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

[RAE]

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.

Most doctors I've been to suggest having the PSA blood test done as part of the package of tests they want to order, and I don't have a problem with that, as long as insurance pays for it. I would never agree, though, to have a prostate biopsy done based on one PSA test result that the doctor felt was high, since the reliability of the PSA test is quite poor when it comes to indicating the presence of cancer.


Good points with regard to colonoscopy. Instead of having a colonoscopy done recently, I went with the Cologuard test, which of course is noninvasive. Seems like a better option to me at this point.

 

[6miths]

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.

Totally agree with you except maybe your inclusion of 'physician preference'. They do not recommend 'routine' screening. My reading is that they recommend frank discussion of pros and cons and acting based on patient preference and informed consent.

 

[FreeBear]

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.

Thanks for your thoughts, roughly similar to my understanding.

Are you familiar with Dr Gilbert Welch's book "Over-Diagnosed"? It's a bit older though, 2011. Same general observations as your bold. Still, a relatively compact, yet nuanced, dive into of the challenges of screening from several perspectives.

I fought cancer years ago. At the time, I was fortunate to be able to consult with a couple of doctors in my extended family, not as specialists, but just to give everything a "sniff test" or common sense test.

Well, I ended up on insisting on an option B from my specialists for part of the treatment plan that seemed very high risk, but very low reward. One specific recommendation just didn't pass the common sense test.

What drove home the point, though, was a second visit to the specialist to deep dive into survival stats for various monitoring options. At one point, the Dr. couldn't justify his recommendation on the numbers and just said, "well, all my patients follow this option" and stalked off.

Needless to say, I stuck to my guns, no regrets. I did take a statistical risk, well aware of specific odds. I guess this was an early sign that I had the mindset to FIRE, by understanding the risks and odds!

Got to listen to the experts, but make the final call. Health or financial

 

[Scratchy]

Totally agree with you except maybe your inclusion of 'physician preference'. They do not recommend 'routine' screening. My reading is that they recommend frank discussion of pros and cons and acting based on patient preference and informed consent.

Agree, they would probably not favor physician preference being one of the discussion points, thank you.

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.

Maybe I am reading between the lines too much but do you suspect the panel's hands may have been tied by interested parties and that is why the 55-69 age group was put in the "discussion" category? It is certainly plausible, and I would be very interested in any insights you might have on this.

 

[bmcgonig]

Agree, they would probably not favor physician preference being one of the discussion points, thank you.



Maybe I am reading between the lines too much but do you suspect the panel's hands may have been tied by interested parties and that is why the 55-69 age group was put in the "discussion" category? It is certainly plausible, and I would be very interested in any insights you might have on this.

Funny, physician preference was part of my discussion with urologist when he said "I get my PSA tested". Which made me feel like it was a good idea at that point in time. I think the problem is that we see the PSA test as a no going back point. It's not. If your PSA is high you can always say no to any follow up if you choose. If it's just above normal you can dawdle, but if it suddenly went from 4 to 12 you might be much more concerned.

It's only a blood test. It's just more information. Do with it as you choose I guess.

 

[bclover]

have not read all the pages but probably twice a year.

get an annual mammogram and pap smear.

This year it's been much more due to bad knees.

 

[CardsFan]

Late to this thread. Caught my eye as I just had an office visit with my GP this morning.

I used to be in the "it ain't broke, don't fix it" camp. That is until I was getting some routine vaccinations for overseas travel, and the Dr. told me my BP was something like 200/105 and that I damn well need to see my PCP to get on meds before travelling to China.

And then, about 1.5 years ago DW finally nagged me in to a dermatologist visit. Good thing, after three exams (I have a LOT of moles) she found a basal cell and a melanoma (very early stage)

So, now it is:
2 times per year for PCP to check on meds (BP and cholesterol) and do blood work (includes PSA once per year to establish baseline). I don't think this is unrealistic.

4 times a year to the dermatologist. Everything I read says this is normal once melanoma has been found. Might reduce to 2 times per year after 3-4 years.

As far as the the billings go (is the doctor "running up the tab"), when I review what the docs and lab get paid, after the insurance discount and including my co-pay, I sometimes wonder if they are getting enough.

 

[RAE]

Got to listen to the experts, but make the final call. Health or financial

+1, you are absolutely right. I have not had to face a cancer diagnosis, or any other medical issue that serious in my life to this point, but if it ever happens, I hope to approach the treatment in the same way that you did, FreeBear.

 

[deserat]

Thanks Gumby!

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?

While in the military, I got the annual exam whether I wanted it or not. They added a few more tests when I passed age 45. I didn't get paid if I didn't get a yearly flu shot. Old habits die hard, so I get a yearly flu shot and just had a thorough checkup (every orifice probed and all fluids tested). Good to go for another year and ten years (colonoscopy). I've had several docs tell my I'm a boring patient....good!

I've seen how preventive medicine can catch issues early on. Moreover, good lifestyle management (along with decent genes) can also mitigate health issues as one ages. Caveat, none of us gets out alive, however, the quality of one's life can vary measurably, especially in the later years.

 

[ychuck46]

Every other year

I have been averaging once every two years, which is my "annual" physical. So far everything has been going well.

 

[rk911]

we go to see docs as little as possible. we each see our PCP every six months as a follow-up on a chronic condition, our eye doc once a year for the same chronic condition, my kidney doc once a year (same reason).

 

[Sconie]

-I'm a "Snowbird" and see each of my primary Docs---I have one in AZ and one in Upper MI----once a year for a basic check, physical check, script renewals, etc.
-Others: Dermatologist - 1x per year; Ophthalmologist - 1x per 2 years; Dentist/Periodontist - 3x per year.

 

[dlhanson]

Zero to primary care - annual physicals cause more harm than benefit.
The cardiologist has me trapped by a pacemaker. 3 pacemaker checks by a technician and 1 visit to the cardiologist each year. I enjoy talking to the cardiologist though. We talk about music and travel.
If we need medical advice, we ask my wife’s sister who is a MD.

 

[sandbox2832]

This is interesting topic.

I am in my early 60s, fairly healthy, ride bikes, work a part time job in addition to regular job during the week. Somehow I stay healthy. People around me at work will get sick or their kids get sick and I am left to hold up the place many days. It is always the single person seems like that holds down the fort when everyone is out. I try to take care of myself and eat right and do what I need to stay healthy.

The last time I really needed a doctor was back in spring 2012 when I dislocated my shoulder, had it in a sling and off from work for about 7 weeks, and it has healed, though I have 3.5 tears in my shoulder, with no pain due to alternative medicine mainly laser 4 treatment for pain and healing, along with PT stuff two or three times a week. That was not done through my medical doctor but on my own, mostly out of pocket as my insurance wouldn't cover it. My ortho doctor then said I would be in pain the rest of my life with no recourse available. I didn't go back to him as the alternative stuff worked and he never was aware of anything alternative I was doing to help get well faster.

I rarely go to a medical doctor, unless the yearly cough/mucus thing I occasionally get when my resistance is down gets really hard to deal with; otherwise, I just home treat it myself.

I once had a water in the ear problem and an ear doctor gave me some meds and it clear it up. On the return checkup it was all gone yet the ear doctor insisted that I take it for the rest of my life even though I no longer had any ear issues, that it might come back to haunt me so rather than argue with the ear doctor, I agreed with him and never went back and didn't take the medicine anymore after that. I lost faith in him by his wanting the profit from the meds he thought I would take forevermore.

The one time I did go back in October 2016 to my medical doctor was for the cough/mucus stuff, was only due to I had scheduled the appointment when I was mostly already over it and rather than cancel it I went ahead and went just in case. He gave me a prescription med which had worse side effects than the current coughing I was dealing with at that time and I didn't take the medicine at all. Prior to this Oct 2016 appointment I kept, I hadn't seen a doctor in 3 years and almost got refused as a patient--apparently if you have not gone in 3 years to see him, he terminates you as a patient as I am not making them any money by keeping me on as a patient.

I only go to a doctor when I truly need it. I don't go in for routine tests or yearly physicals as I am not required to by my insurance or my job. I do have insurance yet I have the lowest premium possible to save on money.

I am currently in a similar situation again, as I have had no health issues since Oct 2016 to see a medical doctor. I could supposedly go into to have my ear wax checked since I transcribe documents for a living as a secretary yet why pay full cost when I am not sick (I have a huge deductible to meet before insurance pays anything due to having the HSCA account) in order to keep him as my medical doctor yet I really don't like him as he commented last time about my not going in for routine tests, etc--very poor taste in my opinion.

I had thought about going in to the same clinic when I do need a doctor and selecting a new doctor that is taking patients if I can't get into see my normal doctor (if he has released me due to not checking in with him every 3 years) yet a new doctor would require routine tests, etc that I have no interest in.

I know due to the Nov 2017 AMA blood pressure guidelines being revised from 140/90 to 130/80 that before that I met the bp standards or close enough to not be considered to be in the high blood pressure category. Yet with the new guidelines I am now pushed into a higher state of bp category that would likely make them want me to take statins which I oppose outright. For some people they work well and may be needed, yet I disagree that I need them.

I do have elevated bp due to job stress since mid 2017 when there was a department merger at my job. The only reason I know I have elevated bp is due to a Dec 2018 dental visit where I was told my bp was too high (between 150 to 160) and they couldn't do any work on me at all unless I saw a doctor.

Then when I went to a new general dentist at a dental school situation, I had what some call white coat syndrome and my bp level spiked on top of my job stress, and then went down after a few minutes, but not much down. They kept me on despite my bp being higher than they preferred.

My point in all this rambling is I have no medical evidence that I have high blood pressure, other than the home bp machine I use to monitor it since I became aware of it in Dec 2018. Because the bp goes down when I am away from work long enough and on weekends, I know it is due to elevated job stress and the dental visits only made it worse as I never got comfortable at being a guinea pig by a student who was still in the learning stage of dentistry. I am no longer with the dental school setup anymore as it didn't work out.

Right now I have no plans to go to my medical doctor before Oct 2019 just to keep my doctor in place. My records are there and in the event I need real help, I hope that one of the doctors there will be able to assist. As far as emergency care goes, hopefully that won't happen for a long time. No need to fuss about that. It is what it is.

I may regret later on not going in for routine yearly tests yet to me, if it is not fixed, why mess with it.

I do go to a good eye doctor yearly, I make a concession on that. My eyes are healthy and no signs of any problems or any of high blood pressure issues, despite my off and off spikes in bp found by my recent dentists.

I read the thread and just thought I would put my two cents in here.

Gail

 

[mickeyd]

My doctor (GP) wants to see me every 3 months need it or not. All he does is spend 5 mins asking how I am, renews any prescriptions I may need and then proceeds to bill the insurance for $227.

As a result I have stopped going as I feel fine and my BP is in Check.

I used to have a Dr. who asked that I return every 3 months and only spent abut 5 minutes with me since I was not sick.. Since I have Medicare/Tricare it did not cost ME a cent. I finally realized that I was his cash-cow. I finally dumped him and now have a military doctor that sees me when necessary and payment is not an issue.

 

[6miths]

Maybe I am reading between the lines too much but do you suspect the panel's hands may have been tied by interested parties and that is why the 55-69 age group was put in the "discussion" category? It is certainly plausible, and I would be very interested in any insights you might have on this.

Certainly it is possible that monetary issues are in play, however, it is even simpler than that I think... we all have biases. As an example, if I were a urologist, or especially a urologic oncologist (if there is such a thing), then I would see all of the worst possible cases of prostate cancer and come to believe that this was a scourge that needed to be found and stopped at any cost and likely come to believe that all the biopsies and surgeries that I did to stop this scourge were justified. On the other hand, if I were a family doctor or a geriatrician and dealt with the long term side effects of the biopsies and surgeries such as incontinence or impotence and saw that the majority of prostate cancers are actually slow growing and non-metastatic then I would likely have a different view. The growing feeling is that perhaps people who have a better view of the 'big picture' related to the burden of illness, the burden of screening and treatment, and health economics are better positioned to make better recommendations. Most physicians never see rare adverse outcomes related to their interventions (or they see few enough that they can rationalize them to bad luck) but when one starts looking at populations then the view can change dramatically. A 1 in 10,000 procedure related mortality rate is very low but if you or your loved one turns out to be the death then it hits home and one would really like to be absolutely sure that the procedure was justified.

It is likely that the system in the US is more prone to being influenced by monetary issues than those of countries with more organized health care systems. Recommendations regarding routine (and even selective) PSA screening tend to be against in almost every other country that makes a recommendation. Here is a good article looking at this from last year (Prostate screening is discussed after breast, cervical and colorectal cancer). You will note that the USPSTF recommendation changed (from against screening to selective screening in the 55 to 69 age groups) from 2012 to 2017. There was much discussion about why this happened and what the rationale was (there was a suspicion that this was related to lobbying as it was felt by many that the evidence did not justify a change). It is interesting to see that the American Cancer Society (ACS) is even more likely to recommend screening - again, there world view is different.

 

[Scratchy]

Certainly it is possible that monetary issues are in play, however, it is even simpler than that I think... we all have biases. As an example, if I were a urologist, or especially a urologic oncologist (if there is such a thing), then I would see all of the worst possible cases of prostate cancer and come to believe that this was a scourge that needed to be found and stopped at any cost and likely come to believe that all the biopsies and surgeries that I did to stop this scourge were justified. On the other hand, if I were a family doctor or a geriatrician and dealt with the long term side effects of the biopsies and surgeries such as incontinence or impotence and saw that the majority of prostate cancers are actually slow growing and non-metastatic then I would likely have a different view. The growing feeling is that perhaps people who have a better view of the 'big picture' related to the burden of illness, the burden of screening and treatment, and health economics are better positioned to make better recommendations. Most physicians never see rare adverse outcomes related to their interventions (or they see few enough that they can rationalize them to bad luck) but when one starts looking at populations then the view can change dramatically. A 1 in 10,000 procedure related mortality rate is very low but if you or your loved one turns out to be the death then it hits home and one would really like to be absolutely sure that the procedure was justified.

It is likely that the system in the US is more prone to being influenced by monetary issues than those of countries with more organized health care systems. Recommendations regarding routine (and even selective) PSA screening tend to be against in almost every other country that makes a recommendation. Here is a good article looking at this from last year (Prostate screening is discussed after breast, cervical and colorectal cancer). You will note that the USPSTF recommendation changed (from against screening to selective screening in the 55 to 69 age groups) from 2012 to 2017. There was much discussion about why this happened and what the rationale was (there was a suspicion that this was related to lobbying as it was felt by many that the evidence did not justify a change). It is interesting to see that the American Cancer Society (ACS) is even more likely to recommend screening - again, there world view is different.

Regarding your comment that the U.S. is more prone to being influenced by monetary issues, I actually have had the opposite notion, i.e. that other countries tend to place more emphasis on cost per quality-adjusted life year when implementing their screening programs. Not only in screening, the U.S. has shown a rather poor ability to optimally allocate health care expenditures, in my opinion. However, I certainly cannot claim to be an expert and I appreciate your very good insights and the interesting article, which are great food for thought.

 

[RetiredAt55.5]

i don't get the "if it's not broke ...."

My dad didn't believe in seeing a doctor regularly, so he never went.

He planned to retire at 64, but never made it. He passed at 63. One day he had a sudden, massive aeortic aneurysm in the late afternoon. This was in the early 90's. There was only one doctor in the area that was skilled in this procedure and he was coming off another major surgery so he couldn't do it immediately. By the next morning it was too late to do the operation.

I try to go every year for a checkup, including the various blood and urine tests, including PSA levels, and checking the heart and breathing.

I don't get why one wouldn't take advantage of the yearly free (or mostly free) annual checkup. From a purely monetary perspective, it seems like a good investment. Given copays and deductibles, it's always going to be cheaper to catch something early.

 

[bmcgonig]

My dad didn't believe in seeing a doctor regularly, so he never went.

He planned to retire at 64, but never made it. He passed at 63. One day he had a sudden, massive aeortic aneurysm in the late afternoon. This was in the early 90's. There was only one doctor in the area that was skilled in this procedure and he was coming off another major surgery so he couldn't do it immediately. By the next morning it was too late to do the operation.

I try to go every year for a checkup, including the various blood and urine tests, including PSA levels, and checking the heart and breathing.

I don't get why one wouldn't take advantage of the yearly free (or mostly free) annual checkup. From a purely monetary perspective, it seems like a good investment. Given copays and deductibles, it's always going to be cheaper to catch something early.

That's how I feel too. If my PSA or whatever is abnormal THEN I will have that discussion with the smartest urologist/doctors I can find. But I'd rather know. I think the alternative is just sticking my head in the sand.

 

[becca]

I am terrible about going to the dr. I am 66 female not on any medications. I tend to only go when I am in pain....had a diverticulitis attack last fall which sent me to the ER, had lots of blood work, CAT scan and then a subsequent colonoscopy...ugh, but all was okay. When I force myself to go....like recently I did a skin check at the dermatologist....they find something they want to investigate further which requires some sort of test/biopsy....days of worrying waiting for the results and then everything comes back normal...then you get the bill. The dermatologist seems to biopsy something every time I go. Last visit, this cost me $150 after medicare and insurance (had to meet my deductible).

DH has high blood pressure and goes all the time to the dr. I can't tell you how many different medications he takes for hbp, high cholesterol, bph, stomach issues and maybe more...I just feel all that medication can't be good for you. Everyone else I know who goes to the dr. regularly ends up taking lots of medications.

I probably need a bone scan as I am small boned but I am sure I have osteopenia (like 100% of women after menopause) and they will want me to take the osteoporosis drugs which I hear horrible things about.

For now I will just keep doing what I am doing...I am not overweight, have low blood pressure, I try to eat well, walk 5 miles a day, yoga 3 times a week. Maybe I will wait till I'm 70 to have a physical...we will see.

 

[audreyh1]

My dad didn't believe in seeing a doctor regularly, so he never went.

He planned to retire at 64, but never made it. He passed at 63. One day he had a sudden, massive aeortic aneurysm in the late afternoon. This was in the early 90's. There was only one doctor in the area that was skilled in this procedure and he was coming off another major surgery so he couldn't do it immediately. By the next morning it was too late to do the operation.

I try to go every year for a checkup, including the various blood and urine tests, including PSA levels, and checking the heart and breathing.

I don't get why one wouldn't take advantage of the yearly free (or mostly free) annual checkup. From a purely monetary perspective, it seems like a good investment. Given copays and deductibles, it's always going to be cheaper to catch something early.

Do you think this is something that would have been detected or prevented with an annual checkup?

 

[RetiredAt55.5]

Do you think this is something that would have been detected or prevented with an annual checkup?

Maybe, maybe not.

But, our family is pretty sure he had high blood pressure for years. And he probably had high cholesterol. Just those two things might've aggravated the condition and caused the aneurysm to happen sooner in his lifetime. Maybe he would've lived 10 years longer if he took care of those. I like to think so.