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Experts warn yearly checkups carry risks and do not reduce mortality

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Re: Experts warn yearly checkups carry risks and do not reduce mortality

#81

Post by wswope »

Arborealist wrote: post #75
electric_mayhem wrote: post #68

Earlier quoted context omitted.

That’s a great way to articulate the problem. Imho, a brilliant solution is direct primary care. For $80/mo, I have access to a dr that works for me, and not my insurance company. Absolute game changer in that he has a bias toward understanding and optimizing rather than gaming insurance metrics to be rated as a double-plus preferred provider or whatever. Also gets my lab work done at a fraction of what my insurance…

Is this the same thing as concierge medicine? I’m interested but it seems quite expensive. 80$ a month seems much lower than normal.

DPC is just concierge-lite; the difference basically comes down to the head count that the provider wants for their practice.

A lot of docs do DPC for a while to build up a client base, then exit to concierge, keeping a third of their previous roster at three times the cost.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#82

Post by waterhouse »

tetromino_ wrote: post #29
lloydatkinson wrote: post #7

I find this to be dubious and honestly a little insulting. Here in the UK there is a not insignificant number of people that die from cancers because their local health practice ignored or even refused to listen to a patient. The idea of a yearly checkup is totally foreign here unless you are going private.

I think the idea is this: even accurate tests have false positives. For patients in a low-risk group, virtually all positive results in the checkup will be false positives. When the low-risk group is large (the entirety of a nation's healthy 20-30 year olds), the number of such false positives will also be large. The positive results, regardless of whether they are true or false, will have some sort of follow-up. May…

> whether it is ethical or worthwhile to expose patients to the risk of harming their health through the follow up

So you seem to be saying that, in certain cases, if you have a positive test result, then the expected value of taking certain follow-up actions is negative. It follows that a rational actor, knowing this, would not take those actions in that situation. Then isn't the solution for doctors to update their procedures so that they don't take those follow-up actions in those situations (and explain the odds to patients who care)?

The phrasing "expose patients to the risk of harming their health through the follow up" makes it sound like the follow-up is something that automatically and unavoidably just happens, as if no one has any agency in the matter. If that's true, due to some kind of regulations or rules or liability rulings, then that sounds like a problem.

To some extent this is resolved by backpropagating: if the test is just a two-value "positive"/"negative" thing, and you plan to take the same action (i.e. nothing) regardless of the result, then there's no point in taking the test. However, I expect there are also other tests where, say, the test has a "super positive" value (or value range) where you should take action, and a "technically positive" value where you shouldn't act (plus a "negative" value); and the test is worth taking because of the likelihood of "super positive", but that means you do sometimes end up with the "technically positive" result, and must solve the problem of knowing when not to act.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#83

Post by Arborealist »

ctennis1 wrote: post #80
electric_mayhem wrote: post #76

Earlier quoted context omitted.

I honestly don’t know if ‘concierge medicine’ is a different thing, but from what it sounds like and my own experience with direct primary care they sound equivalent. Possibly different by cost or target demographic. A rose by any other name, and all that.

We have DPC, and it's amazing. We pay $250/month for a family of 4. Some places charge less, but then also charge you for each time you see the doctor. Ours is all inclusive except for any in office incidentals - like lab work. It's truly amazing. Our doctor knows us all well, can get responses to email or text within just a few minutes, generally same day appointments, or next day if she's really busy. Most things w…

Thanks. I might try this out for a year. Can’t be worse than my current experience of only seeing a NP for 5 minutes.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#84

Post by amluto »

ghostpepper wrote: post #9

There's a similar phenomenon when you look at fetal heart monitoring for otherwise healthy pregnant women going into labour. The two options are continuous monitoring, where the monitor is left in place for the entire hospital stay, and periodic monitoring, where a nurse installs it, takes a reading, and removes it about once an hour. Common sense would dictate that negative outcomes are reduced with continuous monit…

Looking at this from the other direction is interesting. Suppose hospitals had a way to monitor fetal heart rate with no possible side effects (e.g. no possible placebo or psychological effects from wearing the monitor). And they discover that intervening based on the results leads to poor outcomes, and they do better if they completely ignore the data except for one sample taken every hour roughly on the hour.

One solution would be to say “great! Let’s sample once an hour!” But surely one could come up with much better filters and heuristics.

Of course, doing this in an ethical way might be complicated.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#85

Post by electric_mayhem »

Arborealist wrote: post #83
ctennis1 wrote: post #80

Earlier quoted context omitted.

We have DPC, and it's amazing. We pay $250/month for a family of 4. Some places charge less, but then also charge you for each time you see the doctor. Ours is all inclusive except for any in office incidentals - like lab work. It's truly amazing. Our doctor knows us all well, can get responses to email or text within just a few minutes, generally same day appointments, or next day if she's really busy. Most things w…

Thanks. I might try this out for a year. Can’t be worse than my current experience of only seeing a NP for 5 minutes.

I think you’ll be very pleasantly surprised.

Consider talking to a couple local dpc providers and see which you feel you’d work best with.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#86

Post by nradov »

mhaberl wrote: post #66

This is just clickbait and people comment the title without reading the article. It doesn't say "don't do checkups" > “The conclusions do not imply that physicians should stop clinically motivated testing and preventive activities,” The article is saying that some tests give false positives, some tests even if positive don't point to illness without symptoms, but people get treated for illness. I believe you should d…

That depends what you mean by "checkups". For healthy adults there is no proven net benefit to an annual physical exam.

https://www.nejm.org/doi/full/10.1056/NEJMp1507485?af=R&rss=...

However, there are certain preventative care and screening services that everyone should get periodically.

https://www.healthcare.gov/coverage/preventive-care-benefits...

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#87

Post by soco »

kevinmchugh wrote: post #64
armitron wrote: post #22

Earlier quoted context omitted.

A lot of cancers have no symptoms at the beginning, but they can be flagged in blood tests performed as part of general health checkups.

I think the optimal move might be regular (possibly more than annual) blood work and only talking to a doctor when there's symptoms.

And if the results look dramatic, get a second or third opinion (and check) before doing anything.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#88

Post by wyldberry »

Arborealist wrote: post #83
ctennis1 wrote: post #80

Earlier quoted context omitted.

We have DPC, and it's amazing. We pay $250/month for a family of 4. Some places charge less, but then also charge you for each time you see the doctor. Ours is all inclusive except for any in office incidentals - like lab work. It's truly amazing. Our doctor knows us all well, can get responses to email or text within just a few minutes, generally same day appointments, or next day if she's really busy. Most things w…

Thanks. I might try this out for a year. Can’t be worse than my current experience of only seeing a NP for 5 minutes.

At this point, I just reschedule if it looks like im seeing an NP or PA-C and the time is only going to be 10 minutes or less.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#89

Post by nradov »

polalavik wrote: post #44

You would think doctors would be able to collect data and then come up with statistical tables of “hey you may have xyz. The risk to look into this further has these possible complications with these success/failure rates. The risk of no intervention has these other set of outcomes with these likelihoods” All you get at a doctor is someone typically saying “eh you’re young don’t worry about it” until it’s too late. I…

Your expectations are unreasonable. Most doctors are practitioners, not researchers. They are applying existing care protocols rather than collecting data and coming up with statical tables. Good doctors will follow evidence-based medicine practices where applicable, but individual cases often diverge from the standards.

There is a huge amount of medical research going on but the field is so complex that progress is necessarily slow. Carrying out long-term studies in humans is extraordinarily expensive because researchers need large study populations to extract a useful signal from the noise caused by confounding factors. You could make a case that doctors should intervene earlier to prevent chronic conditions while patients are still young rather than waiting for more serious signs and symptoms to develop. But on the other hand, the available drugs often have significant side effects that impact quality of life or cause other harmful side effects. So it's not an easy call and there are still many unknowns.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#90

Post by saulpw »

newaccount74 wrote: post #32
im3w1l wrote: post #11

I find this sentiment almost offensive. Like it goes against everything I believe to say that less data is better. But the root of it is pretty clear "even basic blood tests can lead to unnecessary interventions or treatments". It's the belief that a test leads to interventions. But it doesn't have to of course. An intervention is a decision, and if an intervention is likely to be unnecessary, then they shouldn't int…

If you ignore elevated values, why test in the first place? Also, often the test itself is somewhat invasive. Sticking various apparatuses into our bodies comes with all kinds of risks, so it better be worthwhile to do it.

Extreme values should be treated, and 'borderline' values should be ignored, but then they often aren't. People are scared when it comes to their health.

Also a blood test and urine sample aren't invasive and come with ~0 risk.

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