Is much of the annual physical a waste of time?

Is much of the annual physical a waste of time?

So much in medicine and in life is done out of habit.   We do stuff simply because that’s the way we always did it.  Repetition leads to the belief that we are doing the right thing.

In this country, we traditionally eat three meals each day.  Why not four or two?

We prefer soft drinks to be served iced cold.  I’ve never tried a steaming hot Coke.  Maybe this would be a gamechanger in the food industry.

Life gets more interesting when folks question long standing beliefs and practices forcing us to ask ourselves if what we are doing makes any sense.

In the medical profession, a yearly physical examination was dogma.  Now, even traditionalists have backed away from this ritual that had no underlying scientific data to support it.  Yet, patients would present themselves to this annual event believing that this checkup was an important health preserver.

Here were some medical routines that were never questioned.

  • yearly ear drum examinations with the otoscope
  • palpation of the abdomen
  • listening to the lungs with a stethoscope
  • testing your reflexes (sure, this was fun, but did it help anyone?)

Keep in mind that I am referring to components of the physical exam that are performed on asymptomatic individuals who feel well.  Obviously, listening to a patient’s lungs has more value if a patient has a fever and a cough.

Yes, I recognize that there may be an intangible value in having a physician make physical contact with his patients, which some argue help to create a bond in the relationship.   This may be true in part as patients have been taught to expect this from their doctors.  Indeed, a “hands-off” physician may be construed by patients as being an inattentive or even an incompetent practitioner.

Recently, the American College of Physicians issued a new guideline published in the Annals of Internal Medicine stating that routine pelvic examinations should not be performed.  Why?  Because there is no persuasive evidence that they do any good.

Sure, there will be pushback.   In medicine and elsewhere, there is often resistance to change from those whose practices are being challenged.   Review the following complex table that I have prepared.

Procedure under review : resistors

PSA : urologists
mammograms : radiologists
colonoscopies : gastroenterologists
term limits : politicians
tort reform : take a guess

If all of the elements of a routine checkup were subjected to scientific scrutiny, we might be shocked at how little of the exam remained.   This might create an unintended benefit.  It would free up time that we physicians could use to talk more with our patients.  So far, no scientific study has deemed this to be a waste of time.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower

Image credit: Shutterstock.com

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  • Patient Kit

    As a patient, I sincerely don’t know who to trust anymore about what is necessary and what is unnecessary. The whole Choosing Wisely campaign has my head spinning as hundreds of commonly done medical tests and procedures are being deemed largely unnecessary.

    So, which is it? Are payers attempting to eliminate a lot of medical care to save money? Have doctors and hospitals been knowingly doing tons of unnecessary things for a long time now to make money?

    I understand that medicine is a constantly changing thing as we learn new things and that we legitimately learn that some things we thought were necessary have turned out to not be so necessary, at least, for many patients. But this Choosing Wisely campaign is suddenly coming up with so many unnecessary things all at once. It’s hard not to be suspicious.

    Add to that, my own personal experience of having early stage ovarian cancer found during an annual well-woman checkup/pelvic exam and it’s hard for me to believe that now suddenly pelvic exams, pap smears and mammograms are all allegedly not as necessary as we all thought.

    I just don’t know what to trust anymore.

    • Lisa

      Kit, you are extremely lucky that your early stage ovarian cancer was found during via a pelvic exam. Many/most would not be detected.

      • Patient Kit

        Lisa, I do understand how very lucky I am. If I remember correctly, OVCA is only found early, in stage 1 or 2, in about 20% of OVCA, most of which is only found in later stages, 3 or 4, at which point it is far more difficult to treat.

        So, what are we saying to those 20% who will be found early if we say that women, in general, don’t need pelvic exams? It’s not worth it to the overall healthcare system? It’s not worth it to most women, so those who would have benefited greatly can be sacrificed as collateral damage for the majority? It’s hard for me to shake the fact that I might not even be alive today, let alone healthy, if I had not gone for that well-woman/pelvic exam.

        • Lisa

          I don’t think there are any easy answers. Were those early stage OVCA found as a result of the well woman exam, or were they found as the result of symptoms that prompted the women to see their doctors? Or were they found incidental to another test? How many early OVCAs are missed during annual physicals, to be discovered at later stages when they do cause symptoms?

          As I have a higher risk of developing ovarian cancer than the average woman, my gyn told me I should continue to have annual pelvic exams even though I no longer need to have pap smears (based on age and the number of normal ones I have had). But she also said that ovarian cancer is very hard to detect, so no guarantees.

          • Patient Kit

            Oh, I’m absolutely aware that there are no guarantees. I just wonder whether there are ways to increase our chances (or decrease them). I agree that there are no easy answers.

          • Lisa

            I wish they would spend the same amount of money on looking for a good blood test to detect ovarian cancer as they do in the name of breast cancer ‘awareness.’

            Ah well, at least I like my gyn and don’t mind going to see her . . .

          • Patient Kit

            I wish for that too, Lisa — more money for research to find a good way to screen for early detection. I’m lucky too that I like my GYN ONC so much and don’t mind going. In fact, I have a checkup with him this Friday morning. I’m a year and a half post-surgery and dx so I’m still in the zone of many pelvic exams (4x a year). You get used to it. Six more months and we go to 2x a year.

          • Lisa

            Kit, I know what you mean about getting used to it. I am so used to taking off my shirt so my doctors can examine my chest, it is funny.Sort of like a Pavlovian reaction.

            I hope all goes well at your checkup.

          • querywoman

            That would be nice. Breast cancer treatments have improved considerably also; we need improvements for ovarian cancer.

          • Lisa

            Well, I’ll disagree with you about treatment for Breast Cancer; it is still slash, burn and poison, with considerable colateral damage. I just think we are all quite aware of breast cancer and raising money in the name of breast cancer awareness doesn’t address treatments for advanced stage breast cancer. So if I was queen for a day and could decide such things, I think research money should be spent on research leading to better treatements (and even a cure) for metastatic breast cancer. And as there is no good, accurate screening for ovarian cancer, I’d like to see research on that.

          • querywoman

            Lisa. we are not really in conflict. I am just repeating what the medical profession says about breast cancer. It’s hard to determine if the treatments prolong life.
            We do know that leukemia used to be 99% fatal and that some people can survive leuk a long time now.
            If a woman has a suspicious lump on her breast, she will be hounded and terrorized until she comes in for treatment. I have read lots of comments on the mammogram and seen a few women who refused to come in for what they call 0 stage breast cancer treatment and said they were fine a year or so later.
            And so many women claim mammograms and subsequent treatment saved (prolonged) their lives, when they really don’t know.
            Now some people claim that breast cancer treatment leads to living as a cancer patient with treatment a few years, not knowing if it actually prolonged their lives.

            Cancers are different. Leukemia survival seems easier to measure, maybe because it involves the entire blood circulation system.
            I do know that when my mother was going for lung cancer treatment, which gave her about 8 more months, the other patients, and that includes breast cancer patients, weren’t complaining of vomiting constantly. Most of them lost their hair.

          • Lisa

            No we are not really in conflict, althought I do think that If a woman has a suspicous lump on her breast, she would be foolish not to get a diagnosis. Once you know what the lump is, then she can make an informed decision about treatment.

            Breast cancer is very complicated. I think it is actually many different diseases, that need to be treated in different ways. DCIS is the worst becuase, at this point in time, you can’t predeict which cases will go onto become invasive cancer if untreated and which cases could be monitored. This leads to a lot of overtreatment. Contrast this with the fact that the number of women dying of breast cancer is not decreasing and treatment for women with metastatic breast cancer basically consists of chemo for life.

            So everyday I drive by the breast center where I had the mammogram that lead to my diagnosis. They have a sign out front, with Rosie the riveter dressed in pink overalls. The sign says “Yes, we can cure it.” I get mad everytime I see it because the truth is there is not a cure.

          • querywoman

            Five years is considered the hallmark of cancer survival. If a woman dies of breast cancer five years and one month after initial dx, she was never cured.
            After I wrote this earlier, I sat down and mused some more. Just over twenty years ago, I was working a temporary job with a man whose ex-wife, his children’s mother, had just died. She had been dx’d with breast cancer. It wasn’t the cancer that killed her. It was the pneumonia from the immune suppressing drugs. Of course, I wondered how long she would have lived if she never been dx’d with breast cancer and just left alone.
            Now, from my experience with my mother’s cancer, I saw that many of the side effects of cancer treatments are being controlled better.
            I don’t think they ever kept statistics on how many people died from the pneumonia from having their immune systems messed with instead of actually dying from cancer.
            So, if not that many cancer patients are dying from those pneumonias, it may look like cancer patients are living longer.
            Now some doctors who treat cancer are starting to wonder if the treatments are too aggressive for some of the early stages.
            I just despise some of the language of the cancer industry, like, “the war on cancer.” Rosie the Riveter in pink with the sign boasting they can cure “it” is the same mentality. Cancer gets discussed as a survival matter, not as a quality of life issue. No other sick people are given just so many months to live.
            There’s no war on diabetes, pneumonia, or a thousand other illnesses. There’s no war on HIV. Vaccines are not talked about as a war against certain infectious diseases. Diabetes and HIV are chronic conditions that can be managed, and quality of life is discussed with them.
            I told my mother and her doctors when she got lung cancer that I didn’t believe in being told how many months she had to live. She was with me on that one.
            Lung cancer kills more women than breast cancer, and it’s still mostly fatal. However, the real improvements in lung cancer treatment are the supportive treatments, like oxygen, that make the patients more comfortable and help them live longer.
            Most lung cancer patients live about 6 weeks without treatment. With treatment, they may get 8 months to a year. She got 9 months, and her treatments weren’t that devastating. I shared with her oncologist that I had researched that it was it the supportive treatments, not the cures, that helped lung cancer patients live longer. He confirmed that was correct.
            I had a friend whose mother died of breast cancer, including recurrence. She was a very strong women. She lasted about ten years, and endured all kinds of treatments.
            However, she did some foolish things in the beginning. He said she went to fortune teller types who told her stuff like, “You don’t have cancer.”
            My mother’s oncologist was always clear that he couldn’t cure her.
            I really do think that changing the lingo and how cancer is viewed would help. Cancer is a fact of life. Often, it can’t be cured. But some people can live longer, relatively comfortable lives with treatment.

          • meyati

            You don’t live in NM. War on diabetes. My oncologists think my weight is perfect. I walk large dogs about a mile/day, exercise (weights), yard work. Although my BMI is higher than young slim women, my glucose and sugar stick is lower than my doctor’s nurse, who isn’t pre-diabetic, and some oncology staff that I talked to.
            My PCP has permission of the HMO and Medicare to declare to me that I’m diabetic. Labs are allowed to set their own ranges, I went over my labs, and the results of one glucose test was changed 3 times. When the PCP’s staff found out that I have incurable cancer, they apologised to me for making my life miserable with nagging about diet, getting exercise-weight lifting causes a thicker-heavier body core.
            My PCP asked me what I ate-I was in for my annual thyroid scan-and I told him. He asked where I found that diet. I said the the ACS. He yelled, “Just what is the ACS?”
            They are nagged into these wars by insurance, HMOs, Medicare, the state, and they get tunnel vision-nagged to bring their patient compliance % to a certain amount. Nobody cares about the health of and the stress on the patient .
            The PCP scares you to death, then says you don’t have to take insulin if you eat kale or whatever, exercise-and you aren’t doing enough or your BMI wouldn’t be this, etc.
            I’m 72 years old, with incurable cancer that’s currently in remission. I walk my 100 lb coonhounds, sleep well, work in the yard. Why can’t I be left alone? Just treat me for what I go in for?

          • querywoman

            I think I’d get another PCP. Yeah, the cancer docs don’t want you to thin. Cancers eat calories. Oh well!
            Does war and battle conflict really belong in medicine? Many diseases are chronic and treatable. Antibiotics do fight some bacteria, maybe reduce or stimulate others. Not sure how antivirals work.
            Surgery is a battle/war. How much of other medicine really is?

          • JR DNR

            1.5% of women who have regular pelvic exams end up having unnecessary surgery. That’s more than 1/100. (Number from web.md) More women are hurt by exams than saved by exams.

            In addition, doctors miss most masses on exam anyways. There was a study on women about to have surgery to remove a mass found on imaging. The women were given a pelvic exam before the procedure.

            The doctor was only able to feel something on 50ish% of women under 200 lbs. The doctor was only able to feel something 8% of the time on women above 200lbs.

            (I can’t find the link for this right now).

          • Lisa

            Either way, it is relevant….

          • JW

            I found it helpful, too. I was able to read up on mammograms and find out that they aren’t very necessary for many women and just a self-exam is fine, but I hadn’t read about this other exam.

          • Kristy Sokoloski

            Self-exams were recently ruled as that they are not beneficial to women. And I can understand why because for years I used to do them. But I would have no way of knowing whether what I felt was normal or not. I quit doing it and then around that time they said that these exams are not reliable either. As for mammograms, they are not only not very necessary for many women but they are often not that reliable in younger women because their breasts are often dense any way. It is normal for a younger woman’s breasts to be dense. This is the case for me.

          • JW

            Ok, will look into that, thank you. Other than inflammatory breast cancer which gets visible on the outside once it is very advanced, how are we supposed to find cancer?

            I do understand the danger of finding stuff not necessary to treat–my genetics teacher told me most people have about 100 cancers in their life that their immune systems can manage on their own.

            But the times it can’t, those times we need to know.

        • JR DNR

          1.5% of women who have regular pelvic exams end up having unnecessary surgery. That’s more than 1/100. (Number from web.md) More women are hurt by exams than saved by exams.

          In addition, doctors miss most masses on exam. There was a study on women about to have surgery to remove a mass found on imaging. The women were given a pelvic exam before the procedure.

          The doctor was only able to feel something on 50ish% of women under 200 lbs. The doctor was only able to feel something 8% of the time on women above 200lbs.

          (I can’t find the link for this right now).

          • Patient Kit

            Unnecessary surgery for some women is unarguably a real downside. At the same time, if I hadn’t had my annual pelvic exam because of that possibility, my life might be very different — or over. Knowing both, it’s hard to know what women should do. I guess we each have to decide for ourselves which chance we are more comfortable taking.

            The study you referenced is also very interesting — only 50% and 8% of masses known to exist via image are found during a pelvic exam. That’s a lot missed, especially on heavier women. But still, if half are missed, what about the half that would have been found?

            The more I read, the more I realize how incredibly lucky and blessed I am. My ovarian cyst wasn’t even that big but my GYN found it. Then she ordered the much-loved vaginal wand to get a better look at what she felt
            and the rest is my most recent medical history.

            I definitely see your POV on this but my own experience has me advising my beloved sister and close friends to get their annual well-woman exam.

          • JR DNR

            That was for all masses (ovarian and uterine). I found one just for ovaries (adnexal means ovaries and fallopian tubes)

            http://www.aafp.org/afp/2010/0715/p141.html

            In another study of women examined preoperatively under anesthesia, the sensitivity of detecting an adnexal mass was 28 percent for the attending physician and 16 percent for a resident.

            So it seems the chance your physician felt something was about 25%.

          • Patient Kit

            The more stats I read, the luckier I feel. I’ve beat some odds in layers of ways. Maybe I should buy a lottery ticket. ;-)

          • SarahJ89

            Yay, Kit! We’re glad you were lucky. You add a lot to the conversation.

          • Patient Kit

            Thank you, Sarah. I’m very happy to be alive and kicking. I enjoy the discussions here at KMD. We talk about a lot of important things here.

    • rtpinfla

      Trust yourself.
      If you are not sure if a test is appropriate or not discuss it with your doctor. A good physician should be able to explain the reasoning behind doing or not doing a procedure or test to your satisfaction. Continue to trust yourself after that conversation. If the answer and reasoning still doesn’t feel right than seek at least a second opinion.
      Mind you, I’m not advocating shopping around until you get the answer you want. But ultimately you are the one who needs to decide to get a test or procedure and should feel comfortable that the decision is the best one for you based your situation and the best available medical evidence that, admittedly is in constant flux.

      • Patient Kit

        I do trust myself and I think I actually have both very good instincts and research skills. In general (not just in healthcare issues), trusting my instincts is one of the rules I live by. But I’m not a doctor and I want to be able to trust my doctors. I do trust my GYN ONC, who does seem to welcome my questions and explains his reasoning to me very well about why he does or does not want to do something (chemo, CT, pap smear, whatever). He’s always willing to discuss it with me and listen to me. I don’t really feel like I have that with primary care right now. But perhaps I will somehow be able to find it.

      • Eric Strong

        I appreciate the desire to be able to rely on your physician to explain his/her reasoning behind a recommended test/procedure/medication. However, for a person with medical training, a confident voice, and an MD after his/her name, it’s very easy to talk most patients into just about anything. It’s not infrequent that I encounter patients who completely trusted their doctor, and agreed with the reasoning used when committing to an unnecessary surgery, undergoing non-indicated tests, or taking useless (and potentially harmful) medications.

        I’m not suggesting you shouldn’t trust your doctors. And there are always clinical situations which are exceptions to the rule. But the majority of the time, when the doctor is recommending something in contradiction to the Choosing Wisely campaign, or in contradiction to recommendations from USPSTF, the doctor is in error.

        • SarahJ89

          ” for a person with medical training, a confident voice, and an MD after
          his/her name, it’s very easy to talk most patients into just about
          anything.”
          This is why I believe informed consent is a fantasy. I do better if I have someone in my life I can trust and with whom I can be honest and who is honest with me. I do not expect them to be perfect, in fact they *will* make mistakes. I know when we discuss something I am getting that person’s biased beliefs, not “informed consent” and, as long as the person is competent, honest and willing to acknowledge mistakes I’m okay with that.

        • querywoman

          Heh! Heh! I wish I could find the quote I read years ago when one doc said he was astonished how many people believe anything he said just cuz he was a doctor.
          Think of all the infomercials that dig up some doctor.
          You can go to 2 doctors and get a very different opinion confidentially put out by both.
          I know Mehmet Oz is a traditional, very skilled surgeon, but I don’t believe anything he says,
          Does anyone believe Conrad Murray when he says he didn’t do anything wrong with Michael Jackson?

          • Kristy Sokoloski

            Querywoman,

            It seems like nowadays with just about anything it’s just as you said you can go to two different doctors and get a very different opinion that is put out confidentially by both. My relative ran in to this just recently where she was told from her stay in the hospital last year that she had a certain problem with her heart. Then when we went to consult about another way to care for said problem the other doctor that dealt with the category of said problems that this issue fell in to then got a different answer. She had a test done and just based on that test the doctor was like “well, said problem is not as bad as was said, but other said problem is of concern and needs to be dealt with. We weren’t told about other said problem because first said problem was of more concern. Funny thing is that she didn’t have symptoms that are often associated with that problem. Talk about crazy.

          • querywoman

            Sometimes you have to decide for yourself. In gynecology, it seems you will get lots of variance.
            I take thyroid medicine, and I take synthetic. I have had umpteen problems with thyroid adjustments until I went on diabetes treatment. They are related.
            Some people swear by Armour thyroid, the natural stuff from cows or pigs,
            but many doctors won’t prescribe it.
            Most people died from burst appendixes before they started removing them. Most doctors say to remove them. Some people refuse an appendectomy, and actually recover from appendicitis. I’m pretty sure I’d want mine removed if I had appendicitis.
            One of my uncles said his daddy died of a, “busted appendix.”

    • querywoman

      You are fortunate your ovarian cancer was found early and that you got successful treatment.
      It’s usually found late, and it’s very fatal. Yet, if they really look at the women with ovarian cancer, many of them had a history of abdominal complaints that were trivialized.
      Life has no guarantees, though. Preventive screenings can fail also.

  • JustADoc

    I’ll just quote myself from another post on this site:

    As internists and family doctors get squeezed more and more, now they want us to just do all the discussion with adults about mammograms, colonoscopies, pros/cons of PSA and prostate testing, vaccine discussions(pneumovax, zostavax, Tdap, Hep B, Hep A, menactra in certain patients, prevnar for some), PAP smear pros/cons as age, lung cancer screening pros/cons, screening for HIV/DM/Hep C(now for baby boomers), and the list goes on in the middle of another office visit.
    So Mr Doe your f/u of your hypertension/diabetes/heart disease/COPD and your concern about that skin lesion that was scheduled for 15 minutes is now only 3 minutes as I have to squeeze in all this other conversation as well.
    The purpose of the physical is not the ‘physical’. It is to keep up with all the above stuff.

    • JR DNR

      But someone with “hypertension/diabetes/heart disease/COPD” isn’t a healthy, asymptomatic adult, they are someone who is chronically ill who needs regular follow up. For them, once a year may not be enough, especially if they have medication whose dosage needs to be checked

      • Kristy Sokoloski

        Most people that I am aware of that has these conditions do get that regular follow-up care.

      • JustADoc

        Agreed completely.
        The point of what I said was that the patient has many needs that require attention(hypertension, diabetes, heart disease, COPD) that they need to be seen for regularly.
        The physical is to take care of all the other things listed so I am not having to do all of that and all of the other at the same visit in exchange for the same payment I normally get for just treating the former. It is twice the work yet insurance/payors want to give essentially same pay.
        I prefer to have an income above $0. So do my patients as if I don’t, I won’t be here shortly.

  • Acountrydoctorwrites

    I basically don’t do physicals except when they are mandated for patients in DHS custody or by an employee health plan. Remember, Medicare never did pay for physicals, and still doesn’t. The Annual Wellness Visit is NOT a physical.

  • Eric Strong

    The only component of the physical exam that is likely indicated in a healthy, asymptomatic adult is a periodic blood pressure check.

    Every other appropriate part of routine health care maintenance is counselling, vaccinations, age-appropriate cancer screening (debatable what’s included in here), and screening for HIV, DM, HCV (if risk factors), and possibly AAA in upper middle aged patients who are smokers or have family history. None of this is part of a traditional “physical”.

    I’m amazed at how often patients get the routine physical (e.g. eyes, ears, mouth, lungs, heart, abdomen, legs) when they have no complaints, yet receive an identical (and often equally worthless, but for different reasons) exam when they do have complaints. Instead, patients should be getting virtually no exam when they are feeling fine, and a very detailed and focused exam when they have a symptoms.

    • ErnieG

      One thing that is overlooked about the physical exam, from the standpoint of physicians, is the ability to improve competency. The more you do, the better you get at it, and the more you know normal and abnormal physical findings, and the better you get at helping patients. Like a poster stated above, I have picked up AAA that needed surgery and thyroid cancers needing resection on “routine” physical exams. The many normal thyroid and abdominal exams I have done made me better at picking up abnormal findings. I have never believed that residency can teach you all you need to know about medicine, and the more you know the normal variations of people in all sizes, the better you can find pathology. I will turn the tables– as a consulting rheumatologist, I have seen many patients with COPD misdiagnosed as left sided CHF in hospitalized patients who I see because there was an over-reliance on studies, and not enough attention to physical exam, mistaking normal for abnormal findings and vice versa.

      I take issue with the idea that “the majority of the time,
      when the doctor is recommending something in contradiction to the Choosing Wisely campaign, or in contradiction to recommendations from USPSTF, the doctor is in error.” In general, the USPSTF and Choosing Wisely campaign are like guidelines. They also speak to large audiences and the nuances are lost. They seem to be also concerned about costs, rather than accurate medical care. The two are different. I could easily say that when “when the doctor is recommending something in contradiction to the
      Choosing Wisely campaign, or in contradiction to recommendations from USPSTF” the campaign and guidelines are in error.

    • JW

      I definitely agree with the second part, that it’s a bit silly to use an identical exam for every patient with symptoms of any kind. Or just some basic screening tests and when they come back fine, the patient is pronounced well, even if she is clearly not.

  • betsynicoletti

    This is why I think the Medicare annual wellness visits are a valuable service, despite the initial reluctance to perform them. They provide an opportunity to have the lengthy discussion that JustADoc doesn’t want to cram into a short visit. The reimbursement is good. Staff members can collect the screening information. Although a physical isn’t required, there’s nothing that prohibits a physician from doing any or all of the physical. The work RVUs are high and the total payment for the welcome to medicare and initial wellness visit about equivalent to a 99204. The subsequent is equivalent to a 99214.

    • Kristy Sokoloski

      There was a time where Medicare did not have annual wellness visits for those that are on Medicare. It used to be just a one time physical as a way to welcome someone to Medicare and that’s it.

      • betsynicoletti

        That changed in 2011.

        • Kristy Sokoloski

          Right, I am aware of that. That’s why I said that there was a time when those visits were not covered.

  • PrimaryCareDoc

    Not a day goes by when I am not questioned by an elderly patient as to why I don’t do “routine” ECGs every year. Oh, and “routine” urinalysis.

    • querywoman

      Some people just have to have all that good stuff: the machines, the treadmill, etc.

  • querywoman

    Scaring patients almost never works. At 72, I think you have done something right to get that far.
    Also, at 72, your here and now should matter the most. I want you to make it to 82, but what are the odds anyway? Keeping you comfy now should be the most important.
    As you get older, you can be more comfortable with higher glucose levels. Go to an endocrinologist if you want more info. Some of them are bad, like any other doctor, but I’m on my sixth endo now, and he’s terrific!
    Are you on any steroids? They raise blood sugar!
    I think there was an official war on polio.
    It’s true that most medical care is no form of battle or war. Just surgery, really!
    It’s also true that some fat helps you survive cancer longer. My mother lost weight unexpectedly and got kudos. Later we found out that she had lung cancer. I researched and saw that rapidly growing tumors eat calories. That’s why she lost weight. My brother said she should have been dx’d sooner, because of her weight loss.
    She should have. She had stopped smoking almost 10 years before the lung cancer dx, but she had been a very heavy smoker. It should have been obvious!
    When I started losing weight due to tapering off insulin and going on Victoza, I was scared at first because of what my mother had. But, I eventually stabilized, and nothing in my body indicates a wasting disease. I’m still fat, but I’ve lost 70 lbs, and both my doc and I are pleased. He’s a realist. He says he’s only seen that kind of weight loss in one or two other patients.

  • querywoman

    Hmmm, not sure, but I think Dr. Kirsch implied he drinks Cokes! I imbibe diet soda, and am drinking it now, that demon from the deep unknown infierno!
    True, some things are just the way they are. I lost my brother due to diabetes noncompliance. Once I knew he had actually gone to a community charity clinic. Six or nine months later, my mother and I just knew he wasn’t doing his insulin.
    I told her I never knew anyone to get more than three months of med at a time. That’s just the way it is; that’s the max modern insurance companies get.
    She finally got her to an emergency room. He would not allow the doctor to talk to her due to, “confidentiality.” She’d been supporting him. I told her she didn’t have to let a total stranger die like that in her house.
    While waiting for him in the ER waiting room, she did get to talk to the social worker. She mentioned the community clinic. The social worker said, “They usually don’t dispense more than three months of medicine at a time.”
    Mama replied, “That’s what my daughter says.”
    Oh, just an aside here, I take my diabetes med and always have. He told my mother my diabetes was different than his and that I had lousy control because I drank aspartame in my drinks.
    After his three amputations and ensuing heart attacks and stroke, he craved diet drinks in his nursing home. He didn’t always have a lot of appetite, but we kept his fridge stocked with diet drinks. I think he forgot about aspartame. He also seemed to have forgotten that microwaved food was poison. Luckily, after the brain damage, we never heard another word about government conspiracies, either.
    I don’t need sympathy here. It’s over for him, and he’s in eternal rest, away from the pills and shots he hated. He survived much longer than the average noncompliant diabetic.

    • Kristy Sokoloski

      Querywoman,

      What is the average lifespan of a Diabetic who is noncompliant?

      • querywoman

        I don’t know but most people won’t last as long as him. A dermatologist, who was mine also, told him in his mid-twenties that he was probably diabetic and should see a GP type of doctor. He didn’t.
        I think he went at about age 40 and had got some med but didn’t keep taking it. I think the first amputation was at age 40, maybe another at age 50, and a third at about age 52.
        He was a double amputee below the knees. After the third, he still wouldn’t take his medicine. He had a stroke and heart attacks about 6 months later.
        Like I said, they usually don’t dispense more than 3 months of med at one time. He had Medicaid, so it was free. He went to the surgeon for followup after the 3rd amputation, but we never knew him to go to a diabetes doctor. Just before he collapsed on public bus with a stroke, heart attacks, he had asked our mother if she had thrown away his insulin. Of course not!
        He bounced back and lived almost another 2 1/2 years in a nursing home where he did get his meds.
        Sometime after the amputation years, a woman in my mother’s church was dealing with a noncompliant diabetic family and asking Mama questions. I told Mama that most people who don’t take their med would die much sooner than him.
        I had been working in welfare for several years, and had seen lots of people suddenly get dx’d with diabetes and be dead in 6 months.
        Diabetes is a different disease for everyone, and follows different progressions.
        I don’t think the doctors could adequately state the average life for a noncompliant diabetic. Before insulin, a lot of people would have got nasty fatal infections and heart attacks and died as their blood sugar rose.
        He had gas gangrene three times. Mama’s words were, “I watched him die in front of me so many times.” It’s not pretty.

  • querywoman

    Medicaid in Texas, and probably every other state, allows high quality physical exams annually for people under 21. That includes stuff like a lead screen.
    Many private Medicaid docs won’t do them right, since they don’t get paid enuf. I preferred my clients use public clinics for their children where the doctors were on salary.
    I told a very good private doctor about this once, what he was supposed to be getting for his tax dollars spent on children. I trusted him to do a quality exam on a child, and if he noticed something not right, to send the child to a children’s hospital for more evaluation and treatment.
    When I worked in public welfare, I saw lots of preschool children who weren’t quite right. Usually their parents already recognized it.
    As I’m reviewing this in my head, I think you are right about routine well child exams for children above age five. If they actually make it to school, they are probably developing normally by then. Also, in school, there will be other people besides the parents who can see if a child is not right.

  • querywoman

    Lots of people refused diabetes treatment. My brother did, and we couldn’t force it. I often talk about this around people who have HIV. They always talk about people who refuse HIV treatment and are in apparently denial.
    Diabetes has been treatable much longer than HIV. It’s also much more common.

  • querywoman

    Your blood sugar should be read as what it was: with recent food in the system. And sugar in cake is not the only thing that affects blood sugar. Carbohydrates raise blood sugar.
    Even if you did have diabetes, doctors aren’t supposed to just start nagging people about diabetes and exercise anymore. They are supposed to start people on medicine, usually metformin at first.
    Your seeing somebody who is gung ho in the wrong way. I agree, the person is at war with you.
    And even if you did have diabetes, you can’t be forced into any kind of treatment. My mother and I couldn’t force my brother into treatment.
    So why do you keep going to this person? This doctor sounds like a real control freak.

  • querywoman

    I did not know that they ever took Armour thyroid off market. Thyroid can be quirky, and some people prefer the natural stuff.

  • querywoman

    WOW!
    Armour was my first T pill. Eventually, I got the synthetic stuff.

    I have been on levothyroxine for years. About ten years ago, I got over $100 in the Synthroid class action, which concluded the Synthroid manufacturers had interfered with patient’s right to choose generics.
    A couple of years later, I found myself arguing with a young pharmacist who insisted I needed the brand Synthroid and knew nothing of the class action lawsuit.
    It’s really had arguing with many medical types.