefighter regardless of age is to get this test. This test is recommended for men over 40, yet men in their 20's and 30's receive it.
– Stool for ova and parasites: there is no recommendation anywhere that anybody should be screened for worms/parasites in their stool.
– RPR (syphyllis): once again, no recommendation anywhere to be screened yearly for this sexually transmitted disease.
– Stool for occult blood: recommended as a possible screening test for colon cancer in those over the age of 50. Not recommended otherwise.
– CBC: screening for low blood iron/anemia on a yearly basis in the absence of symptoms is not recommended.
– CMP (complete metabolic profile): evaluates kidney, liver, and electrolyte function. No recommendations for yearly testing in persons without any symptoms exist.
– EKG (electrocardiogram): no need to perform a yearly EKG on patients without cardiovascular disease.
– Chest X-ray: no need to perform x-rays every 4 years in the absence of symptoms.
– Yearly cholesterol screening: no need to perform yearly cholesterol testing on people with normal cholesterol.
The cost of the above testing alone, not including the cost for the medical examination, runs in the hundreds of dollars. If this is multiplied by the amount of firefighters in the VI, we are talking of tens or possibly hundreds of thousands of dollars spent yearly on unnecessary testing. If we add to this the costs of the medical examination, even more money is being misspent. If a fire fighter should suffer from diabetes, hypertension, high cholesterol, or any other chronic disease, he or she should be treated by their own physician. Duplicating these tests during a yearly examination is useless.
I am also told that the funds that cover these unnecessary costs come from taxpayer funds earmarked by the fire department as a budget item for these expenses. These exams/testing are not covered by the firefighter's health insurance. By no means am I not in support of the health and well-being of the VI's public servants. However, spending unnecessary funds on unnecessary testing is not the most prudent way of spending taxpayer dollars especially in these trying economic times.
Joseph DeJames, MD, FAAFP
St. John
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