Doctor questions

[Mulligan]

Just go, get it done, and keep healthy. There. I have been both on the provider side and on the receiving end also, no need to make a big deal out of this.

I am only 48, Obgyn, so I can put it out of my mind for a little while longer. I must admit though, the thought bothers me as only my GF's have been anywhere close to those areas. . Buckeye, that is one advantage I have over you on my high deductible plan. It has no provision for any insurance payment before the $5500 deductible. So I know someone is digging into my wallet no matter what happens.

 

[Buckeye]

I am only 48, Obgyn, so I can put it out of my mind for a little while longer. I must admit though, the thought bothers me as only my GF's have been anywhere close to those areas. . Buckeye, that is one advantage I have over you on my high deductible plan. It has no provision for any insurance payment before the $5500 deductible. So I know someone is digging into my wallet no matter what happens.

I thought, by law, insurance policies have to cover one "wellness" visit per year?

 

[Mulligan]

I thought, by law, insurance policies have to cover one "wellness" visit per year?

Not on the grandfathered plans, at least mine this year anyways. I checked online and it hadn't changed yet. I get to pay $5500, then they are supposed to pay for everything above that.

 

[Buckeye]

Not on the grandfathered plans, at least mine this year anyways. I checked online and it hadn't changed yet. I get to pay $5500, then they are supposed to pay for everything above that.

We purchased our plan in April 2011 and, like you, are covered 100% for the remainder of the year after meeting our deductible. Humana One. IIRC, the covered wellness visit was added after we purchased the policy.

 

[sengsational]

Don't fear modern medicine. It is a great tool and we benefit mightily from it. But, also, do not fear questioning modern medicine. Doctors today are rushed and pressured from all sides. As human beings they will make mistakes at times, and at other times take the easier way out. You must manage your own care to the best of your ability. A doctor is a professional you hire to do to a job. Nothing more.

I agree 100%! And has a hired gun, you probably want to pick one out very carefully. Someone right out of medical school might lack experience, but might not hold a lot of bias on science that was later disproven. But they might lack experience. Or you could go with more experience. I'm no doctor picking expert, but I guess there's an internist and GP, and various other designations. That might be the difference in what a "routine physical" entails?

--Dale--

 

[sengsational]

What you are suggesting is not standard of care.

I don't know what that even means. I do know that some doctors prescribe statins without making any attempt at lifestyle changes, which was what I was warning Kahn about. I also know that CIMT allows the doctor to visualize effects of a disease process, whereas a lipid profile requires ascribing truth to a theory, or set of theories, and basing action on the outcome of that process. Another thing I know is that there is no concensus between doctors, and in fact there is quite a wide divergence between doctors on what actions are appropriate after having seen only standard lipid profile test results. This is based on personal experience and discussions with a handfull of my work associates, comparing notes. So are there any tests you DO suggest for Kahn that would give a better indication if CHD was present, or is the blood test good enough for a scrip in your book?

 

[meierlde]

When you're scheduled for blood tests (lab work), you should certainly fast at least from midnight before your blood draw. Some tests will give inaccurate readings otherwise. Also, at your age you should also consider the pneumonia vaccine in addition to the shingles one.

I would say the most important thing to keep in mind is twofold:

A. Make a list of questions and take it with you to the appointment so you can remember to ask them all.

B. Bring a notepad so you can jot down the answers you get.

One thing that seems at bit strange, the cost of a blood glucose monitor and 50 test strips is far less than the cost of a lab based test. Why not use this and do say readings for 20 days, before hand. Likewise, one should IMHO get a home blood pressure cuff and go to the physican with a 20 day record of bloodpressure, to avoid the white coat effect (i.e. being around someone in a white coat causes the blood pressure to rise).
In my case having high blood pressure which is treated I provide such a list to my physician at every visit and there is talk of integrating this with the smart phone, so that to monitor blood pressure no visit to the office is needed.

 

[obgyn65]

I would prefer not to discuss medical topics on this website, as this is not why I joined. However, I cannot let anyone telling a forum participant, without knowing her medical history, and who has not seen a provider in 20 years, that "what you want is a carotid IMT test" for her first visit, instead of following basic ATP treatment guidelines for example. This has nothing to do with being for or against the use of statins with or w/o CHD. This will be my last post under this thread.

I don't know what that even means. I do know that some doctors prescribe statins without making any attempt at lifestyle changes, which was what I was warning Kahn about. I also know that CIMT allows the doctor to visualize effects of a disease process, whereas a lipid profile requires ascribing truth to a theory, or set of theories, and basing action on the outcome of that process. Another thing I know is that there is no concensus between doctors, and in fact there is quite a wide divergence between doctors on what actions are appropriate after having seen only standard lipid profile test results. This is based on personal experience and discussions with a handfull of my work associates, comparing notes. So are there any tests you DO suggest for Kahn that would give a better indication if CHD was present, or is the blood test good enough for a scrip in your book?

 

[Brat]

It has been many years since the OP has seen a physician - - I would add to the ask list recommended vaccinations and where to obtain them.

Also ask for a GYN recommendations.

You will probably need a colonoscopy, as for recommendations for a GI.

Keep in mind that once you are over 65 Medicare is primary and your health care providers must deal with their rules.

 

[Mulligan]

I agree 100%! And has a hired gun, you probably want to pick one out very carefully. Someone right out of medical school might lack experience, but might not hold a lot of bias on science that was later disproven. But they might lack experience. Or you could go with more experience. I'm no doctor picking expert, but I guess there's an internist and GP, and various other designations. That might be the difference in what a "routine physical" entails?

--Dale--

You reminded me of a quote Coach Bobby Knight said quite a few years ago. Paraphrasing it went something like this... Why the hell does everyone want to know my won/loss record, and no one seems to care what a doctors is.

 

[Redbugdave]

Kahn...Insurance...you mentioned Federal, (I am too), so make sure you check your provider's list for your doctor. Your plan will spell out all the things that are covered.

That's a lot of advise you have gotten. Don't get cold feet or the One More Year syndrome. Yes...I know...I haven't been to the doc in about 3 years. Dentist...I try every 6 months or so for cleanings or cavities.

 

[freebird5825]

Here's a basic checklist.
Annual Physical Exams: What to Expect

ooops...this has already been posted.

Great to see you back on the forum, Khan.

 

[Meadbh]

Here's how it should NOT go!

The Doctor Sketch - It's Kevin - Episode 3 Preview - BBC Two - YouTube

 

[Tyro]

I'm scheduled to visit a doctor for the first time in ~20 years.
What should I talk about?
I have some minor things to be taken care of; I need some long term pain-killers.
Is there something I should ask about (I'm 62).
My insurance will pay for "a physical", what should that entail?

Finding the right doctor (in this case, Primary Care Physician) for you is important. You want someone who will listen, communicate well, answer all your questions, and whose skill & judgement you trust. A few articles that may help you in how to find the right doctor for you:

selecting a primary care physician - Google Search
selecting the best primary care physician for you - Google Search

Your first visit will likely be some sort of "get acquainted visit", which it should be. Some doctors charge for a "get acquainted" and some do not -- call and ask. If there is no charge for that visit, don't expect to discuss particulars; that will come next.

Hopefully, the first one you see will work out for you, but if not, don't be afraid to find another, even if it takes a few tries. This is important, and is SO worth the effort! I'm sure there are many folks here who've "fired" doctors that weren't a good mix for them for myriad reasons. If specialists become necessary later on, it's your PCP who will act as coordinator (quarterback), so s/he's got to be someone you can work with.

Other posters have covered the medical history, notes, exam & tests, etc. Medicine has changed a bit in 20 years. Most doctors nowadays (IME) prefer to limit visits to one or two medical issues. You can bring a list, but don't be surprised if the doc asks you to prioritize and pick one or two issues to discuss at this visit and leave the rest for subsequent visits.

A note of caution you mention need for long term painkillers. Of course discuss your pain issues and how you have been trying to control it and that you need help dealing with it. Be careful though about requesting drugs. It is a sad fact that there are people who make the rounds of doctors under various guises seeking narcotics and many of us are very wary of new patients who are asking for drugs. I totally understand that you are not one of those people but I would bring it up gently and listen to your doctor's plans for pain management and work up and if necessary ask after that for medicine. This is a very tough issue because so many of us have been deceived too many times.
Congratulations on making the appointment and good luck!

I agree with most of this (from a pain patient's POV). A few articles that may help can be found here:

talk doctor pain - Google Search

Tyro

 

[Khan]

Went to doctor 26 March.
He did all sorts of stuff and asked all sorts of questions.
29 March went to clinic and gave blood and urine samples.
Scheduled for mammogram: 4 April.
Dr wants to schedule colonoscopy; requires someone for transportation after sedation.
Got shingles vaccine.
Would have been cheaper to die young.

 

[REWahoo]

Would have been cheaper to die young.

Missed opportunities are a byproduct of growing old...

 

[W2R]

Went to doctor 26 March.
He did all sorts of stuff and asked all sorts of questions.
29 March went to clinic and gave blood and urine samples.
Scheduled for mammogram: 4 April.
Dr wants to schedule colonoscopy; requires someone for transportation after sedation.
Got shingles vaccine.
Would have been cheaper to die young.

Congratulations! I am glad you went ahead and saw the doctor. It's good that you got these things checked out so that you *don't* die young.

 

[Brat]

Keep in mind that although preparing for a colonoscopy is a PITA you will only need to do that probably once more in your lifetime. The reason for the friend transport is the anesthesia, if you ever have surgery you will have the same need. Anesthesia is your friend!!

DH had a colonoscopy about 7 years ago. Last week he had copious blood in his stool and was hospitalized for a ASAP colonoscopy. It turned out to be diverticulitis. Now he is off aspirin and adding roughage to his diet. And, I drove him home.

So, a colonoscopy isn't just for finding cancer, it can diagnose other age related GI conditions that can help you live a better life.

Congratuations for taking the first step in maintaining your health!

 

[Gumby]

. . . for the doc to put you on a statin

This phrasing has always puzzled me. My doctor merely makes recommendations about drugs. I'm the one who decides if I will accept his recommendation and actually take them. I may be grossly misinformed, but I'm always in charge of my own life and health.

 

[REWahoo]

My doctor merely makes recommendations about drugs. I'm the one who decides if I will accept his recommendation and actually take them.

Oh my, another misinformed layman...

I love it when non clinicans provide medical advice here

 

[MichaelB]

This phrasing has always puzzled me. My doctor merely makes recommendations about drugs. I'm the one who decides if I will accept his recommendation and actually take them. I may be grossly misinformed, but I'm always in charge of my own life and health.

Oh my, another misinformed layman...

On the contrary. Gumby wasn't giving doctor's advice, he was giving user advice on how to deal with a doctor.

 

[tinlizzy]

I'm glad you went Khan!

Preventative medicine is much cheaper. A friend's co-worker ignored his high blood pressure and diabetes and had a stroke. He's now mute and paralyzed on his right side.

Ambulance to the ER. Life flighted to a bigger hospital. One week in ICU. Back to regular hospital now for the last 3 weeks. Lots of uncertainties about care still. I'm guessing his bills will come in manilla envelopes.

 

[gerrym51]

Went to doctor 26 March.
He did all sorts of stuff and asked all sorts of questions.
29 March went to clinic and gave blood and urine samples.
Scheduled for mammogram: 4 April.
Dr wants to schedule colonoscopy; requires someone for transportation after sedation.
Got shingles vaccine.
Would have been cheaper to die young.

Khan,

not to infringe on your funny line but with the insurance you have you probably payed-will pay-next to nothing-but it was funny

 

[Tyro]

My doctor merely makes recommendations about drugs. I'm the one who decides if I will accept his recommendation and actually take them. I may be grossly misinformed, but I'm always in charge of my own life and health.

You might be surprised at the number/% of people who don't take charge, and unquestioningly acquiesce to anything anyone in the medical field says.

Tyro

 

[sengsational]

You might be surprised at the number/% of people who don't take charge, and unquestioningly acquiesce to anything anyone in the medical field says.

My FIL (a mow-an-acre without blinking an eye kind of guy) degraded from the statins his doctor "put him on" to the point of being in a wheel chair before he challenged the doctor! When he said he was hurting when standing from a squat in the garden, I, a mere non-clinician, asked him what meds he was taking. He's not a complainer, so I knew it was "something". He told me about the statins and I said "I'd quit taking that stuff NOW". He said "but what about my 'numbers'", to which I replied, "numbers are no good if you're dead". It was a month later when he finally got off the statins. And it turns out his cholesterol/HDLC ratio was 2.8 at the time his doc "put him on" the statins. His doctor was trying to push LDL down below 100. Just nuts.

--Dale--