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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

#121

Post by asdff »

debacle wrote: post #101
qgin wrote: post #99

Earlier quoted context omitted.

It can be hard to know what specialist to see.

For someone who doesn't know, it's impossible. But being a patient advocate has a moral hazard that insurance companies (who provide them now) aren't equipped to deal with.

Which is why the GP is so useful IMO. Maybe they could be replaced with a nurse though. The administrative assistant matches their referral with someone in my network. You need that medical profession somewhere in the chain, otherwise people browsing insurance websites for in network providers just aren't qualified to decide if they need to see an orthopedist or a podiatrist or a physical trainer for example.

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

#122

Post by giantg2 »

wyldberry wrote: post #53
sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

I was listening to Peter Attia on some podcast and he says to essentially throw out any BP reading that didn't occur after sitting down for five minutes. In his practice they have patients measure many times a day for multiple weeks just to get a baseline point to work from. More and more i find that, at least in America, if you're talking to a GP you're just talking to a human interface of insurance approved treatme…

In America we also (mis)use blood pressure machines. I'd better quality or used correctly, they're usually ok. However, I've had nurses just crank the thing up to 200. No shit it's going to be high - it cut off my circulation for 90 seconds while it climbs all the way up and then all the way down. I can feel my pulse increase in force trying to get blood to my numb arm. Let's be lazy and let the machine do everything for us.

"More and more i find that, at least in America, if you're talking to a GP you're just talking to a human interface of insurance approved treatment algorithms."

I largely agree, although from a slightly different angle. Many newer doctors just read from their Epic WebMd equivalent and record your answers. I assume it's so they don't get sued.

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

#123

Post by stu2b50 »

onewheeltom wrote: post #72

You need to remember that health care in the US is a business whose secondary function is to cure disease

You also have to remember that this study was done by Danish researchers and involved a meta-analysis on not just US healthcare, but also European healthcare systems.

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

#124

Post by 1970-01-01 »

Andy Grove would completely disagree:

https://money.cnn.com/magazines/fortune/fortune_archive/1996...

MY FIRST PSA. It all started about a year earlier when my family doctor of 20 years retired. In the fall of 1994, my new doctor gave me a physical exam to establish a new baseline. The physical involved an assortment of blood tests, all of which were in the normal range, with one exception. The test called PSA came back with a result of 5. The acceptable range, according to the lab computer, was 0 to 4.

I didn't know what this test was. In fact, I don't think I'd ever had one before. My doctor's comment was, "It's slightly elevated. It's probably nothing to worry about, but I think you should see a urologist."

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

#125

Post by hgsgm »

sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

The first part of this story is the plot of the beginning of the movie Amelie.

I'm sorry about the second part. I wish he'd done blood pressure monitoring at home.

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

#126

Post by acchow »

ChancyChance wrote: post #113
prirun wrote: post #92

Personal example: my primary care physician scheduled me for a physical, including picking the date, without even asking. It just showed up on my online chart. Okay, I hadn't had a physical for a while, so I just went with it. While stopped at an intersection on the way to his office, a woman plowed into me and 2 other cars because she wasn't paying attention, and was likely on her phone. That wreck generated $45K of…

Did you go back to working out and protein shakes? Because if you did, you still don't know why you are reacting that way which could be masking a problem elsewhere, and are exposing yourself to risk. There is a reason why metabolic values have "normal" ranges. Heck, if this were a JIRA ticket, I'd want a code review!

> There is a reason why metabolic values have "normal" ranges.

The "reason" is that they assumed a normal distribution and wanted to include 95% of people. If you're outside the normal range, you are abnormal. Which doesn't necessarily mean unhealthy or that something needs to be changed, but could potentially mean that questions should be asked to understand why you are outside the range? Maybe it's totally fine, like you are an athlete or have a particular kind of diet.

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

#127

Post by hgsgm »

Etheryte wrote: post #52

As an analogy to business, sometimes the best thing is to do nothing. Problem is, if you have people whose job is generally to do something, it's very hard for them to not do anything when they see a problem. Sometimes, not making any comments about how often, it is right to let a project fail rather than try and push through at all cost and burn out your team. The study makes a similar claim, that regular checkups o…

The beauty of a GP is that they are the the ones that get paid when you have to "do something" based on a checkup.

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

#128

Post by ChancyChance »

Since this thread is chock full of anecdotes, here's mine that is the exact opposite.

I was completely healthy into my late 20's. I started a new job at 30. I got health insurance and figured for my 30th I'd get a checkup ... my first exam since I was 18 under my parent's plan. My blood pressure was high, so they did some tests which uncovered portal hypertension, and found I may eventually need a liver transplant. Zero history of it in the family. Good thing I had a checkup because I thought I was the model of health.

Again, since these are all anecdotes, I'm sharing. Yes be alert and ask questions but don't just blow it off. Maybe not yearly, but at least twice a decade maybe?

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

#129

Post by btilly »

waterhouse wrote: post #82
tetromino_ wrote: post #29

Earlier quoted context omitted.

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…

If it is not worth taking the follow-up action, then it is not worth doing the screening either.

Concrete example. Younger women have firmer breasts. A chunk of relatively firm breast looks a lot like cancer. Therefore the younger a woman is, the higher the odds are of a false positive from a mammogram.

As a result a woman who is 30-40 SHOULD NOT get a mammogram UNLESS she has a variety of specific risk factors that increase the odds that a positive on the test is a true positive, and not a false positive.

You may verify that guideline description against https://www.cancer.org/cancer/breast-cancer/screening-tests-....

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