“I paid for a full health MOT and it’s flagged nine things — I need you to go through every one and refer me”

People increasingly bring results from private, direct-to-consumer blood panels. GMC guidance is that doctors must act on clinically significant information, whatever its source, but the NHS is not obliged to repeat private screening tests on request or provide follow-up for every flagged marker. The skill is prioritisation. Panels flag results that are statistically outside a range rather than clinically important, may use unsuitable samples (finger-prick, non-fasting, afternoon testosterone) and include tests that need counselling (PSA). Here the important signal is cardiovascular: raised non-HDL cholesterol, low HDL, high triglycerides, non-diabetic hyperglycaemia, obesity, raised blood pressure, ex-smoking and a brother with a heart attack at 50, which is a family history of premature CVD that QRISK3 includes. NICE NG238 (2023) recommends formal risk assessment with QRISK3, lifestyle advice, and offering atorvastatin for primary prevention when risk is 10% or more, after confirming lipids. Blood pressure should be confirmed with home or ambulatory monitoring (NICE NG136). A raised ALT with metabolic risk factors is most often metabolic dysfunction-associated steatotic liver disease (MASLD, previously NAFLD): repeat venous LFTs, a liver aetiology screen, assess alcohol, and use FIB-4 (with ELF if indeterminate) to decide on referral (NICE NG49). Raised ferritin is commonly inflammatory or metabolic, but transferrin saturation excludes haemochromatosis. HbA1c 42–47 mmol/mol is non-diabetic hyperglycaemia (NICE PH38): repeat annually and offer the NHS Diabetes Prevention Programme. Vitamin D supplementation is a self-care purchase for most adults. An isolated hs-CRP and an afternoon testosterone without symptoms are not actionable. The hidden agenda, fear after a sibling’s heart attack, explains the demand for repeated testing; addressing it directly and channelling it into risk reduction is the heart of the consultation.