New Doctor, New Rules?

[easysurfer]

My regular primary care doctor of about 30 years retired a few months back.

I just got back from a physical with a new doctor. I was on same page with old doctor. Pretty much routine was monitor my prediabetes and cholesterol. Keep on doing a good job dieting and exercising.

During the visit with new doctor, doc wanted to start me on statins for cholesterol. I was thinking as doctor mentioned, I haven't changed much in a year. Only difference is new doctor.

 

[Koolau]

My regular primary care doctor of about 30 years retired a few months back.

I just got back from a physical with a new doctor. I was on same page with old doctor. Pretty much routine was monitor my prediabetes and cholesterol. Keep on doing a good job dieting and exercising.

During the visit with new doctor, doc wanted to start me on statins for cholesterol. I was thinking as doctor mentioned, I haven't changed much in a year. Only difference is new doctor.

We changed cardiologists a couple of years back (our old one retired.) Lots of changes and emphasis on new/different tests. Makes you wonder. Science or art? Both, of course, but...

 

[razztazz]

Both, of course, but...

Plus "business"

 

[badatmath]

I have "heard" that doctors that work for large corporations are "graded" on how well they follow "rules" like prescribe x or order y.

No way to know if this is accurate but I could believe it.

 

[ivinsfan]

Did you ask the doc his reasoning? Different docs have different ideas about stuff, no one has to take meds if they decide it's not in their best interest.


Hubby has contact with a nationally ranked cardiac clinic and over the course of 10 years has interacted with a few docs. It's kind of interesting how much their opinions on certain issues varies.

 

[athena53]

As you can tell from threads here on the subject, statins aren't for everybody and who may benefit from them isn't an exact science. And yes, it keeps changing.

If they're being graded on how well they follow "rules" they should get a break if they recommend something and the patient chooses not to comply. My own cardiologist has offered statins, I've chosen not to take them (prior bad side effects, conclusion from my own research is that if you look at the big picture they won't benefit me), he recorded that and it's in my records.

 

[Car-Guy]

I'm convinced, a lot of these tests are ordered and drugs prescribed by doctors as a CYA's. I know in my case, as I mentioned in another related thread, I've had doctors recommend a number of procedures/drugs for me that I refused. In all cases, (except one) the issue(s) resolved on it's own. The verdict is still out of the last one but it's not getting worse so I'm hopeful.

 

[Aerides]

My PCP wants me on a statin. My Cardiologist says Nope, you are good.

I listen to the specialist on this one. (my cholesterol numbers are not even that bad).

 

[Car-Guy]

My PCP wants me on a statin. My Cardiologist says Nope, you are good.

I listen to the specialist on this one. (my cholesterol numbers are not even that bad).

I did go on a drug for my cholesterol when the doctor said it was too high to be accurately measured.

 

[easysurfer]

The doctor suggested I take statins because of it for cholesterol and to help avoid heart attacks saying someone at my age, and being male is a higher risk.

I declined the statin suggestion as I told the doctor that I prefer not to take medications unless really necessary. The doc didn't put up much resistance to my answer and we agreed as part of the blood tests (along with my A1C) is to do a cholesterol test.

I must admit that the doctor (and other person in the room -- doctor in training?) was courteous and polite. But my levels really shouldn't be off the charts. I'm not one of those folks who think I'm on the drugs to treat so I can binge on all the bad foods.

I don't know, maybe I'm against the norm as probably many insist on getting medication.

For me, well the possible statin side effects do not sound friendly.

 

[Aerides]

The doctor suggested I take statins because of it for cholesterol and to help avoid heart attacks saying someone at my age, and being male is a higher risk.

I declined the statin suggestion as I told the doctor that I prefer not to take medications unless really necessary. The doc didn't put up much resistance to my answer and we agreed as part of the blood tests (along with my A1C) is to do a cholesterol test.

Sorry, but wait... did he say he wanted you on a statin even though you haven't had a recent test just based on age and gender? Have your cholesterol numbers been high over time before?

 

[badatmath]

My PCP wants me on a statin. My Cardiologist says Nope, you are good.

I listen to the specialist on this one. (my cholesterol numbers are not even that bad).

You would think it would be the opposite - specialist wanting it!

 

[Turbo29]

One doctor wanted to start me on statins and also commented jokingly that he thought they should be in the water supply. Next year he had left the practice and the doctor I had that time said that my cholesterol was no where high enough that he would consider statins.

Don't get me wrong, doctors can save your life, but many times it seems like they just pull stuff out of their you know what.

 

[easysurfer]

Sorry, but wait... did he say he wanted you on a statin even though you haven't had a recent test just based on age and gender? Have your cholesterol numbers been high over time before?

I know. Doc must have been going on last year's test .

 

[ls99]

Over the last 20 years many times I had a hard time deciding if docs were practicing art, science or business agent roles for pharma.

 

[Rianne]

I will cry if my PCP leaves or retires. I trust her, enjoy her sense of humor, and she's in touch with new medical information. She has guided me through some health trauma with encouragement and optimism. Plus she has a good sense of medical BS.

 

[easysurfer]

I will cry if my PCP leaves or retires. I trust her, enjoy her sense of humor, and she's in touch with new medical information. She has guided me through some health trauma with encouragement and optimism. Plus she has a good sense of medical BS.

A good doctor with a good bedside manner is a treasure.

My doctor who retired had the best beside manner. Every visit for about the first 10 minutes he'd just listen and talk and ask how's it going as we went over any changes to my medical history.

After my last visit I congratulated him on his retirement (he practiced over 30 years) and mentioned that I appreciated his bedside manner as not all doctors do that.

I'm approaching the change of doctors with an open mind and give the new doctor the benefit of the doubt. But with that said, I do miss my old doctor.

A sign of getting old when almost all the professionals have retired. My dentist from a long time ago is still the same. But my other heath professionals since years ago have moved on.

 

[Car-Guy]

I like my current PCP. He's a practical "older" guy who believes as I do, don't fix it if it's not broken. He doesn't "push for tests or prescribe pills" unless there is a clear need that even a medical laymen like me can understand. He also is nearer my age (~10 years younger) and has similar aliments, so we compare notes/experiences/opinions. Also, if I want a particular test or medication, he sees to it that I get it. Priceless.


A lot different than a couple of specialist I've seen in the past.

 

[Teacher Terry]

My doctor is 10 years younger than me and I love her. She’s smart, kind and listens to me. I will cry when she retires. I had a neurologist tell me 8 years ago that I absolutely had to go on a statin. You couldn’t pay me to take one. I did decide to lose 50lbs which took care of my cholesterol problem however my yearly test showed it can range from 152 to 210.

I know people with levels of over 300 that lived long healthy lives. I did my research and know that statins are only helpful for a small specific group of men. I won’t be surprised if in the future they will determine that they contribute to people getting dementia. The people I have known to take them went from very sharp to a decline within a year.

 

[Koolau]

I have "heard" that doctors that work for large corporations are "graded" on how well they follow "rules" like prescribe x or order y.

No way to know if this is accurate but I could believe it.

The gummint apparently rates them on how many opioids they prescribe. (Fewer is better and zero is an "attaboy" apparently.) Docs used to hand 'em out like candy. I had to beg my PCP for 8 (count 'em 8 pills) for 4 months of travel.) I'm dealing with serious back issues and that's all I could get.



In the doc's notes (which I see in MyChart) he made a "case" for me being a non-drug-seeking patient of impeccable character, apparently. Hadda throw that all in in case anyone was watching - which they are. Nice the gummint is protecting us from opioids. Who's protecting us from them.

 

[W2R]

My internist is 81 years old (I am 75). He is also a qualified endocrinologist, and his practice is mostly elderly diabetics like me. His office is only about a mile from my house, right next to our biggest/best hospital. He has been my doctor for 23 years, and he and I see things pretty much the same way.

I dread the day he dies or retires! If he stops seeing patients, I'll have to "break in" another internist. And if the new guy is on the other side of town, that could be so inconvenient. Plus my guy doesn't require me to use Quest (which I hate) for my bloodwork, and instead lets me go to a place that isn't so busy and where they treat me like a human.

 

[Katsmeow]

My regular primary care doctor of about 30 years retired a few months back.

I just got back from a physical with a new doctor. I was on same page with old doctor. Pretty much routine was monitor my prediabetes and cholesterol. Keep on doing a good job dieting and exercising.

During the visit with new doctor, doc wanted to start me on statins for cholesterol. I was thinking as doctor mentioned, I haven't changed much in a year. Only difference is new doctor.

Alas, many primary care doctors under prescribe statins. Having a new doctor may be of great benefit to you. If you have been seeing a doctor for over 30 years then you may be of an age where a calcium scan could be illuminating.

I realize now I had years of doctors making that mistake of under prescribing. The result is that I now have heart disease. The risk of elevated LDL is that you develop heart disease which can be completely silent. If someone has mildly elevated LDL then maybe dietary changes can be enough. But, if that doesn't work to at least get LDL under 100 (maybe lower depending on individual risk) then taking a statin certainly seems completely reasonable particularly as people are of higher risk.

Over 20 years ago I was briefly on a statin but I moved to a new area and the prescription lapsed and my LDL went back up. During the last 15 years or so my LDL mostly averaged around 150. Every once in awhile it bounced up to the 160s or 170s. Doctors (different ones over time) would say to watch what I ate. If I went back to the 150s they would say nothing. Occasionally I went lower. The lowest I could get to was the 130s. But it would go back up and then they would say to watch why I eat...This patterns went on for years.

Once I asked a doctor if I should take a statin. He said "no" since I had a low risk for the next 10 years. Finally my LDL bounced up to 181 last year and a doctor told me take a statin. He prescribed low dose. I think he would have been happy with the 80 that my LDL got to.

I asked for a calcium scan and found out I have more calcified plaque than 95% of women my age. I ended up at a cardiologists. We discussed my history and he was almost apoplectic that these doctors had not prescribed a statin earlier. Instead, I just continued building up plaque and building up plaque.... And getting to 80 LDL was completely inadequate.... (I know take high dose statin and my LDL is 40).

 

[pacergal]

Statins can help, especially if diet changes don't move the numbers much, which can happen more than you think.
After I started, my cholesterol, triglycerides, LDL, etc all improved significantly.
And I told my PCP I wouldn't take it daily, due to concern to risk of side effects. I take it three times a week, M/W/F, and still got improvement. No side effects, have been on it for 7 years.

 

[misanman]

It was after I had a calcium scan that my doctor recommended going on statins. I thought the scan results were really pretty good but he focused on some what I thought was limited build up in a couple arteries and was really serious about me taking them. If there are side effects for me I'm not aware of them.

 

[athena53]

Ah, we're back on discussing statins again!

We're all different. I had severe tendonitis a few months after I started taking them. My last LDL was 144, which was a bit higher than usual, but my calcium score was 1. I just checked- for a 70-year old woman (that's me) 20 is "excellent" so 1 is even better.

OTOH, Dr. Peter Attia, a podcaster I consider highly credible, is 50, has an exercise routine that would leave us unable to get out of bed the next day, gets colonoscopies every 2 years because he thinks that's optimal (pays out of pocket if insurance won't), is on a low dose of Prevastatin and and takes PCSK-9 inhibitors. (The latter manages his Lp(a) and Apo-b levels, which he says should be monitored starting at age 30.)

Medicine is not an exact science and we're all different. And even the eminent Dr. Attia occasionally changes his mind based on recent research.