Poll:Number of doctors you see regularly

[grasshopper]

Yeah, my paternal grandmother was like that, and she also had at least one brain scan to make sure her headaches weren't brain cancer. (They weren't.) She also insisted on seeing her podiatrist regularly even though I'm unaware of any ongoing conditions that would have required it. We think she liked the attention.

My mother, OTOH, said you should never let them do a scan of anything because they'll find all kinds of problems you never knew existed. When DH hurt his back they found a lesion on his lung that's probably Stage I non-small cell lung cancer. His PCP was really adamant that they should do a biopsy and get it treated if necessary even though DH had already been diagnosed with acute myeloid leukemia. His oncologist (for the leukemia) said not to even bother unless the leukemia achieved remission, which it has not. It was almost laughable at that point. Even if it's lung cancer, treating it wouldn't accomplish much.

Me? Never had a PET scan/CAT scan or MRI yet. Hoping I never do.

A lot of old folks can't reach their toes anymore and have a podiatrist do the job.

 

[Meadbh]

So, perhaps if you read my earlier post, you might agree that my brother's health would be much improved if he took the annual exam and its customary blood test as recommended.

I know. Just teasing.


I take it that it is not customary in Canada to at least have the comprehensive kidney and liver metabolic panel (CMP).

That is surprising, considering that the CMP plus the lipid panel is only $37 here, if one orders it himself and pay cash. The price negotiated by the insurance may be even less (I thought it was about the same, but am not sure).

Also, it is customary for women to have annual pap smear and mammogram here. Apparently not in Canada.

All you ever wanted to know about health screening recommendations in Canada:
Home | Canadian Task Force on Preventive Health Care

 

[NW-Bound]

Thank you (I think). I was expecting a spoon-fed answer, and you gave me a reading assignment.

It's OK. I am among the few who like to read non-fiction, and now at the threshold of geezerdom, find myself more interested in health issues (could have died a couple of years ago because of an unexpected illness).

Now that my curiosity is piqued, I need to find something equivalent in the US from the US HHS or AMA, if it exists. I expect to see some differences. After all, doctors often cannot agree between themselves, let alone between countries.

Ah, how much more informed (or confused?) I will be after this recreational (self-torture?) activity I am going to put myself through. But what else does an ER spend his time on?

 

[Sarah S]

You could start here
https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations

The task force recommendations are not always the same as those of various professional organizations such as the ObGYN, oncology etc associations but it will give you an idea of current recommendations which are probably different than you expect in some cases

 

[6miths]

This is the equivalent site for the U.S.. The United States Preventative Services Task Force.

https://www.uspreventiveservicestaskforce.org/

And like Meadbh, I practice Western Medicine and what is called Evidence-Based Medicine which is well aligned with the 'first do no harm' philosophy. So this means that I follow the recommendations of the professional bodies with respect to PSA screening. They feel (and I agree) that it is not a good screening test for low risk males and do not recommend it for this population (see meadbh's discussion above regarding screening tests). I am in this population and I have never had nor ever wanted to have a PSA done.

 

[NW-Bound]

I have looked through the Canadian guide on preventive care. The US reference takes longer to read through, and I will do that later for a comparison.

Fine! I can just skip the doctor visit for the annual exam which really does not achieve much, and keep the $83 blood test which actually gives me some measurements of my health.

Not a bad idea. You might want to read this article.
MMS: Error

I just read the above short article in the New England Journal of Medicine. It questioned the usefulness of the traditional annual physical exam.

"In 2013, as part of the Choosing Wisely campaign, the Society of General Internal Medicine recommended against annual preventive examinations in asymptomatic patients."

There are many cases where the patient has symptoms, and does not know it. I don't know if my brother could have recognized his hypoglycemia condition earlier than that time when he got a wake-up call while at work. It requires the layman patient to recognize a symptom when he really has it. And many don't know that something is wrong with themselves. Men are particularly good at that.

I agree with the article that false-positive tests may cause people to pursue unneeded care. That should be balanced with people who fail to recognize symptoms, whether due to denial or ignorance, at the peril to their health.

PS. The article makes no distinction between young and older people. When I was young, I never had annual exams. Even when reaching the age of 50, I had the "annual exam" once every 2 years. Now that I am older, I get more concerned. My adult son does not have a doctor, despite having health insurance from work. He's healthy, and we see no need to push him to go for a checkup.

 

[ls99]

A visit to an NP for a wellness check is the same as one to a doctor. That ought to count as one.

My doctor does not do anything more that an NP could (the stethoscope listening, the abdomen pressing, the fondling and poking, etc...). And indeed, many doctors use PAs to handle most office visits.

Ahem, a wellness check (An annually scheduled medicare thing, as I discovered after the doc's office nagging me to show up for one) does not include a physical exam. Thus no placing of the hands or of the stethoscope.

A nurse asks a bunch of of questions, then a Doc or NP will have more questions.

A medical practitioner can get a good general idea of one's condition "just looking" and smelling, observing posture, body language, speech, etc. .

Old saw for medicos: The exam begins the moment you lay eyes upon the patient and smell them.

The wellness check is answering many questions and being observed. If the medical practitioner notes odd behavior or finds answers inconsistent with what they observe, or you complain about something they deem problematic, will recommend an appoinment for an exam.

 

[NW-Bound]

Ahem, a wellness check (An annually scheduled medicare thing, as I discovered after the doc's office nagging me to show up for one) does not include a physical exam. Thus no placing of the hands or of the stethoscope.

A nurse asks a bunch of of questions, then a Doc or NP will have more questions.

A medical practitioner can get a good general idea of one's condition "just looking" and smelling, observing posture, body language, speech, etc. .

Old saw for medicos: The exam begins the moment you lay eyes upon the patient and smell them.

The wellness check is answering many questions and being observed. If the medical practitioner notes odd behavior or finds answers inconsistent with what they observe, or you complain about something they deem problematic, will recommend an appoinment for an exam.

Sounds good to me. It is not offered here, or at least I was never offered that. I do not care to be poked or fondled.

As mentioned earlier, why don't I just order my own annual blood test as it is allowed here in AZ, and pay cash?

The problem is my frugal wife said that if the blood test is part of the annual exam, then the insurance pays for it. It was not like this pre-ACA, when I had to pay for the test anyway. And pre-ACA, I had to pay for the doctor's fee too, which I would save by ordering the test myself. Her point is that now, after paying so much money, I would still have to shell out $37. I guess that $37 is a matter of principle to her, and you know that wives know best.

So, looks like I will continue to be poked and fondled. By the way, they used to test your knee-jerk reflex, but I do not recall my doctor doing that the last time. Maybe he forgot. Hey, I want to get my money's worth. Or is it that he did and I forget? Hmm... Need an Alzheimer test. But for me or for him? Most likely me, as he's about 10 years younger.

 

[gerntz]

Eyes- glaucoma watch
Allergist
skin
GP for cholesterol

 

[msieweke]

I see an internist annually for a physical, but I only care about the blood tests. When I started seeing him in 2011, I had leg cramps, high cholesterol, low blood pressure, low eGFR, high uric acid, low body temp, and a few other symptoms. Over 2 years I developed severe iron deficiency (ferritin went from 87 to 9). Doc sent me to a kidney specialist, who ran a lot of tests but found nothing. Doc's advice: take a statin for high cholesterol. Fortunately I knew enough to ignore that advice.

It took me 3 years to figure out that these are all symptoms of hypothyroidism. Since I started taking thyroid hormone (without prescription) my cholesterol went from 299 to 170. Doc never asked how I managed that. TH keeps my gout in control if I minimize my sugar intake. The leg cramps are gone. My eGFR seems to be rising. I still have low blood pressure, but that doesn't seem to cause any other issues.

I really need to find another doc, but it's so hard to find one that emphasizes prevention instead of treating lab values. I feel I will have better results figuring things out for myself.

 

[kcowan]

Are you aligned with those that think women shouldn't have mammograms and men shouldn't have a PSA test?

Also the "stool" test for cancer of the colon. PSA is only an indicator and not anything that should lead to surgery. Trends might be key especially levels crossing 30. DRE is more definitive. But DRE can raise PSA levels for a couple of weeks.

 

[6miths]

Sorry but not 'also'. The evidence for fecal occult blood testing is quite good and the USPSTF recommends screening using it beginning at age 50 until age 75. One doesn't need to see a doctor to get this test done.

Recommendations against routine screening with PSA are because it is expected to cause more harm than good when used as a screening test in low risk populations.

 

[Just_Steve]

Sorry but not 'also'. The evidence for fecal occult blood testing is quite good and the USPSTF recommends screening using it beginning at age 50 until age 75. One doesn't need to see a doctor to get this test done.

Recommendations against routine screening with PSA are because it is expected to cause more harm than good when used as a screening test in low risk populations.

PSA 1.3 at 50 6.2 at 52, Gleason 3+4 yup I guess I should not have had routine testing, maybe it would have metastasized by now and the USPSTF could have saved the insurance company some money and just had to have paid for palliative care and not treatment. I think the older you get the less you need to be screened. PSA now 0.02 and holding.

 

[NW-Bound]

I said that I would read the prevention recommendations from Canada and the US medical panels and make a comparison. I did. I will report on the things that are of concern to myself, and hopefully to many readers too.

Caveat: There's a chance that I misread the reports. Please read them yourself to confirm, if you find some topics of interest.

First, about the PSA. I will report on other topics later. Don't want to overload y'all.

Canada: PSA screening strongly not recommended for men younger than 55, or older than 70. For men aged 55-70, weakly not recommended. The above applies to men not previously diagnosed with prostate cancer, including men with lower urinary tract symptoms (nocturia, urgency, frequency and poor stream) or with benign prostatic hyperplasia (BPH).​

US: PSA screening strongly not recommended. The reasons cited are well known, such as risks from overtreatment, even from biopsy, and that prostate cancer is slow growing and fine to leave untreated because the risk from treatment is higher, etc...​

I had a PSA test long ago when I reached the age of 50, and the number was OK. My doctor has not brought this up since, and neither do I. So, it is now common practice to disregard this test.

What I found interesting is that even urinary symptoms cited by the Canada recommendation are not reasons to use PSA. So, there must be some other ways to diagnose true prostate cancer, but that is not discussed.

 

[bld999]

PSA 1.3 at 50 6.2 at 52, Gleason 3+4 yup I guess I should not have had routine testing, maybe it would have metastasized by now and the USPSTF could have saved the insurance company some money and just had to have paid for palliative care and not treatment. I think the older you get the less you need to be screened. PSA now 0.02 and holding.

So you were treated?

Sorry, sometimes I need to be hit over the head with the obvious.

 

[Live And Learn]

So I just lied. I answered 1 - 2 in the poll but after thinking about it its actually
1. PCP, 2x per year 2. Retina specialist, monthly 3. Glaucoma guy, 2x per year 4. OBGYN, annually 5. Optometrist, annually 6. Low dose lung cancer screening, annually. And then there is the dentist twice a year.

 

[ShokWaveRider]

I NEVER see my GP (Unless I need a Referral) I go directly to my Cardiologist, Dermatologist and "Bum" Doctor. DW goes to Derm., Gyno & Orthopedist.

 

[meierlde]

I NEVER see my GP (Unless I need a Referral) I go directly to my Cardiologist, Dermatologist and "Bum" Doctor. DW goes to Derm., Gyno & Orthopedist.

Do they share the same medical record system, or do you use just 1 pharmacy, to avoid unintended drug interactions? Way back in the 1960s my grandfather went to a number of physicians and my mother was convinced that there were interactions in the drugs he was given. That lead to dementia.

 

[bmcgonig]

I said that I would read the prevention recommendations from Canada and the US medical panels and make a comparison. I did. I will report on the things that are of concern to myself, and hopefully to many readers too.

Caveat: There's a chance that I misread the reports. Please read them yourself to confirm, if you find some topics of interest.

First, about the PSA. I will report on other topics later. Don't want to overload y'all.

Canada: PSA screening strongly not recommended for men younger than 55, or older than 70. For men aged 55-70, weakly not recommended. The above applies to men not previously diagnosed with prostate cancer, including men with lower urinary tract symptoms (nocturia, urgency, frequency and poor stream) or with benign prostatic hyperplasia (BPH).​

US: PSA screening strongly not recommended. The reasons cited are well known, such as risks from overtreatment, even from biopsy, and that prostate cancer is slow growing and fine to leave untreated because the risk from treatment is higher, etc...​

I had a PSA test long ago when I reached the age of 50, and the number was OK. My doctor has not brought this up since, and neither do I. So, it is now common practice to disregard this test.

What I found interesting is that even urinary symptoms cited by the Canada recommendation are not reasons to use PSA. So, there must be some other ways to diagnose true prostate cancer, but that is not discussed.

My urologist suggested that I get it. Says he gets it himself. He says you can always decide to do nothing if it's high. Or not.

 

[NW-Bound]

So I just lied. I answered 1 - 2 in the poll but after thinking about it its actually
1. PCP, 2x per year 2. Retina specialist, monthly 3. Glaucoma guy, 2x per year 4. OBGYN, annually 5. Optometrist, annually 6. Low dose lung cancer screening, annually. And then there is the dentist twice a year.

I did not think of the dentist when I made the poll. And I think most posters did the same when they answered. It may be because we all go to dentists, while not everyone needs the same specialists like a podiatrist, an allergist, etc... Yet, we can spend a whole lot of money on our teeth or their replacements.

And optometrists do not really count. Getting eyeglasses is common and not expensive. It does not reflect a person's special medical need.

The intention of the poll is to see how much special care people need, but it becomes obvious that the number of doctors means nothing. One person may see only a couple of doctors, but is under intensive care and has monthly visits, while another may see 2 or 3 specialists but just for an annual update.

 

[Just_Steve]

So you were treated?

Sorry, sometimes I need to be hit over the head with the obvious.

Yes. With no side effects.

 

[Just_Steve]

I said that I would read the prevention recommendations from Canada and the US medical panels and make a comparison. I did. I will report on the things that are of concern to myself, and hopefully to many readers too.

Caveat: There's a chance that I misread the reports. Please read them yourself to confirm, if you find some topics of interest.

First, about the PSA. I will report on other topics later. Don't want to overload y'all.

Canada: PSA screening strongly not recommended for men younger than 55, or older than 70. For men aged 55-70, weakly not recommended. The above applies to men not previously diagnosed with prostate cancer, including men with lower urinary tract symptoms (nocturia, urgency, frequency and poor stream) or with benign prostatic hyperplasia (BPH).​

US: PSA screening strongly not recommended. The reasons cited are well known, such as risks from overtreatment, even from biopsy, and that prostate cancer is slow growing and fine to leave untreated because the risk from treatment is higher, etc...​

I had a PSA test long ago when I reached the age of 50, and the number was OK. My doctor has not brought this up since, and neither do I. So, it is now common practice to disregard this test.

What I found interesting is that even urinary symptoms cited by the Canada recommendation are not reasons to use PSA. So, there must be some other ways to diagnose true prostate cancer, but that is not discussed.

And yet prostate cancer is the # 2 cancer killer of men # 1 being lung cancer and they suggest you not be screened for that either.