How does your doctor "doctor"?

[wathe]

Also pointing out, Americans, you have posters from 3 different non-US countries all saying much the same thing.  USA is the outlier here. US health care system as a whole is an outlier.  $$$$$$ more than other countries, with, on a population basis, worse outcomes.

[Jean in Newcastle]

My most extensive exams and testing were done by specialists, not my primary doctor. Those visits required long questionnaires, a long talk with the doctors and specialized tests that delved into all areas of that specialty. But that’s because I has “mystery “ symptoms which required a lot of sifting through to narrow it down to a diagnosis. 
 

I would not expect or want that level of testing done for a physical. A physical is preventative and the screening tools make sense if there isn’t much prior contact with physicians but (in my opinion) are best used judiciously. Not because it hurts anyone to have their knee hit by a tiny rubber hammer but because I would rather our limited  time be spent in a more efficient manner tailored to my needs. My doctor doesn’t rush me through but he doesn’t waste my time or his either. (And if our discussions and tailored exam shows a potential problem he zeros in on it). 

[Jean in Newcastle]

2 minutes ago, wathe said:

Also pointing out, Americans, you have posters from 3 different non-US countries all saying much the same thing.  USA is the outlier here. US health care system as a whole is an outlier.  $$$$$$ more than other countries, with, on a population basis, worse outcomes.

As you pointed out earlier, the US has recommendations for Preventative Health Examinations. As far as I know, they aren’t that different than what you have. But we have easier access to specialists. It is true though that those with better insurance have better, more comprehensive  health care. Possibly because those people also tend to schedule it more frequently because they can get time off work.  Co-pays don’t tend to be attached to preventative care so that isn’t as much of an issue. 

[wathe]

This thread is also highlighted the art/science duality of medicine.  And the commercial/business aspect.

People (including doctors, who are people) like to think of medicine as science.  But, really, the art component of medical practice is huge.

The science of periodic health exam (evidence of no benefit) is robust, and a has been a settled thing here for more than a decade.  Family medicine had moved away from annual physicals and toward PHEs when I was training in the '90s.

But the science isn't what people want.  They think they want it, but as this thread shows, it isn't really the main thing much of the time.  What they want to feel cared for. And that's the art.  

Patients will often use time spent, performative non-evidence based physical exam, and number of tests ordered as a sort of metric for competency in their doc.  When it's really the often the opposite.

It's really difficult as a clinician to be scientific/evidence-based, efficient (medicine is your doc's livelihood and is a business), and be perceived as caring.  It's possible and the best clinicians find the balance.  But it's actually really hard.

[wathe]

18 minutes ago, Jean in Newcastle said:

As you pointed out earlier, the US has recommendations for Preventative Health Examinations. As far as I know, they aren’t that different than what you have. But we have easier access to specialists. It is true though that those with better insurance have better, more comprehensive  health care. Possibly because those people also tend to schedule it more frequently because they can get time off work.  Co-pays don’t tend to be attached to preventative care so that isn’t as much of an issue. 

Clearly the docs of many posters here are not either familiar with them, or just don't follow them (because art and pt satisfaction (ETA and business) is more important in private medicine than science, see post above)

US also suffers from higher rates of iatrogenesis, IIRC.  And much more defensive medicine because of medico-legal culture.

Over-medicalization of normal life (relative to other countries) is a general, enduring  theme on this board.  Which may be invisible to American boardies, but definitely noticeable to non-US boardies, I think.

Edited August 20, 2022 by wathe

[Jean in Newcastle]

2 minutes ago, wathe said:

Clearly the docs of many posters here are not either familiar with them, or just don't follow them (because art and pt satisfaction is more important in private medicine than science, see post above)

US also suffers from higher rates of iatrogenesis, IIRC.  And much more defensive medicine because of medico-legal culture.

Over-medicalization of normal life (relative to other countries) is a general, enduring  theme on this board.  Which may be invisible to American boardies, but definitely noticeable to non-US boardies, I think.

I do think that you make some valid points. But I do want to point out that when it comes to needing more timely care for more urgent matters, all our Canadian relatives come down to the States for medical care. In other words, no system is perfect. And each have their issues.   I personally have experience with medical practices in the US, Canada and Japan. Dh has been a HCW in Canada and the US. And I was interning in a Japanese hospital (in a healthcare adjacent capacity that has no equivalent here) for two years. 
 

ANYWAY, for the purposes of this particular thread, it does help to learn how to advocate for yourself. But that includes learning what to advocate for and I personally don’t think that the OP’s list is of primary importance. 

[ktgrok]

If you are in a country that doesn't ahve well visits annually, do people get their blood pressure checked on any kind of schedule? I know it was said that many screenings are done outside of the regular doctor visits, so maybe there is a procedure for those? If nothing else, given that high blood pressure has no symptoms until critical, and is so damaging, I'd think that having blood pressure checked at least annually is wise. Same with blood sugar, A1C, etc. Which it sounds like maybe is stuff being screened for, but at a different place than regular doctor's office?

That may be the difference. Since that stuff is done by our regular doctor, once you are in the office it only makes sense to take the 3 minutes or so to do a physical exam. 

[wathe]

6 minutes ago, Jean in Newcastle said:

I do think that you make some valid points. But I do want to point out that when it comes to needing more timely care for more urgent matters, all our Canadian relatives come down to the States for medical care. In other words, no system is perfect. And each have their issues.   I personally have experience with medical practices in the US, Canada and Japan. Dh has been a HCW in Canada and the US. And I was interning in a Japanese hospital (in a healthcare adjacent capacity that has no equivalent here) for two years. 
 

ANYWAY, for the purposes of this particular thread, it does help to learn how to advocate for yourself. But that includes learning what to advocate for and I personally don’t think that the OP’s list is of primary importance. 

Absolutely, all systems have their issues.   The US system has more issues than most, I think.

Waitlists are definitely an issue for sub-acute problems.  Access to care in emergency situations is actually very good, though.

Travel to the US from Canada for care is not common.  No one can afford it!  I personally only know one person who has done it - travel to Detroit for prostate surgery, because "wanted the best", and paid something like $63,000 out of pocket.  Might be more common in border towns?  The only data I found in my quick search was an estimate by the Fraser Institute (right wing think tank with a political agenda), which had serious methodological limitations. Even their possibly inflated estimated value of 63,000 is peanuts for  a country of almost 40,000,000.  Also need to discriminate the difference  between care received while traveling vs traveling with the purpose of receiving care - Canadian snowbirds are in Florida up to 6 months of the year, and will receive care while there.

I'll add that we see a lot of Americans travelling here for care here too.  My border town colleagues especially.  Care costs less OOP here.

 

[wathe]

23 minutes ago, ktgrok said:

If you are in a country that doesn't ahve well visits annually, do people get their blood pressure checked on any kind of schedule? I know it was said that many screenings are done outside of the regular doctor visits, so maybe there is a procedure for those? If nothing else, given that high blood pressure has no symptoms until critical, and is so damaging, I'd think that having blood pressure checked at least annually is wise. Same with blood sugar, A1C, etc. Which it sounds like maybe is stuff being screened for, but at a different place than regular doctor's office?

That may be the difference. Since that stuff is done by our regular doctor, once you are in the office it only makes sense to take the 3 minutes or so to do a physical exam. 

Diabetes screening frequency depends on risk factor profile.  Not annual for most people.https://www.cmaj.ca/content/184/15/1687.full, and https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-4#panel-tab_FullText.   

Screening interval for hypertension also depends on risk factor profile.   BP is a vital sign, so tends to get done pretty often outside the context of the PHE (at visits for literally anything else), so screening interval is less of an issue. https://canadiantaskforce.ca/tools-resources/hypertension/hypertension-clinician-algorithm/

PCP also has to balance conflicting sets of guidelines.  Disease-specific organizations (diabetes canada, hypertension canada etc) may come up with different recommendations than comprehensive primary care orgs (canadian task force).  Prostate screening is a good example of this, the urologists (who see all the bad disease outcomes in the screeing numerator, but don't see the screening denominator) have different opinions on screening than primary care specialists (who see all the harm from false positives prompting further invasive testing, resource mis-use etc)

Primary care is complex and hard.

Edited August 20, 2022 by wathe

[Jean in Newcastle]

22 minutes ago, ktgrok said:

If you are in a country that doesn't ahve well visits annually, do people get their blood pressure checked on any kind of schedule? I know it was said that many screenings are done outside of the regular doctor visits, so maybe there is a procedure for those? If nothing else, given that high blood pressure has no symptoms until critical, and is so damaging, I'd think that having blood pressure checked at least annually is wise. Same with blood sugar, A1C, etc. Which it sounds like maybe is stuff being screened for, but at a different place than regular doctor's office?

That may be the difference. Since that stuff is done by our regular doctor, once you are in the office it only makes sense to take the 3 minutes or so to do a physical exam. 

Every doctor's visit I have here in my corner of the US includes taking vitals.  Even if I'm at a specialist for something totally different, they take my vital signs.  So anyone who gets any kind of regular healthcare are going to have their blood pressure taken.  Also- screening for diabetes is common if your bmi is above a certain level and also if you answer "yes" to some screening questions.  (Which incidentally includes whether you have high blood pressure)..  None of the OP's list are important screening tools for prediabetes or diabetes.  (She said that the "bad" doctor did have a nurse check vitals and also ordered blood tests.) 

[wathe]

gotta go for now - time for me to go to work and balance art and business with science in the real world 🙂

Edited August 20, 2022 by wathe

[KungFuPanda]

Maybe we need a poll to see how many people get a physical every year. I know I don’t go in for a physical every year and I suspect I’m not alone. I’m healthy, not overweight, and I don’t take any prescriptions. I’m rarely sick so I can go for years without seeing my doctor. I go when I’m sick. When I DO go for a physical I usually have to catch up on something like a tetanus shot.  I’m not getting any younger so I should probably pay more attention. I’m not sure I like the idea of walking around with something like high cholesterol or high blood pressure for years before finding out and taking steps to address the problem while it’s small. 
 

There must be YEARS where a yearly exam isn’t the guideline. You stop taking kids in every year when they get older. I don’t even know at what age the recommendation goes back to yearly. 

[TravelingChris]

9 minutes ago, wathe said:

Because every test has a false positive rate.  The more tests you do, the more false positives.  With enough tests, you are certain to have a false positive.  Which then prompts further testing, often more invasive.  The tests themselves can have physical complications (radiation, infection, tissue trauma).  And use resources that might be better spent elsewhere - healthcare capacity is finite and under tremendous strain.

A good clinician will balance the pre-test probability (odds that this particular patient has whatever condition the test is testing for) with the sensitivity and specificity of the test in question.  The best clinicians test less.

That is utter nonsense.   The best clinicians do not do tests that are totally unnecessary based on a patient. Amd they understand what is an alarming test result versus normal for that particular person or is something to wait and monitor with more testing at a later date. But the standard CBC and Comprehensive Metabolic Panel is a very good way to monitor all types of problems that arise with blood, kidneys, and  liver before you become symptomatic. There is a very good reason, I have to be tested at least 4 times a year with complete blood count, and comprehensive metabolic panel and once a year with a tb test and once every 2 years with A1C, etc.  I am on medications that can affect liver, etc plus have many serious diseases===all autoimmune.

My dh had never had his vitamin D tested the entire time he was in the military (27.5 years).  He also was tested at the physicals and it was low, but Dr. thought it was due to not enough sun.  Then we did the genetic testing and he is genetically unable to efficiently produce Vitamin D and while the insurance denies the claim for a separate Vitamin D test, as part of his physical, it does not.

[TravelingChris]

2 hours ago, Laura Corin said:

Sometimes things are detected that would not have developed within the person's lifetime and that lead to damaging treatment.  Eta prostate cancer is the classic example. 

That is the choice of the patient-not the guvmn't and we don't want that choice gone.

[Jean in Newcastle]

12 minutes ago, KungFuPanda said:

Maybe we need a poll to see how many people get a physical every year. I know I don’t go in for a physical every year and I suspect I’m not alone. I’m healthy, not overweight, and I don’t take any prescriptions. I’m rarely sick so I can go for years without seeing my doctor. I go when I’m sick. When I DO go for a physical I usually have to catch up on something like a tetanus shot.  I’m not getting any younger so I should probably pay more attention. I’m not sure I like the idea of walking around with something like high cholesterol or high blood pressure for years before finding out and taking steps to address the problem while it’s small. 
 

There must be YEARS where a yearly exam isn’t the guideline. You stop taking kids in every year when they get older. I don’t even know at what age the recommendation goes back to yearly. 

One of my regular monitoring appointments is labeled my "physical".  It actually varies very little from my other monitoring appointment with the exception of a couple of extra screenings that are done at that time.  The difference is really in how my insurance treats it.  A physical doesn't have a co-pay for the physical exam, whereas my other appointments do. 

[TravelingChris]

1 hour ago, wathe said:

Clearly the docs of many posters here are not either familiar with them, or just don't follow them (because art and pt satisfaction (ETA and business) is more important in private medicine than science, see post above)

US also suffers from higher rates of iatrogenesis, IIRC.  And much more defensive medicine because of medico-legal culture.

Over-medicalization of normal life (relative to other countries) is a general, enduring  theme on this board.  Which may be invisible to American boardies, but definitely noticeable to non-US boardies, I think.

We didn't do annual physicals until we got the concierge doctor, and that was when we were in the age to start doing them according to that PHE or whatever.  Yes, we are doing some more frequently than the PHE.  But I am only a few years away from the age both my parents died, and dh is within a five or six years from his mother's age at death.  

And as to over--medication, I am a poster child of this and it has to do with partially the whole war on drugs and because I have so, so, so many autoimmune issues including complicated ones like asthma and allergies wherein if I do not manage them, I flare with all my other autoimmune diseases.

[Pawz4me]

14 minutes ago, KungFuPanda said:

 

There must be YEARS where a yearly exam isn’t the guideline. You stop taking kids in every year when they get older. I don’t even know at what age the recommendation goes back to yearly. 

I'm not convinced that a yearly exam is recommended much at all in the US. This is what I found from a quick search (www.health.gov). It seems to me it's pretty much what those from other countries are referring to as preventive health care. So we're having a semantics issue more than anything.

 

Quote

Children and Adolescents
Immunizations can protect children and adolescents from serious and potentially fatal diseases, including mumps, tetanus, and chicken pox.
Early screening can detect vision and hearing problems in young children.
Screening children and adolescents for overweight and obesity can protect them from adverse health outcomes later in life.
Adults
Regular checkups that measure weight, blood pressure, and cholesterol levels can protect men and women from chronic diseases, such as heart disease and diabetes.
A Pap test every 3 to 5 years for women aged 21 to 65, depending on age and testing method can protect women from cervical cancer.
A mammogram every 2 years beginning at age 50 can detect early signs of breast cancer in women.
Colorectal cancer screening beginning at age 50 can protect both men and women from colorectal cancer.
“Booster” immunizations can protect both adult men and women against tetanus, diphtheria, and whooping cough.

I think it's pretty much what @Jean in Newcastlejust posted -- much of what many of us are calling annual physicals are really just slightly expanded regular monitoring visits for existing issues or medications. Even though I'm fast approaching 60 I doubt I'd go annually "just because" if it wasn't needed for medication monitoring. But the insurance fully covers an annual physical and doesn't cover a medication/blood work visit, so we call one of those visits a physical and it gets covered. Shrug.

[sheryl]

2 hours ago, wathe said:

Big difference being that dogs/cats can't give a first-person (first-animal?) history.  Observation (owner's and vets) is our only history tool. There is overlap with pediatrics (babies) and vet med here, I think,  and evidence-based well-visits/PHE do involve more hand-on exam for peds than for adults.

(I have exactly zero knowledge about preventive vet care or the state of the evidence on that!)

Yes, observation from the pet parent but I'm referring to the "thoroughness" of exam.  I believe Katie is saying that (correct me if I'm wrong).  I also agree with Katie that these little assessments of eyes, mouth, ears - those in particular, are so quick!  It's just so worth it imo.

[TravelingChris]

54 minutes ago, wathe said:

Absolutely, all systems have their issues.   The US system has more issues than most, I think.

Waitlists are definitely an issue for sub-acute problems.  Access to care in emergency situations is actually very good, though.

Travel to the US from Canada for care is not common.  No one can afford it!  I personally only know one person who has done it - travel to Detroit for prostate surgery, because "wanted the best", and paid something like $63,000 out of pocket.  Might be more common in border towns?  The only data I found in my quick search was an estimate by the Fraser Institute (right wing think tank with a political agenda), which had serious methodological limitations. Even their possibly inflated estimated value of 63,000 is peanuts for  a country of almost 40,000,000.  Also need to discriminate the difference  between care received while traveling vs traveling with the purpose of receiving care - Canadian snowbirds are in Florida up to 6 months of the year, and will receive care while there.

I'll add that we see a lot of Americans travelling here for care here too.  My border town colleagues especially.  Care costs less OOP here.

 

It totally depends on your particular situation.  When dd2 went to New Zealand, her health deteriorated dramatically due to their cost-saving universal care that was inadequate for properly caring for her--- she almost died because they didn't have proper sizes needles to put an IV in.

 We all had fantastic care when we lived  in Belgium, but they do not have universal health care.  When I got sick in Toronto, I had to go to an Immunization private clinic for care, and ended up with bad pneumonia and partially collapsed lung by the time I got home. In Greece I used a private clinic and they were totally fine---I had the option to go to the public hospital there but would have waited hours and hours and I had gotten my knee injury because I had been up for hours and hours already--long bus ride, 3 plane flights, etc.

 

[KungFuPanda]

3 minutes ago, Jean in Newcastle said:

One of my regular monitoring appointments is labeled my "physical".  It actually varies very little from my other monitoring appointment with the exception of a couple of extra screenings that are done at that time.  The difference is really in how my insurance treats it.  A physical doesn't have a co-pay for the physical exam, whereas my other appointments do. 

 

3 minutes ago, TravelingChris said:

We didn't do annual physicals until we got the concierge doctor, and that was when we were in the age to start doing them according to that PHE or whatever.  Yes, we are doing some more frequently than the PHE.  But I am only a few years away from the age both my parents died, and dh is within a five or six years from his mother's age at death.  

And as to over--medication, I am a poster child of this and it has to do with partially the whole war on drugs and because I have so, so, so many autoimmune issues including complicated ones like asthma and allergies wherein if I do not manage them, I flare with all my other autoimmune diseases.

It sounds like you both have definite health reasons that determine your frequency of care. So, it’s not as simple as ‘Americans get physicals every year because they don’t know better and their system is messed up.’  The actual schedule is determined by the patient and their doctor and it’s not even an official recommendation for everyone. It’s more of a range. “Go every 1-3 years if you’re x age.”

[sheryl]

2 hours ago, TravelingChris said:

Why would extra testing have a negative effect?  I mean, yes, if radiation is used, but for blood tests, ekgs, palpitations, hearing exams, eye exams, Pap smears, ultrasounds, -what negative effect?  When the CDC decided that Pap Smears should only have to be done every 3 years, and I skipped a year before coming back for one, he said, that if they catch the cancer in year one, it is an office procedure.  If in year 2, it is a procedure that would have to be done at a surgery center or hospital, but not too bad; If you wait, and it is discovered in year 3, you are talking about surgery, and cancer drugs, or radiation too.

Right, I didn't understand that either - negative effect.  Laura, please explain.

[sheryl]

2 hours ago, wathe said:

Because every test has a false positive rate.  The more tests you do, the more false positives.  With enough tests, you are certain to have a false positive.  Which then prompts further testing, often more invasive.  The tests themselves can have physical complications (radiation, infection, tissue trauma).  And use resources that might be better spent elsewhere - healthcare capacity is finite and under tremendous strain.

A good clinician will balance the pre-test probability (odds that this particular patient has whatever condition the test is testing for) with the sensitivity and specificity of the test in question.  The best clinicians test less.

Sure, but what is the percentage of that?  If there is much of that going on, it's time to find a new dr.  But, that's the point of the annual to determine if further testing is needed.

[Pawz4me]

This AARP article is undated (or if there is a date I can't easily find it), but it says only about twenty percent of US adults get an annual physical. 

[sheryl]

2 hours ago, Jean in Newcastle said:

My most extensive exams and testing were done by specialists, not my primary doctor. Those visits required long questionnaires, a long talk with the doctors and specialized tests that delved into all areas of that specialty. But that’s because I has “mystery “ symptoms which required a lot of sifting through to narrow it down to a diagnosis. 
 

I would not expect or want that level of testing done for a physical. A physical is preventative and the screening tools make sense if there isn’t much prior contact with physicians but (in my opinion) are best used judiciously. Not because it hurts anyone to have their knee hit by a tiny rubber hammer but because I would rather our limited  time be spent in a more efficient manner tailored to my needs. My doctor doesn’t rush me through but he doesn’t waste my time or his either. (And if our discussions and tailored exam shows a potential problem he zeros in on it). 

OK, Jean, I agree with you here (mostly).  That is the point of a specialist - detailed, indepth, thorough troubleshooting.  Yes, preventative care through the annual.  Agree.

But, I do believe that the "others" (reflexes, etc list) do not take long at all.  He/she may see something in your eyes (using light is preferred and telling) that you wouldn't have noticed.  But, he did and it can now be discussed for treatment.   

 

[Laura Corin]

9 minutes ago, sheryl said:

Right, I didn't understand that either - negative effect.  Laura, please explain.

Thanks - did that upthread.

[Pawz4me]

5 minutes ago, sheryl said:

Sure, but what is the percentage of that?  If there is much of that going on, it's time to find a new dr.  But, that's the point of the annual to determine if further testing is needed.

The problem is with the tests, not the doctor. False positives are an inherent part of any testing. They just are. The more tests that are done on any individual the more likelihood there is that one or more of those tests will yield a false positive. Or someone pushes for a MRI/CT when it's not really needed and the scan shows up an "incidentaloma" -- something probably not harmful at all but that causes anxiety--often a LOT of anxiety--in the patient.

[sheryl]

2 hours ago, wathe said:

This thread is also highlighted the art/science duality of medicine.  And the commercial/business aspect.

People (including doctors, who are people) like to think of medicine as science.  But, really, the art component of medical practice is huge.

The science of periodic health exam (evidence of no benefit) is robust, and a has been a settled thing here for more than a decade.  Family medicine had moved away from annual physicals and toward PHEs when I was training in the '90s.

But the science isn't what people want.  They think they want it, but as this thread shows, it isn't really the main thing much of the time.  What they want to feel cared for. And that's the art.  

Patients will often use time spent, performative non-evidence based physical exam, and number of tests ordered as a sort of metric for competency in their doc.  When it's really the often the opposite.

It's really difficult as a clinician to be scientific/evidence-based, efficient (medicine is your doc's livelihood and is a business), and be perceived as caring.  It's possible and the best clinicians find the balance.  But it's actually really hard.

Hmm.  Well, my original post clearly states that K did this and M does this.  It is a preference but let me ask you - why were those exams even performed if at some point it wasn't deemed valuable?  Sure, people have changed much since 1920.  People know the problems that are associated with smoking, excessive drinking, and the list continues.  So, today there are NEW issues.  People smoke and drink less but now we have preservatives in food and so many other NEW advances (so or one would think) that those send people to the dr.  

So, you don't know me but "my" preference is for a highly skilled doctor who is degreed from a great school, etc, knowledgeable, experienced, friendly, thorough, think outside the box type of person.   K was that.  He had a great reputation as a "great doctor" on so many levels.  Why isn't that possible now?  I believe it is.  

[Ellie]

1 hour ago, Jean in Newcastle said:

ANYWAY, for the purposes of this particular thread, it does help to learn how to advocate for yourself. But that includes learning what to advocate for and I personally don’t think that the OP’s list is of primary importance. 

I have Hashimoto's, which is an autoimmune disease which affects they thyroid. But it's first an *autoimmune disease,* not a thyroid condition. Most doctors don't know how to treat thyroid issues properly in the first place, and most of them don't know what to do with the autoimmune part, either. I have more thyroid symptoms than autoimmune, and if I am medicated properly, I feel well. But there's vast disagreement on what that means; because of that, I was undermedicated for almost 20 years, allowing my poor thyroid gland to just wear itself out, such that I have to take a boatload of thyroid meds to feel well. I am now letting my primary care physician take care of my thyroid issues (I had an endocrinologist who knew what he was doing but he moved far away), and he does.not.know what to do. I have to push for the correct tests, done on a timely manner and not only once a year at my physical. Ugh. But I was ready to look for another doctor if he would not do the tests, because *I* am advocating for  myself.

[sheryl]

1 hour ago, Jean in Newcastle said:

I do think that you make some valid points. But I do want to point out that when it comes to needing more timely care for more urgent matters, all our Canadian relatives come down to the States for medical care. In other words, no system is perfect. And each have their issues.   I personally have experience with medical practices in the US, Canada and Japan. Dh has been a HCW in Canada and the US. And I was interning in a Japanese hospital (in a healthcare adjacent capacity that has no equivalent here) for two years. 
 

ANYWAY, for the purposes of this particular thread, it does help to learn how to advocate for yourself. But that includes learning what to advocate for and I personally don’t think that the OP’s list is of primary importance. 

That's fine.  You don't have to agree, Jean.  I think it's a very valuable tool!!

[sheryl]

7 minutes ago, Pawz4me said:

The problem is with the tests, not the doctor. False positives are an inherent part of any testing. They just are. The more tests that are done on any individual the more likelihood there is that one or more of those tests will yield a false positive. Or someone pushes for a MRI/CT when it's not really needed and the scan shows up an "incidentaloma" -- something probably not harmful at all but that causes anxiety--often a LOT of anxiety--in the patient.

I understand it's with the tests.  That is true of almost any test.  But, wasn't there mention of multiple tests?  How is that defined?  I do understand though that sometimes "detailed" testing is suggested and not needed.   

[sheryl]

1 hour ago, Jean in Newcastle said:

Every doctor's visit I have here in my corner of the US includes taking vitals.  Even if I'm at a specialist for something totally different, they take my vital signs.  So anyone who gets any kind of regular healthcare are going to have their blood pressure taken.  Also- screening for diabetes is common if your bmi is above a certain level and also if you answer "yes" to some screening questions.  (Which incidentally includes whether you have high blood pressure)..  None of the OP's list are important screening tools for prediabetes or diabetes.  (She said that the "bad" doctor did have a nurse check vitals and also ordered blood tests.) 

Jean, I did NOT call M "bad".   He's good (not like K) but he's not as thorough.  

[sheryl]

29 minutes ago, Pawz4me said:

This AARP article is undated (or if there is a date I can't easily find it), but it says only about twenty percent of US adults get an annual physical. 

But, it doens't mean that's the right or best decision.   Fewer people are stopping at red lights but it doesn't make it right!    Pawz, thanks for your input.

[Pawz4me]

1 minute ago, sheryl said:

But, it doens't mean that's the right or best decision. 

I think the evidence is overwhelming that annual physicals aren't really helpful for improving long term health outcomes. A Google search, and if you want to go really deep use Google Scholar, will show that.

I totally get that it's hard to let go of something that you've been told all your life. For many people it's scary. Perhaps you see that yearly visit as insurance, something that's more or less guaranteeing that you'll stay healthier longer. But evidence doesn't show that to be true. Clinging to something that's false isn't beneficial.

I'm reminded of years ago when some of the health groups came out and said yearly mammograms weren't necessary and didn't save lives. A lot of women were upset, and I was (kind of) among them. But my gynecologist patiently explained that some breast cancers are going to be curable regardless of when they're detected, and some aren't going to be curable regardless of when they're detected. Early detection really wasn't much, if any, benefit. It took awhile for that to worm around in my brain, but I finally did get it. I think that's pretty much what people are saying WRT annual physicals. Thinking they're helpful is false comfort.

[Kassia]

25 minutes ago, Pawz4me said:

I think the evidence is overwhelming that annual physicals aren't really helpful for improving long term health outcomes. A Google search, and if you want to go really deep use Google Scholar, will show that.

I totally get that it's hard to let go of something that you've been told all your life. For many people it's scary. Perhaps you see that yearly visit as insurance, something that's more or less guaranteeing that you'll stay healthier longer. But evidence doesn't show that to be true. Clinging to something that's false isn't beneficial.

 

But annual physicals result in yearly lab work and that can be very beneficial.  

[Pawz4me]

6 minutes ago, Kassia said:

But annual physicals result in yearly lab work and that can be very beneficial.  

My guess is that if we moved away more from the annual physical model that medical providers would order more lab work when patients are in for a sick visit or a medication check. My provider has a thing about cholesterol and my numbers have been creeping up for awhile. So when I go in for a thyroid check she often says let's go ahead and check your cholesterol while we're at it. I'm often not fasting so it's not totally ideal. But it still gives some insight, and no extra visit required. I suspect we'd see more of that when patients come in for fairly routine sick visits like sinus infections, etc.

[ktgrok]

2 hours ago, Jean in Newcastle said:

Every doctor's visit I have here in my corner of the US includes taking vitals.  Even if I'm at a specialist for something totally different, they take my vital signs.  So anyone who gets any kind of regular healthcare are going to have their blood pressure taken.  Also- screening for diabetes is common if your bmi is above a certain level and also if you answer "yes" to some screening questions.  (Which incidentally includes whether you have high blood pressure)..  None of the OP's list are important screening tools for prediabetes or diabetes.  (She said that the "bad" doctor did have a nurse check vitals and also ordered blood tests.) 

My point was more for those without chronic health problems (that they know of), who are not going to see a doctor other than for a well visit/physical. If someone is say, age 45 and has no known medical problem, when would they have their blood pressure or blood sugar checked?

 

[Kassia]

30 minutes ago, ktgrok said:

My point was more for those without chronic health problems (that they know of), who are not going to see a doctor other than for a well visit/physical. If someone is say, age 45 and has no known medical problem, when would they have their blood pressure or blood sugar checked?

 

@Pawz4me this is pretty much how I was going to answer your reply.  Many of us don't go to doctors and wouldn't have those lab tests done without an annual physical.  

[Pawz4me]

10 minutes ago, Kassia said:

@Pawz4me this is pretty much how I was going to answer your reply.  Many of us don't go to doctors and wouldn't have those lab tests done without an annual physical.  

Another way it could be handled is for people to go have labs w/o having it tied to a provider visit. So you get an electronic or snail mail notification every year (or two or three, depending on age/interval recommendation) that it's time for routine lab work, you go have it done and only go to see a provider if it shows a problem. I just don't see this is a hard or insurmountable issue. ETA: It might result in more people getting more regular lab work done, since a lot of people really don't like the in-person exam, particularly the weigh in.

Edited August 20, 2022 by Pawz4me

[Jean in Newcastle]

1 hour ago, ktgrok said:

My point was more for those without chronic health problems (that they know of), who are not going to see a doctor other than for a well visit/physical. If someone is say, age 45 and has no known medical problem, when would they have their blood pressure or blood sugar checked?

 

You can get them checked at any pharmacy here. Obviously it requires someone actually going and having it done but that’s true for a doctor’s appointment as well. 

[Kassia]

30 minutes ago, Pawz4me said:

Another way it could be handled is for people to go have labs w/o having it tied to a provider visit. So you get an electronic or snail mail notification every year (or two or three, depending on age/interval recommendation) that it's time for routine lab work, you go have it done and only go to see a provider if it shows a problem. I just don't see this is a hard or insurmountable issue. ETA: It might result in more people getting more regular lab work done, since a lot of people really don't like the in-person exam, particularly the weigh in.

Yes, this would be PERFECT!  

[Jean in Newcastle]

Nothing is going to replace someone having some interest in monitoring their own health. Unless you are in an institution like a nursing home or it’s a requirement like vaccinations for a school or activity where you could still choose to abstain, no one is going to force you to have a screening test or lab work. I actually am not against healthier people having a physical exam. (Though I don’t think that it has to be yearly but instead maybe every couple of years especially if someone goes in if anything new pops up. ).  Nor am I against them having regular dental or eye exams.   I think that all of that is good responsible health management even for healthy people. 

[Melissa in Australia]

1 hour ago, ktgrok said:

My point was more for those without chronic health problems (that they know of), who are not going to see a doctor other than for a well visit/physical. If someone is say, age 45 and has no known medical problem, when would they have their blood pressure or blood sugar checked?

 

Blood pressure is taken every time you go to the doctor.  If you go to the doctor sick,  he can give you a pescription. 

Some people usually older people who are specific medication think opiads,  get weekly blood tests to made sure if levels and medication adjusted accordingly at a special clinic 

At things like country field days there are pop up clinics where nurses do sugar test and blood pressure tests.  

All women over a certain age get 2 yearly mammogram scans without seeing a doctor.  They just book an appointment at the testing site.  There are even mobile clinics that travel to rural areas with all the machinry in a walk in truck

 There are also womens health nurses that do Pap smears though if you only have one partner you can go 3 years between tests if you like. 

Eye tests are done by an optomitrist,  every person in Australia gets a free check every 2 years.  If the optomitrist reccomend it,  then this could be 6 monthly.  My twins are on 6 monthly appointments

There are diabetic clinics  that include having a specialist diabetic nurse that does house checks and blood testing for people who  need it 

Skin check clinics. 

The list goes on and on

 

 

[Jean in Newcastle]

43 minutes ago, Melissa in Australia said:

Blood pressure is taken every time you go to the doctor.  If you go to the doctor sick,  he can give you a pescription. 

Some people usually older people who are specific medication think opiads,  get weekly blood tests to made sure if levels and medication adjusted accordingly at a special clinic 

At things like country field days there are pop up clinics where nurses do sugar test and blood pressure tests.  

All women over a certain age get 2 yearly mammogram scans without seeing a doctor.  They just book an appointment at the testing site.  There are even mobile clinics that travel to rural areas with all the machinry in a walk in truck

 There are also womens health nurses that do Pap smears though if you only have one partner you can go 3 years between tests if you like. 

Eye tests are done by an optomitrist,  every person in Australia gets a free check every 2 years.  If the optomitrist reccomend it,  then this could be 6 monthly.  My twins are on 6 monthly appointments

There are diabetic clinics  that include having a specialist diabetic nurse that does house checks and blood testing for people who  need it 

Skin check clinics. 

The list goes on and on

 

 

There are free specialty health fairs here in the US as well. My husband (nephrology RN) has worked at them. They provide various screenings for free as well as little toys and various handouts. And referrals for more medical help if the screening warrants it. 
 

There are free or low cost medical clinics in poorer areas - many of them with  bilingual practitioners. 
 

There are mammograms given in mobile clinics (motor homes). We have one in our grocery store parking lot once a year. It’s all walk in. 

Edited August 20, 2022 by Jean in Newcastle
Typo

[bookbard]

9 hours ago, ktgrok said:

doctor legally cannot treat someone, including prescribing meds or tests, if they have not seen them in the past year.

but how does that work - you've got to start somewhere, right? Do you mean they can't treat them if they haven't had a physical? 

Anyway, definitely not the law in Australia. You can go to any doctor you want, if they have a space, and they'll treat you. There are some doctors who won't take on new patients because they're busy, I  hear about issues in certain areas of Australia where people struggle to find a GP, but I have been to a lot of different doctors in my local area without problem. If my kids are sick, I can get in that day to someone, even if my usual Dr is busy. 

[Wheres Toto]

7 hours ago, shawthorne44 said:

I think there is a value in those checks.   

For example, as a kid my parents took me in for a physical every year.   A recent check was needed before going to summer camp, so it was even done about the same time every year.  One year at school the school nurses did a scoliosis check on everyone.  I had it!   The doctor had never checked for that!   Since then finding a primary care doc that includes checks that don't cost extra has been a priority.  Because of the scoliosis check in school I was able to get a surgery that mostly corrected it.   If it had been found earlier, it would likely have been completely corrected.  I hadn't been aware that it was a problem.  

 

My pediatrician has always checked my kids for scoliosis.  I do remember getting the checks in school so maybe she does them because she knows my kids are homeschooled?  I don't remember if she did them with my oldest.

I get a physical every year (ish) from my gp in order to get my albuterol prescription refilled.  I'm also now on an allergy medication.  She does the usual blood work, checks weight, blood pressure, ears/nose/throat, heart/lungs, stomach checks.  She asks if I go to a gyn and if I get regular mammograms (I do) and discusses any problems.  

[Jean in Newcastle]

8 minutes ago, bookbard said:

but how does that work - you've got to start somewhere, right? Do you mean they can't treat them if they haven't had a physical? 

Anyway, definitely not the law in Australia. You can go to any doctor you want, if they have a space, and they'll treat you. There are some doctors who won't take on new patients because they're busy, I  hear about issues in certain areas of Australia where people struggle to find a GP, but I have been to a lot of different doctors in my local area without problem. If my kids are sick, I can get in that day to someone, even if my usual Dr is busy. 

She means that you can’t just call a doctor and ask for a new med or a refill on an old one if a doctor hasn’t actually diagnosed you with anything and prescribed it and in the case of an old med, if they haven’t seen you in a year to monitor for side effects or to see if the med is still needed. 

[Lecka]

I was very relieved when my new doctor didn’t touch me!  I had blood pressure taken, blood drawn, and discussion.  I thought the discussion was good and I really like him.  
 

At the same time, I would hope he would touch someone who seemed like they needed that.  
 

https://primary-healthpartners.com/how-it-works/

 

I know some people who are very happy with this place.  I don’t quite understand how it works.  It’s not a concierge but it has a lot of similarities I think.  

 

[bookbard]

20 minutes ago, Jean in Newcastle said:

She means that you can’t just call a doctor and ask for a new med or a refill on an old one if a doctor hasn’t actually diagnosed you with anything and prescribed it and in the case of an old med, if they haven’t seen you in a year to monitor for side effects or to see if the med is still needed. 

Oh, fair enough. I assume that'd be the case here, although I got a new asthma preventer med from a random Dr. But she did examine me and I needed it. 

[cintinative]

I didn't read all the responses, but I will comment on the annual physical thing. My husband's company requires us to get an annual physical to be on a certain rate plan for health insurance (it's not that great, but it would be worse without the physical).  Also, insurance fully covers our annual physical.

My GP is actually a DO and I sort of think that makes a difference. He spends a lot more time with me than other doctors, including my specialists.  I guess he is old school, but I feel like he really listens and does take the whole picture into view. My guess is he will retire in the next few years and I will have no idea how to replace him.

[chocolate-chip chooky]

6 hours ago, ktgrok said:

If you are in a country that doesn't ahve well visits annually, do people get their blood pressure checked on any kind of schedule? I know it was said that many screenings are done outside of the regular doctor visits, so maybe there is a procedure for those? If nothing else, given that high blood pressure has no symptoms until critical, and is so damaging, I'd think that having blood pressure checked at least annually is wise. Same with blood sugar, A1C, etc. Which it sounds like maybe is stuff being screened for, but at a different place than regular doctor's office?

That may be the difference. Since that stuff is done by our regular doctor, once you are in the office it only makes sense to take the 3 minutes or so to do a physical exam. 

I'm in Australia. As previous Australians have already pointed out, we don't have annual physicals here, for adults or children. 

We do have scheduled things at various points in life eg pap smears, childhood vaccinations, bowel cancer screening at 50 etc

But other than that, we just go to the GP if we feel the need. Things like BP are only checked if it seems necessary, either in the context of the visit, or if the person has risk factors. I had my BP checked at the ER last week, but that was the first time in maybe 15 years, and was done as part of the routine ER intake. My husband, on the other hand, has his BP checked regularly by the GP if he goes in for anything. 

Blood sugar? I have no idea when I would have had that last checked. During my last pregnancy maybe, which is now over 16 years ago. And I really don't feel concerned that it hasn't been checked.

The differences between health systems is interesting.  I really couldn't say which ones are better or worse, but I've never felt like I didn't have health care when needed, and I feel no need for regular physicals. But I guess it could just be what we're all used to.