Ethical implications of screening and case finding

Many clinicians confuse screening and case finding tests. Screening and case finding carry different ethical obligations. Before initiating screening in asymptomatic individuals, clinicians must consider whether the test results would change the management of the patient. If the results would not change how the patient is managed, then the test should not be ordered.¹ In addition, the potential harms should be discussed with the patient, including overdiagnosis and false positives. In case finding, the patient has presented with a particular problem, or has asked for some level of assistance or is suspected to have, or be at risk of, a condition. In this situation, there is no guarantee of benefit of the tests undertaken. It could be argued that there is at least some implied exposure to risk (eg performing a colonoscopy to investigate abdominal pain).