How often do you go to the doctors in a year if you are NOT sick?

[ziggy29]

Once a year for a regular checkup, and maybe once more if I need lab work. It helps that I have never been on any prescriptions regularly, though my blood pressure is high end of normal and threatens to need medication every so often.

I'm not including things like vaccinations (which I get from the pharmacist at a local drug store anyway), the occasional EKG (mine was "textbook" 2 years ago, so that's good) or a colonoscopy, which I don't have to repeat until '22.

[bmcgonig]

Quote:

Originally Posted by msieweke None of the above. Since I was a teen I have seen doctors for a number of issues (from acne to warts to cat scratch disease) and in almost every case the diagnosis or treatment was out of proportion to the ailment or downright wrong. In self defense I study nutrition and isolated bits of medicine on my own. I've long since passed the point where I know more than my doctor about the true causes of chronic illness. I check my blood pressure regularly and order blood tests every year or so. No doctor needed.

Do you do your own DRE as well? Since that can detect cancer even in the case of normal PSA?

[msieweke]

Quote:

Originally Posted by bmcgonig Do you do your own DRE as well? Since that can detect cancer even in the case of normal PSA?

According to AAFP, "Digital Rectal Exam does not improve detection of prostate cancer and should not be performed as a part of screening.". More information here.

[ShokWaveRider]

Quote:

Originally Posted by bmcgonig Do you do your own DRE as well? Since that can detect cancer even in the case of normal PSA?

Is there an app on iPhone or Android for it?

[Mark1]

In response to:

Mini-corp incentivized the annual checkup with a $100 gift card, but I think they only did this once. No other requirement.

Is anyone aware of similar sanctions outside of first responser/military? What about in private industry?

In my case, Mega-corp provides 15% discount on HI, if DW and I have annual physical with PC Dr to "know our numbers". It must work somewhat, as our premiums have remained unchanged since I retired in 2016. In fact, we had a "premium holiday" the first 3 months of this year where no pensioner or employee had to pay a dime of their normal 20% of the HI cost.

[bmcgonig]

Quote:

Originally Posted by msieweke According to AAFP, "Digital Rectal Exam does not improve detection of prostate cancer and should not be performed as a part of screening.". More information here.

It's controversial I guess

https://www.icgp.ie/go/library/notic...5ECB131ED.html


CONCLUSION:

DRE is a key part of the assessment for prostate cancer. It can independently identify patients at risk of prostate cancer, with a substantial proportion of these having clinically significant disease requiring treatment. This study reinforces the importance of DRE in the primary care setting in the assessment for prostate cancer. An abnormal DRE, even in the setting of a normal PSA level, necessitates referral.

[msieweke]

I don't have access to the full report, but it appears to be a small study. It's a prospective cohort study, not a randomized trial. Other than than I don't have enough info to evaluate the quality of the info.

A more in-depth analysis of the evidence used in the recommendation against screening is available here. It appears they relied on info from larger, randomized trials.

[Gumby]

Quote:

Originally Posted by bmcgonig It's controversial I guess https://www.icgp.ie/go/library/notic...5ECB131ED.html CONCLUSION: DRE is a key part of the assessment for prostate cancer. It can independently identify patients at risk of prostate cancer, with a substantial proportion of these having clinically significant disease requiring treatment. This study reinforces the importance of DRE in the primary care setting in the assessment for prostate cancer. An abnormal DRE, even in the setting of a normal PSA level, necessitates referral.

Plus, it's so much fun.

[bmcgonig]

Quote:

Originally Posted by Gumby Plus, it's so much fun.

Indeed...Don't you find it exhilarating?

[Winemaker]

My family doctor required me to see her every three months to get HBP, even though my BP has been 130/90 ever since I was in high school. She put me on pills when I turned 50, but after one visit when reading my "office visit receipt", it was showing that I had chronic heart disease. After flipping out on the phone to the nurse about when this diagnosis was made, and why I wasn't informed of it, she couldn't explain, it had been in my records for 3 years. Well, I don't see her anymore.

[FreeBear]

Quote:

Originally Posted by msieweke According to AAFP, "Digital Rectal Exam does not improve detection of prostate cancer and should not be performed as a part of screening.". More information here.

Interesting link. Are you generally sceptical of conventional screening (PSA, colonoscopy, mammogram, etc)?


So far we're, trying to take the live well and avoid the traditional medical establishment as much as possible.

[6miths]

Quote:

Originally Posted by msieweke According to AAFP, "Digital Rectal Exam does not improve detection of prostate cancer and should not be performed as a part of screening.". More information here.

And this is based on the US Task Force on Preventative Health Final Recommendations for Prostate Cancer Screening which has been cited in other threads. The DRE is mentioned as one sentence on the discussion regarding prostate screening while the thrust of the article concerns the issues surrounding PSA which is not recommended as a routine.

'Routine screening for prostate cancer should not be done'. Italics theirs.

I'm all for things that have good supporting evidence such as screening for colon cancer but routine screening for some cancers just does not work.

[Clone]

Quote:

Originally Posted by bmcgonig DRE is a key part of the assessment for prostate cancer. It can independently identify patients at risk of prostate cancer, with a substantial proportion of these having clinically significant disease requiring treatment.

Beside all that, I thought they needed the DRE in order to read the Serial Number off the prostate. Apparently it is written in Braille. I may have learned that on this forum some place.

[bmcgonig]

Quote:

Originally Posted by 6miths And this is based on the US Task Force on Preventative Health Final Recommendations for Prostate Cancer Screening which has been cited in other threads. The DRE is mentioned as one sentence on the discussion regarding prostate screening while the thrust of the article concerns the issues surrounding PSA which is not recommended as a routine. 'Routine screening for prostate cancer should not be done'. Italics theirs. I'm all for things that have good supporting evidence such as screening for colon cancer but routine screening for some cancers just does not work.

The link says that for over 70s. Not for 55-69 which advises "discussion"

My last two doctors and also the urologist were solidly in the DRE and PSA camp. It's a strange one that there are such different opinions among the medical community.

[bmcgonig]

Quote:

Originally Posted by Clone Beside all that, I thought they needed the DRE in order to read the Serial Number off the prostate. Apparently it is written in Braille. I may have learned that on this forum some place.

I wish they'd write it down in my record once they read it the first time.

[6miths]

Quote:

Originally Posted by bmcgonig The link says that for over 70s. Not for 55-69 which advises "discussion" My last two doctors and also the urologist were solidly in the DRE and PSA camp. It's a strange one that there are such different opinions among the medical community.

Advising 'discussion' is a recommendation against routine screening. Routine screening would mean that everyone is told that they should get this, like routine vaccination for measles, mumps and rubella. One can still decline but one's caregiver wouldn't be too happy about it. 'Discussion' means a frank discussion about the 'dangers' of doing the PSA test - i.e. the large numbers of false positives and the risks of pain, incontinence, impotence, infection and death that result from them. Screening can save a few lives but the question is whether the all in costs are worth it.

There is a move to have panels that make public health recommendations not contain individuals/interest groups who have the potential to benefit from said recommendations be involved in the process.

[RAE]

Quote:

Originally Posted by FreeBear Interesting link. Are you generally sceptical of conventional screening (PSA, colonoscopy, mammogram, etc)? So far we're, trying to take the live well and avoid the traditional medical establishment as much as possible.

From the U.S. Preventive Services Task Force Recommendations:

For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)–based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.

The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.

[Scratchy]

Quote:

Originally Posted by 6miths Advising 'discussion' is a recommendation against routine screening. Routine screening would mean that everyone is told that they should get this, like routine vaccination for measles, mumps and rubella. One can still decline but one's caregiver wouldn't be too happy about it. 'Discussion' means a frank discussion about the 'dangers' of doing the PSA test - i.e. the large numbers of false positives and the risks of pain, incontinence, impotence, infection and death that result from them. Screening can save a few lives but the question is whether the all in costs are worth it. There is a move to have panels that make public health recommendations not contain individuals/interest groups who have the potential to benefit from said recommendations be involved in the process.

This would not be my interpretation of the word "discussion". If the panel was recommending against screening, they would simply state that screening is not recommended, as they did for patients over 70 years old.

The term discussion would include a discussion not only of the dangers but also the potential benefits of screening.

My interpretation is that the panel is stating that screening for the age group in question may be reasonable, depending on other clinical factors, patient or physician preferences.

[Teacher Terry]

My husband had problems all through his 40’s and thankfully at 49 we went to a urologist that did a PSA. He watched it for 4 years before needing treatment. At 60 he is cancer free. Yes the radiation seed therapy did come with some significant side effects but he would probably have died since he got it so young.

[msieweke]

Quote:

Originally Posted by FreeBear Interesting link. Are you generally sceptical of conventional screening (PSA, colonoscopy, mammogram, etc)?

I'm not skeptical as a general principle. I try to find the best quality research and look at the true risks vs. rewards. The risks are often downplayed and the rewards overstated by doctors, media, drug companies, etc.

For example look at the Cochrane Collaboration report on mammograms. It's not clear that the benefits outweigh the risks.

From what I've read, PSA test results can be misinterpreted. A rising PSA may be more important than a high initial value. I look at my test value only if it's included in a test package where I'm not paying extra for it.

As for colonoscopy, I think the adverse event rate is high, and no one has evaluated the long term risk of damage to the microbiome from bowel prep. High quality research on risk/reward won't be completed for a few years, so I'm on the fence.