I think that your premise is that the knowledge that the doctor would have to pass to the patient in order for the latter to make enlightened choices would require squarely a long and tedious medical training.
To which I would suggest that
1/ no, the knowledge to have for this particular test results, likely (and less likely) prognoses, and the associated possible medical acts and risks, is not equivalent to a full medical training, as it is a tiny bit of one specialty. But I acknowledge that it may require quite some time.
2/ there is no need to apply the same policy to every patient, and you can choose to only allow tests to the patients who went through the basics training evoked in 1/.
In the end, if somebody wants to go through the process to get the knowledge to be able to deal with the information, why to deny it?
Plus, that would make a nice incentive to get people to know better their own body.
Well I agree fully that there are patients who are smart and could take in the info (for that matter, lots of doctors also end up as patients), and I'd hope their treating doctors give them any info they ask for and get them involved in the aspects. After all, in this specific case I'm pretty sure you can get a PSA taken by yourself even and then the cat's out of the bag.
But in a broader sense, what I was thinking of was that when faced with a shocking piece of info ("you might die and there might be nothing we can do about it" etc.), most people don't stay very composed - there are several different reactions and phases and one is certainly "I want as much information as possible and I want to be involved in all decisions" but I'd argue it's not the most common reaction and even in that case, it's a crisis reaction and maybe not as logically driven (or productive at all) as it might seen at first.
So then you'd first have to figure out how this specific patient would react before deciding to do the screening and if you just guess, you'd probable be criticized at some point, so you instead make sure you follow the national plans and recommendations..
Then the (sad) fact is that you usually have maybe 15 minutes allocated in primary care to say hello to a new patient, listen to the symptoms or concerns, examine, make a plan, inform the patient, say goodbye, dictate the journal. You can't spend hours educating the patient. I'd wish this was different (but then again that applies to any service interaction, even your car mechanic or whatever).
- proposing bundles formation + test(1), of course much more expensive than just test, but allowing access to a broader range of tests.
- new job description, "medical teacher for citizens", giving (possibly customized) formations to people (and documents certifying they passed), and then these certificates would be useful later to know which patients already understand which aspects of medicine.
I think that would make nice ideas for startups, and I for one would be a customer.
As for the "emotional" aspect, when receiving shocking news, I don't think that withholding information is a solution, quite to the contrary. In a lot of cases, people don't feel well and imagine the worse, but they actually are fine. Other people feel good and actually are very sick. If an information leads to bad diagnostics, they should know, because if not now it would be required later anyway. If the information does not lead to a 100% accurate diagnostic, just quickly get sure that your patient understands basic stats/probas, and then explain to them why the diagnostic cannot be certain and why some benefit/risk trade-off holds.
Any of the "formations" evoked above could include some lesson on how to deal with bad news about oneself.
(1) of course I mean "medical test" here, like the ones to guide diagnostics, not "knowledge test", although these too would be useful at the end of the formation.
PS: the 15 min/patient thing is a huge PITA, so maybe my ideas are doable only in private clinics. Even the "medical teacher for citizens" is completely outside of what is done (currently) in public health.
To which I would suggest that
1/ no, the knowledge to have for this particular test results, likely (and less likely) prognoses, and the associated possible medical acts and risks, is not equivalent to a full medical training, as it is a tiny bit of one specialty. But I acknowledge that it may require quite some time.
2/ there is no need to apply the same policy to every patient, and you can choose to only allow tests to the patients who went through the basics training evoked in 1/.
In the end, if somebody wants to go through the process to get the knowledge to be able to deal with the information, why to deny it?
Plus, that would make a nice incentive to get people to know better their own body.