Article - unnecessary medical care

[Valley Girl]

   

 

I'm ashamed to admit all the snake oil I've been taking because I couldn't handle the stress of a little girl my daughter's age rattling on and on about how she was going to

 

"educate you that you did not have to let all of your teeth rot out just because you can't remember to call your dentist every six months for a cleaning and didn't know that you needed to buy a new toothbrush if you lose the one we give you instead of just not brushing your teeth"

 

because she was too lazy and/or illiterate to look at my charts and see that I had been coming in every three months for years ever since my dentist suggested it, got my first cavity in my 30s after my $10,000+ gum surgery, and was telling the truth when I politely said, "You don't have to talk to me like that. English is my native language and also what I chose for a major in college."

 

I felt like I needed to do something besides having a panic attack and crying every time I thought about the words "tooth" and "dentist".

 

Something must have helped, though, because this has been a relatively pain free (as well as dentist free) year for the first time in recent memory and I haven't lost any teeth for the first time since before 7yods was conceived.

 

((((((Meriwether))))))))

 

37 is within the realm of normal for peri and low estrogen can have huge and unexpected effects on our health.

You've posted before about the awful things people have said to you about this situation. I just wanted to say that I am so sorry you've been subjected to that. People can be absolutely appalling. I hope that your better health continues.

 

 

[Guest]

Thank you for your kindness, Reluctant Homeschooler, and apologies for the duplicate posts, Hive.

 

It would be pretty stupid to delete it after it's been quoted; I'm still practicing to be the "outrageous old lady who doesn't GAF" IRL but I see now that a more appropriate place to do so would be in a debating group.

 

Meriwether, if you aren't already taking BCP, that might be easier for you to get ahold of than HRT, but it's a much higher dose of estrogen so a greater risk of cancer down thre line and that is a decision you're going to have to make for yourself. You might also look into "The Great Soy Controversy of 2008ish" and see if you find any common assumptions worth questioning.

 

You can also get FSH tests without a prescription here:

 

http://www.early-pregnancy-tests.com/fshfetest.html

 

Again, it's not conclusive and shouldn't take the place of a competent physician but sometimes we just have to do what we have to do. :(

Edited November 21, 2015 by Guest

[Meriwether]

.

 

Meriwether, if you aren't already taking BCP, that might be easier for you to get ahold of than HRT, but it's a much higher dose of estrogen so a greater risk of cancer down thre line and that is a decision you're going to have to make for yourself. You might also look into "The Great Soy Controversy of 2008ish" and see if you find any common assumptions worth questioning.

 

Thank you. The doctor just started me on BCP last month. It hasn't done anything yet, but we are giving it three months.

 

[ktgrok]

T

Edited to comment on doctors not following guidelines: Not sure of the statistics, but in my experience it's pretty darn risky to practice outside of guidelines unless you have a good reason to do so. They aren't the end-all-be-all of course, as every patient situation is unique and they serve as a strong recommendation to guide practice, but that's likely the FIRST thing that will be looked at in malpractice. I have not found one primary care provider (including a few specialists) thus far in my practicums that does not follow guidelines for the most part, unless in unusual circumstances. Not to say it doesn't happen, but I can't imagine it would be very many. (that's why that article was SO bizarre to me)

 

Actually, around here anyway, "standard of care" can mean the local standard of care. So if all the doctors are doing the same thing, that's considered the standard, no matter what the other guidelines are. I've had OBs tell me this to my face, saying they don't follow ACOG guidelines because their standard of care is what is done locally. 

[EmseB]

Actually, around here anyway, "standard of care" can mean the local standard of care. So if all the doctors are doing the same thing, that's considered the standard, no matter what the other guidelines are. I've had OBs tell me this to my face, saying they don't follow ACOG guidelines because their standard of care is what is done locally. 

 

Yes.  Having had my babies in three different hospitals and one at home, this is really true.  Not all practice is evidence based, but rather based on what is acceptable regionally.  For my 3rd, it was considered progressive to allow him to stay in the room while they were doing all their checks (because other hospitals in the area were taking babies to the nursery for a minimum of 2 hours for observation immediately after an uncomplicated birth -- this is 2013 mind you and is still the policy at that hospital to this day), but he had to stay on the warmer to verify that he could regulate his body temperature.  For my fourth, in a baby-friendly certified hospital, it was considered standard of care to make sure baby stayed on mom's chest for at least the first hour after birth.  Now, I've done my google scholar research and can say that one of those options is probably pretty objectively better for baby and mom (barring complications, of course), but it is not standard of care in many, many places.  Where you are can greatly affect what is done.

 

In dealing with DH's recent issues, we've found practitioner will tells us many different things about how to take care of something as (relatively) simple as dressing a small open wound.  Looking around on the internets tells me that medical practitioners don't necessarily agree!

 

And a lot of times it comes down to...who do you trust?  There's the nurse who has been doing stuff for 20 years and really sounds like she has her stuff together, and then there's the surgeon telling you what you've been doing on the nurse's advice isn't necessary.  And not having been to medical school, that is a tense place to be with a lot of responsibility, not just for one's self but thinking about decisions about medical care for kiddos.  Even seemingly simple decisions.

 

I am thankful, though, that decisions can be complicated...150 or 200 years ago there were not the myriad of options and no decisions, right?

Edited November 22, 2015 by JodiSue

[TranquilMind]

But it's not always just "on him". If everyone who wants an antibiotic "just in case" it's a bacterial infection gets one, the amount of antibiotic resistance in the community goes up. That effects everyone not just the one patient. 

 

Labwork done that is unnecessary or medications ordered that are unnecssary drive up the cost of healthcare as well, effecting more people than just that one patient. 

I guess I trust people to make good decisions about their own health more than you (or others) do.  I always know when I need an antibiotic and I am always right.  It isn't very often at all, but when one is needed, earlier is better than later, because I know exactly what will happen.  Fortunately, I have health care people who trust me instead of second-guess me.    Personally, I don't ever want to take antibiotics unless absolutely necessary because it messes up your gut bacteria, so probiotics always happen too, right after.  I don't know the people who generally just want antibiotics for no reason because I know mostly educated people. 

 

If a doctor has ordered labs, I may add additional ones that frequently turn out to be necessary, and the doctor is glad I thought of it. 

 

I had a doctor tell me straight to my face that we didn't have (X disease) in our area.  The people at the lab laughed out loud when I told them this (did not name the doctor, by the way, but he is a well-respected, long term physician who makes the "best doctors" list all the time).   We sure as heck DO have this in our area. 

 

I flew cross-country to have a surgery with one of the few guys who did the method I wanted.  I'm just fine now, when thousands are not, who did the typical surgery. 

 

Having had a sibling die who was mistreated many times (with a substantial settlement upon her death from the hospital to keep it quiet), call me skeptical.    I make my own decisions and will listen to good advice, but I follow my gut, not outside advice that contradicts it.  It has served me well for over half a century, so I don't fix what isn't broken.   

 

I'm sure I am an outlier, but I've lived long enough to see that many things that I knew weren't right are now discredited (frequent mammograms, etc). 

Edited November 22, 2015 by TranquilMind

[TranquilMind]

Yes.  Having had my babies in three different hospitals and one at home, this is really true.  Not all practice is evidence based, but rather based on what is acceptable regionally.  For my 3rd, it was considered progressive to allow him to stay in the room while they were doing all their checks (because other hospitals in the area were taking babies to the nursery for a minimum of 2 hours for observation immediately after an uncomplicated birth -- this is 2013 mind you and is still the policy at that hospital to this day), but he had to stay on the warmer to verify that he could regulate his body temperature.  For my fourth, in a baby-friendly certified hospital, it was considered standard of care to make sure baby stayed on mom's chest for at least the first hour after birth.  Now, I've done my google scholar research and can say that one of those options is probably pretty objectively better for baby and mom (barring complications, of course), but it is not standard of care in many, many places.  Where you are can greatly affect what is done.

 

In dealing with DH's recent issues, we've found practitioner will tells us many different things about how to take care of something as (relatively) simple as dressing a small open wound.  Looking around on the internets tells me that medical practitioners don't necessarily agree!

 

And a lot of times it comes down to...who do you trust?  There's the nurse who has been doing stuff for 20 years and really sounds like she has her stuff together, and then there's the surgeon telling you what you've been doing on the nurse's advice isn't necessary.  And not having been to medical school, that is a tense place to be with a lot of responsibility, not just for one's self but thinking about decisions about medical care for kiddos.  Even seemingly simple decisions.

 

I am thankful, though, that decisions can be complicated...150 or 200 years ago there were not the myriad of options and no decisions, right?

True on all counts.

 

At least we can try various options now, even if we have to make choices! 

[Little Women]

One thing I'm not seeing on the first page, at least, is the pressure that is on primary care drs.   I have a friend whose dh is a dr.  He has recently switched jobs, but had a hard time finding a job which did not demand that he see patients at a rate of no more than 10 minutes each. If he couldn't keep to that timetable, his pay would be docked significantly!    One place he looked at allowed under 20 minutes for a "medium/high complexity" visit!   There is no way a dr can do an adequate job under those conditions, and it doesn't surprise me that they might want someone to come back for a lab follow up, then for another, just so they have 30 minutes to actually deal with your problem!    But that costs you 3 co-pays, too.

[SKL]

My experience has been mixed.  I am with an HMO and they don't tend to push much.  Then again, we don't go to the MD much.

 

But reading this thread reminds me of a situation with my kid's skin.  This was when I was on the PPO option, so I went to out-of-HMO providers.  My kid had some rough whitish patches on her leg.  Our regular MD said it was probably a fungus and he prescribed some cream.  We tried the cream and it did nothing.  So he referred us to a dermatologist.  She said it wasn't a fungus but some sort of infection, and prescribed another cream.  It did nothing.  Next she said it was probably eczema and prescribed over-the-counter creams.  Still no improvement.  Each time I went to the dermatologist, my "co-pay" was $50 out of the total $51 bill (for being looked at for 1 minute by a dermatologist who obviously had no idea).  Needless to say, I didn't go back a 3rd time.  After some time, the patch went away by itself.  In retrospect, I probably should have driven my kid to the HMO, but it was so far away and I figured the specialist we were referred to would get it done more efficiently.

 

There have been times I've said no thanks to treatments.  I have no problem doing that.  There have been other times when I went in and specifically asked them to do X even if they weren't suggesting it.  And they did it.

[EmseB]

I guess I trust people to make good decisions about their own health more than you (or others) do. I always know when I need an antibiotic and I am always right. It isn't very often at all, but when one is needed, earlier is better than later, because I know exactly what will happen. Fortunately, I have health care people who trust me instead of second-guess me. Personally, I don't ever want to take antibiotics unless absolutely necessary because it messes up your gut bacteria, so probiotics always happen too, right after. I don't know the people who generally just want antibiotics for no reason because I know mostly educated people.

 

You might be surprised. I worked with a guy who had his mother send him antibiotics from Mexico and he would take them at any sign of any kind of illness. This is what everyone in his family did.

 

I am skeptical that most people know the difference between a viral and bacterial infection and which one would need antibiotics.

[creekland]

I guess I trust people to make good decisions about their own health more than you (or others) do.  I always know when I need an antibiotic and I am always right.   

 

I'm mixed on this.  I know there are those of us out there who fully understand antibiotics (and any other med we research fully), but I also know I get "the masses" coming through in high school.  These kids have learned what they know from their parents/peers at this point, and I (+ others) do an awful lot of correcting that knowledge.

 

So many things we take for granted as "common knowledge" aren't.

 

With disputed deals or "we're not sure" deals, the person involved should get to make the decision.  The person also always has the option to not take something.  But with some of the undisputed deals and taking ineffective prescribed meds, that crosses my line I think.

[Bluegoat]

I found his article full of baloney. His examples were absurd and none of them follow current guidelines. I'll be an NP in less than 6 months and in my hundreds of hours of clinicals with NP's, PA's and MD's, his "stories" are nothing I've ever seen in practice. Of course not all providers follow guidelines to a T, but nearly every example of his was so far off that I don't even believe him. Was he suggesting breast cancer should be treated as indolent?! The diabetes story? That's how you DO handle diabetes education.....it's NOT a novel concept and health coaches are mainstream now in my clinics. There are very few situations I've seen that was handled with aggression, conservative treatment is ALWAYS tried first and I've had many, many providers serve as my preceptors so far. Many times insurance won't even pay for a CT or MRI unless conservative treatment has been tried. Are tests and treatments overdone? Perhaps at times...but I think he is flat out exaggerating and doesn't even seem to know what he's blabbing about. 

 

The article isn't based on anecdotes - they are there for the benefit of the reader, to see the kinds of things that are being references in the larger numbers.

 

And there are other sources as well that show that there are significant problems of this kind.

 

Plus - a heck of a lot of people, including ones who work in medical care, have experienced it.

 

You don't give much of a basis to say that he "doesn't know what he's blabbing about."  he's a very well respected doctor and researcher on this issue.

[Bluegoat]

I am a bit more hesitant about the "not sure" going to the patient for a decision on prescribing drugs, though generally I believe in patient centered care.  I don't think we would say that about drugs with more significant side effects, or seriously addictive qualities.

 

I think the problems we have with antibiotics are far more serious than people realize, and we are probably going to have to institute very serious controls.  (As well as strictly controlling things like prophylactic farm use.)

[magnificent_baby]

Actually, around here anyway, "standard of care" can mean the local standard of care. So if all the doctors are doing the same thing, that's considered the standard, no matter what the other guidelines are. I've had OBs tell me this to my face, saying they don't follow ACOG guidelines because their standard of care is what is done locally. 

 

Interesting! That could very well be true. I'm in an area heavily populated by medical care, many health systems and medical universities. Perhaps that makes a difference!

[sassenach]

You might be surprised. I worked with a guy who had his mother send him antibiotics from Mexico and he would take them at any sign of any kind of illness. This is what everyone in his family did.

 

I am skeptical that most people know the difference between a viral and bacterial infection and which one would need antibiotics.

It took me over a year of marriage to get my dh to understand that his mom's swap meet penicillin was a bad idea. Not everyone can be trusted to write their own prescriptions. However, I think a good pcp gets to know their patients and figures out who they can trust to follow their gut and who they can't. I have a fantastic relationship with our ped and he does follow my lead on a lot of things. I also respect him and ask for his input. It's a relationship.

[creekland]

I am a bit more hesitant about the "not sure" going to the patient for a decision on prescribing drugs, though generally I believe in patient centered care.  I don't think we would say that about drugs with more significant side effects, or seriously addictive qualities.

 

I think the problems we have with antibiotics are far more serious than people realize, and we are probably going to have to institute very serious controls.  (As well as strictly controlling things like prophylactic farm use.)

 

I definitely agree with you regarding meds with addictive qualities (and antibiotics, of course).

 

I've had far more doctors (even Quick Clinics and dentists) offer med options than not.  I tend to turn most down (all down unless I see the need for it).  I still have a few hanging around that I've never used too - from back when I used to just smile and nod and get stuff filled, THEN check out what it was for.  I save the money now and check things out first.

 

I'm thinking Alice is correct that most doctors just prescribe stuff to people even if they aren't sure about it.

 

(Most of what I've turned down could have been helpful to others - pain meds, etc, - so I'm not really suggesting unneeded things have been offered.  I'm just really against putting much into my body that "I" don't see the need for and can put up with a lot.  I've also been known to skip doctors when I know the solution is antibiotics as I can get those on my own at times.  That's rare though.  I don't get many infections fortunately.)