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In a recent routine diabetic check-up it was agreed in advance with my endocrinologist (diabetic specialist) that a CEA colon cancer and Prostate PSA marker tests should be performed alongside the usual HbA1c average blood sugar level, cholesterol and triglyceride tests.

It should be noted that I have consulted with my endocrinologist at the hospital in question for many years. The name of the hospital and of the doctor is not specifically relevant as the lessons learnt from this episode are universal across the global private hospital industry.

After the customary wait of about an hour for the blood test results I met with my endocrinologist to discuss the blood test results.

On this occasion my HbA1c had risen compared to my previous result about 3 months previously but what was of greater concern was the CEA colon cancer marker test which was recorded at a massively elevated 9.1 ng/mL compared to the usual and normal range expectation of 0 - 5.0 ng/mL.

Clearly this was of great concern and it was agreed that further investigation should take place. An appointment with a colon cancer specialist was set for 1 months time.

At the duly appointed follow-up meeting a further diabetic blood test was performed which indicated that my HbA1c levels were back in range - a good start to the day!

I was then ushered to meet the colon cancer specialist who was reading my previous test results.

Comments regarding the elevated levels were made highlighting that they were well out of range and worrying for her.

It was at this stage that she recommended a full colonoscopy before proceeding to ask if I had ever had a colonoscopy. I stated that I had but that it was some 35 years previously.

"We need to perform a full investigation via a colonoscopy" she reiterated.

Fortunately I had in the intervening month performed some of my own research and consulted with other medical professionals who I am luck to have easy access to.

I must confess to being somewhat shocked at the specialists immediate recommendation to undergo a full colonoscopy not only due to the cost of the procedure (circa USD 700) but more specifically due to what she, as a colon cancer specialist would have been very cognisant of, the unreliable nature of a solitary CEA marker test.

I had armed myself in advance of our meeting with these facts and so quizzed my specialist.

I cited the above facts and requested her viewpoint.

The response was somewhat 'arbitrary' in that she stated 'we always recommend colonoscopies for people aged over 50!'

No further rationale was provided to support this statement.

She did however point out that a full colonoscopy would also provide a stool sample which would be tested for traces of blood and other chemicals.

Noting these comments I asked:

"Would it not be logical to FIRST obtain a second CEA colon cancer marker test result to establish if the high first test result was indeed still higher than normal? and could a simple stand alone stool test be performed to determine if blood or chemicals existed in the sample?"

Her quizzical look spoke volumes but she had to agree that my comments made absolute sense.

Fortunately the blood taken earlier in the day for my diabetes tests could also be used for a second CEA marker test avoiding the need for further blood extraction.

After an hours lunch break I returned with my stool sample and waited to be called back to the consultation room for the test results.

The result for the CEA marker test was now within the 'normal range' and the stool test proved negative for any blood or chemicals.

I was advised that no further testing, colonoscopy or future appointment were necessary. Her parting comment however was to reiterate that she still recommends a full colonoscopy every five years.

As previously, she did not elaborate or scientifically justify this comment as to why a full colonoscopy is the need for such an invasive procedure.

In my set of circumstances I am fortunate that I have full expat medical insurance that covers both 'in' and 'out-patient' treatments that include medications and tests for my diabetes and any other medical conditions. As such cost factors of tests and treatments have little bearing on my decision making processes.

What does concern me however is that when I seek medical advice I expect to receive unbiased medical advice and council that is not tainted by commercial decisions of the hospital or doctor. I also expect the advice I receive to be factually substantiated and corroborated with current medical practises.

On this occasion neither was provided by the colon cancer specialist in my opinion!

I most definitely came away from the experience of feeling subjected to a 'sales tactic' driven by the 'fear of cancer' in order to support the sale and use of a hospital service (colonoscopy) that was neither medically required nor validated.

As referenced above, holding medical insurance cover that could quite easily fund a full colonoscopy was not an issue. What is an additional issue is that ultimately medical insurance premiums are driven largely by the costs of hospital services and procedures. It therefore irks me to witness first hand the abuse that is placed on insurers that are being subject to the commercial nature of hospitals in the private hospital sector. As a consequence, all insured individuals end up paying for these brazen commercial interests by elevated insurance premiums.

I feel certain that had I approached a government run hospital (for example the NHS in the UK) a full colonoscopy would not have been the immediate choice of investigation.

I firmly believe that patients deserve honest, clear medical advice based on solid evidence. I'm concerned that the pressure to perform procedures, and possibly the financial incentives involved, can get in the way of that.

Ultimately, I was lucky. Many people might not question a doctor's advice and end up with unnecessary and expensive tests.

It's critically important to remember that you have the right to ask questions and get a second opinion. Don't be afraid to do your own research and advocate for yourself.