A healthcare/philosophical question

[Mazderati]

40ish something with a hudge hammer but that shouldn't come as a surprise, unlike pushing back so hard on a request for labs at an annual.

PSA is one piece of data. It is not a diagnosis. I just want the data.

[Trackhead]

40ish something with a hudge hammer but that shouldn't come as a surprise, unlike pushing back so hard on a request for labs at an annual.

PSA is one piece of data. It is not a diagnosis. I just want the data.

Did you read the link?

Do you have any urinary symptoms (retention, frequency, dribbling)

Do you have any family history of prostate cancer?

Those are questions you should be discussing with your provider.

TGR won't lead to much useful info.

[Mazderati]

You are focused on the wrong thing. Forget PSA. If I request a metabolic panel as part of preventative care and am willing to pay for it, is there any reason to refuse that request?

[fomofo]

I'm going to go to McDonalds for every meal, for the next 15 years. Then I'm gonna get all you hard working, healthy living, tax payers to pay for my Gastric Bypass.

I'll thank you ahead of time.

Well, 15 years done come and gone. Didja get that surgery? Cause if not I hear there’s a shot** you can take now that’ll solve all your problems.

**Actually a potentially endless series of shots, but don’t worry, it’ll all be paid for. By somebody.

[Trackhead]

Well, 15 years done come and gone. Didja get that surgery? Cause if not I hear there’s a shot** you can take now that’ll solve all your problems.

**Actually a potentially endless series of shots, but don’t worry, it’ll all be paid for. By somebody.

I have United Healthcare, they declined the bariatric surgery and have declined my Ozempic.

[Conundrum]

Did you ask your doctor for an A1C level at your annual physical? There are alternative paths to obtaining GLP1s that most users are unaware of.

[old goat]

TGR won't lead to much useful info.

No one comes to TGR for useful info. Especially not to the padded room.

Mazderati--if you didn't, consider asking your doctor for references re frequency of testing in (presumably) asymptomatic middle aged men. Is the doc a younger, well read hot shot or an old crank who does things their way no matter what the literature says. I'm not primary care and I most certainly am not well read 13 years into retirement but I presume that there is a fair amount of literature on the subject.

When it comes to the issue of whether patients should be able to demand specific tests, meds, or procedures, regardless of benefit--in general no IMO, although as you say, if you are footing the bill lab tests are certainly the easiest to justify demanding. Your doctor is right that unexpected abnormal test results can lead down potentially dangerous and unnecessary rabbit holes. In my case my doctor ordered some fancy tests because of an alarming drop in my red blood cells. Except that I live at altitude and don't drink enough so my RBC's are always high, except right after my big heart operation when of course my blood count was low. I knew the reason but chose to go ahead and get the additional tests, so that my doctor could sleep at night.

If by T you mean testosterone--if you're asking for it you already know it's low.

[ktoor]

alot of what has been said above, but to respond to the question of whether there is any reason to deny a test as youve requested (background: ive done intl clinical guideline development but am not a physician)

an individual may think its in their interest to test for everything but this can be bad for them and bad use of healthcare resources. in the case of ordering multiple tests, if those tests are 95% "accurate" (tests are much more accurate than this typically) 1/20 times you'd get an erroneous result. you order more tests, or the same tests very frequently then there may be a false positive at some point which would mean additional procedures. not fun for you. sometimes they find things that otherwise would have been benign and they take an interventionist strategy. not fun for you and bad for your health. this also has the resulting public health implication of wasting resources.

i dont know if that played a role in the doctor's decision for those specific tests but assume this is what they were alluding to. it may FEEL good for you to get all these tests whenever you want but from an evidence-based perspective, it can be bad for everyone.


Sent from my iPhone using TGR Forums

[neufox47]

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PSA is one piece of data. It is not a diagnosis. I just want the data.

Wait he wouldn’t test your lipids!? Cholesterol and triglycerides?

[Trackhead]

You are focused on the wrong thing. Forget PSA. If I request a metabolic panel as part of preventative care and am willing to pay for it, is there any reason to refuse that request?

That's odd.

Yeah, checking renal function in middle aged doods is pretty standard in the setting of hypertension/obesity, or liver function tests in obese (NAFLD, alcohol, etc). Blah blah blah......blah blah blah.

Go see someone else.

[Core Shot]

I have United Healthcare, they declined the bariatric surgery and have declined my Ozempic.

Have you considered firearms?

[old goat]

Wait he wouldn’t test your lipids!? Cholesterol and triglycerides?

They don't need to be checked yearly.

alot of what has been said above, but to respond to the question of whether there is any reason to deny a test as youve requested (background: ive done intl clinical guideline development but am not a physician)

an individual may think its in their interest to test for everything but this can be bad for them and bad use of healthcare resources. in the case of ordering multiple tests, if those tests are 95% "accurate" (tests are much more accurate than this typically) 1/20 times you'd get an erroneous result. you order more tests, or the same tests very frequently then there may be a false positive at some point which would mean additional procedures. not fun for you. sometimes they find things that otherwise would have been benign and they take an interventionist strategy. not fun for you and bad for your health. this also has the resulting public health implication of wasting resources.

i dont know if that played a role in the doctor's decision for those specific tests but assume this is what they were alluding to. it may FEEL good for you to get all these tests whenever you want but from an evidence-based perspective, it can be bad for everyone.


Sent from my iPhone using TGR Forums

One thing about the accuracy of tests--statistically they are far more accurate when done when the doctor suspects a problem. They are less accurate when done on asymptomatic people.

[MultiVerse]

Since this is a philosophical thread, there's little demonstrable health benefit to routine annual doctor visits for generally healthy people

[bennymac]

I bet I can find an anecdote told from the patients point of view that some people might think proves you wrong

[MultiVerse]

Still salty after you yourself asked for an anecdote... and little demonstrable health benefit doesn't mean the same thing as zero. Meaning sometimes examples are useful, sometimes they're not

[Danno]

I had an annual checkup today. At annual checkups, I ask doctors to order several labs either common at one point in time or that I personally track over time: CBC, MP, urinalysis, lipids, A1C, thyroid, PSA, total T, and free T. This is probably a larger set of labs than most people get but the labs are not uncommon. I have a high-deductible health plan so costs are negotiated but largely out-of-pocket.

No doctor has had a problem ordering the labs even if some questioned the T. Until today, when my new doctor would not order any of them. None. The doctor said they are concerned an erroneous result in one of the tests would do more harm than the rest of the tests would do good. It is a bizarre position to take in general, but especially so for preventative care. We went back and forth a few minutes but the doctor would not budge. So, I'm doctor shopping and questioning the utility of an annual if I can do everything at home.

You have a high deductible so it certainly feels like you are just willing to pay for the tests and the doctor shouldn't care about ordering them. But you are not purely paying for them, it sounds like, but rather wanting the costs to go towards your deductible, ie you want to make them insurable tests. So that does mean the doc needs to play a gatekeeping role here.

Whether the doc should deny the tests is way outside my wheelhouse, but I'm just pointing out that you are not purely paying for these, there is an associated cost to insurance here.

[The AD]

40ish something with a hudge hammer

You know what they say: when the only tool you have is a hammer, every problem looks like a nail.

[RoooR]

How well is the current testing regime in this country doing at catching the “Four Horsemen” of chronic disease (cardiovascular disease, cancer, neurodegenerative disease, and metabolic disease) before they become major issues? Would more comprehensive testing do a better job and enable earlier interventions?

[bennymac]

Still salty after you yourself asked for an anecdote... and little demonstrable health benefit doesn't mean the same thing as zero. Meaning sometimes examples are useful, sometimes they're not

Just because I asked for an example doesn’t mean I’m to blame for your shitty answer.

And anyone who uses mass media news sources for their ideas about how health care works - especially ones thar quote patients but get very little info from the other side (due to patient confidentiality) is someone who doesn’t actually understand what they think they do.

What is on me is for not realizing how you operate on here - plenty of other mags seem very familiar with your inabilities.

[bobz]

Do some googling and you should be able to find a service that will take your money (probably no more than what you would have paid if your doctor ordered the tests) and send you to the nearest Labcorp. My last doc didn't believe in the APO-B test, for whatever reason, so I went that route, and it was reasonably cheap.

Then, I guess, you can submit the bill to your insurance company so that they can deny the reimbursement.

[skaredshtles]

Then, I guess, you can submit the bill to your insurance company so that they can deny the reimbursement.

I chukkled.

[MultiVerse]

Just because I asked for an example doesn’t mean I’m to blame for your shitty answer.

And anyone who uses mass media news sources for their ideas about how health care works - especially ones thar quote patients but get very little info from the other side (due to patient confidentiality) is someone who doesn’t actually understand what they think they do.

What is on me is for not realizing how you operate on here - plenty of other mags seem very familiar with your inabilities.

It wasn't a bad answer. A key part you ignored is the fact the Canadian surgeon told her the HIPEC procedure wasn't recommended in her case was because it would only have a 50-percent chance of success. One reason why American health care is expensive is because, despite unequal access to medical expertise and services, a 50:50 chance is considered a standard of care

[bennymac]

I don’t remember the surgeon being quoted…

[Mazderati]

When it comes to the issue of whether patients should be able to demand specific tests, meds, or procedures, regardless of benefit--in general no IMO, although as you say, if you are footing the bill lab tests are certainly the easiest to justify demanding. Your doctor is right that unexpected abnormal test results can lead down potentially dangerous and unnecessary rabbit holes. In my case my doctor ordered some fancy tests because of an alarming drop in my red blood cells. Except that I live at altitude and don't drink enough so my RBC's are always high, except right after my big heart operation when of course my blood count was low. I knew the reason but chose to go ahead and get the additional tests, so that my doctor could sleep at night.

If by T you mean testosterone--if you're asking for it you already know it's low.

Demand is a loaded word in this context. Patients should be able to request common labs and a doctor should be willing to order them as part of collaborative, preventive care. Missing a true concern because a lab was not ordered is also a risk. Discuss caveats before and interpretations after resulting. I appreciate the perspective.

alot of what has been said above, but to respond to the question of whether there is any reason to deny a test as youve requested (background: ive done intl clinical guideline development but am not a physician)

an individual may think its in their interest to test for everything but this can be bad for them and bad use of healthcare resources. in the case of ordering multiple tests, if those tests are 95% "accurate" (tests are much more accurate than this typically) 1/20 times you'd get an erroneous result. you order more tests, or the same tests very frequently then there may be a false positive at some point which would mean additional procedures. not fun for you. sometimes they find things that otherwise would have been benign and they take an interventionist strategy. not fun for you and bad for your health. this also has the resulting public health implication of wasting resources.

i dont know if that played a role in the doctor's decision for those specific tests but assume this is what they were alluding to. it may FEEL good for you to get all these tests whenever you want but from an evidence-based perspective, it can be bad for everyone.

Guidelines are flexible. They are not rules. But, they do often consider cost.

An erroneous result does not automatically mean out of range or indicate invasive diagnostics. It might just mean retesting or keeping an eye on it at the next annual. Labs are information. What to do with that information is where medical training and experience are invaluable.

Is the public health burden of early or late disease detection higher?

"I don't want my patient to know because it might make them feel some kind of way," is next-level preventive medicine.

Thanks for the perspective.

Wait he wouldn’t test your lipids!? Cholesterol and triglycerides?

Too dangerous, apparently.

One thing about the accuracy of tests--statistically they are far more accurate when done when the doctor suspects a problem. They are less accurate when done on asymptomatic people.

Is this a joke on confirmation bias? Over my head if not.

You have a high deductible so it certainly feels like you are just willing to pay for the tests and the doctor shouldn't care about ordering them. But you are not purely paying for them, it sounds like, but rather wanting the costs to go towards your deductible, ie you want to make them insurable tests. So that does mean the doc needs to play a gatekeeping role here.

Whether the doc should deny the tests is way outside my wheelhouse, but I'm just pointing out that you are not purely paying for these, there is an associated cost to insurance here.

Is a $100 test with a $95 negotiated rate and unmet deductible a meaningful distinction?

[Mazderati]

Do some googling and you should be able to find a service that will take your money (probably no more than what you would have paid if your doctor ordered the tests) and send you to the nearest Labcorp. My last doc didn't believe in the APO-B test, for whatever reason, so I went that route, and it was reasonably cheap.

Then, I guess, you can submit the bill to your insurance company so that they can deny the reimbursement.

Labcorp is like an hour away but maybe it comes to that.