New Doctor, New Rules?

[jrgators]

Advantage of taking statins is you dont have to worry about eating junk food

My cardiologist doesnt have the same sense of humor has my PCP.

 

[Katsmeow]

Advantage of taking statins is you dont have to worry about eating junk food

My cardiologist doesnt have the same sense of humor has my PCP.

Just in case anyone takes this seriously....

The benefits of diet and medication are additive. Even though my LDL is 40 I still watch what I eat.

 

[Winemaker]

My wife's PCP told DW that under Obamacare, doctors have a portion of their salary based on the goals set by the patient and doctor. If the patient meets those goals, then a higher % is paid to doctor. If, after 3 years and the patient has not made any progress reaching those goals, and the doctor's % is shrinking, the doctor can/will drop you as your patient.

So while prescribing any drug that fits your circumstance under normal protocol, the doctor is taking it upon him/herself to follow that protocol. But while protocols are generally followed loosely, (like getting your BP taken as soon as you get in the waiting room without the mandatory "sit quietly for 5 minutes with both feet on the floor and your arm at the same elevation as your heart"), they pick the ones they follow.

Every day there's a new study saying this or that, bebunking that or this. And everybody wants to take a pill or a cream or whatever, to avoid getting out of your Lazy-Boy, bending over to tie one's shoes, going outside, getting sweaty, dirty, or actually cooking a healthy meal. Living healthy, like math, can be hard.

 

[MichaelB]

My wife's PCP told DW that under Obamacare, doctors have a portion of their salary based on the goals set by the patient and doctor. If the patient meets those goals, then a higher % is paid to doctor. If, after 3 years and the patient has not made any progress reaching those goals, and the doctor's % is shrinking, the doctor can/will drop you as your patient.

So while prescribing any drug that fits your circumstance under normal protocol, the doctor is taking it upon him/herself to follow that protocol. But while protocols are generally followed loosely, (like getting your BP taken as soon as you get in the waiting room without the mandatory "sit quietly for 5 minutes with both feet on the floor and your arm at the same elevation as your heart"), they pick the ones they follow.

Every day there's a new study saying this or that, bebunking that or this. And everybody wants to take a pill or a cream or whatever, to avoid getting out of your Lazy-Boy, bending over to tie one's shoes, going outside, getting sweaty, dirty, or actually cooking a healthy meal. Living healthy, like math, can be hard.

Your DW’s physician may be misinformed and subsequently misinformed her. Neither the ACA nor Medicare determine or regulate physician’s salary. That is entirely between the physician and employer.

This does sound like an ACO, which is an initiative to improve patient outcomes by better coordinating care among different care providers. If the coordinated effort results in improved health which then lead to lower care costs, part of the savings is shared with the ACO participants. The opposite is also true, if coordination is ineffective and the patients health worsens, Medicare reimbursement rates may be lowered. Studies show physicians are far more likely to drop ACOs if they judge their participation to be fruitless.

ACOs are voluntary for patients and providers. More information can be found here

 

[brett]

My meet and greet with my new physician was not what I expected.

It started with the usual. My medical history, any issues, any prescriptions. That took all of two seconds. No problems, issues, or drugs. Review of vaccinations to date.

She then moved on to my family history and asked some follow up questions to my replies.

Then it was a deep dive into my eating habits/lifestyle. That covered the entire landscape. Fried foods, meats, poultry, fish, veg, and fruits right down to the grapefruits and blueberries!

Next was exercise. How much, how often, and aches and pains from as a result, etc.

The it was any health foods, supplements? Again...a one second response. And if so prepare a list for the physical appt and bring in the container if appropriate. Only vitamin D3 but she did want to know the amount, etc.

Had the physical. Time was spent on the results of the blood work and what each area meant. No concerns, keep doing what you are doing, and try not to wait another 12 years before having my physical and blood workup. It should be 12-18 months....make an appt on your way out! My spouse if a former RN will make sure of that.

Both times I had my blood pressure taken by the nurse on the desk before I even went into the examining room. All good apparently for a 71 year old.

How stupid am I? I delayed doing this for two years or so because I did not want to go to a female physician. Few family physicians in our area are accepting new patients. My spouse kept telling me that her long time MD would take me on as a patient.

I delayed because the MD was female. It is somewhat embarrassing to admit this this level of stupidity. Perhaps it is an age thing?

I feel very fortunate.

 

[easysurfer]

Got my tests back. HDL in normal range. LDL elevated but not in high range. Still prediabetic. Actually A1C result came back exact as last year.

Doc note said results in normal ranges. No further mention of statins.

I've actually been a good patient (heck, I don't want to kick the bucket as much as the person next door). I lost about 10 lbs last year and managed to keep the weight off.

 

[Katsmeow]

....LDL elevated but not in high range. Still prediabetic. Actually A1C result came back exact as last year....

Doc note said results in normal ranges. No further mention of statins.

You might want to look into this more. LDL for most people should be at least under 100. For people with heightened risk due to personal factors or due to family history may have an LDL goal of under 70 or even under 50.

Doctors are actually fairly notorious for not thinking that elevated LDL is that serious. For years doctors did not take my LDL seriously which ranged from the 130s to the 170s, even telling me I did not need a statin. Finally it bounced to 181 and the doctor recommended a statin. I did a calcium scan and found out I have very high LDL and ultimately found out I have 4 blockages in my arteries (not quite bad enough to stent). The thing is that for years and years doctors weren't concerned about my elevated LDL but during those years the plaque just kept building up and building up.

Some doctors consider elevated LDL to be "normal" if it is below 190 or so. So the actual numbers matter. If your LDL is, say, 105 then that is different from if your LDL is 150. Lower levels of LDL may be able to be alleviated through diet. When it gets higher that can be difficult to do. Anyway, if your LDL is elevated more than just a little bit it is worth having a serious discussion with your doctor. If the doctor doesn't take it seriously, consider seeing a cardiologist.

 

[athena53]

I feel very fortunate.

Your new doc sounds like a gem- I wish she were in my area! Congratulations on admitting your bias and getting through it.

 

[braumeister]

You might want to look into this more. LDL for most people should be at least under 100.

FWIW, I believe it's important to realize that people are different from one another.
The first time my blood cholesterol was measured was over 30 years ago, and the LDL has been somewhere around 200 ever since. Sometimes higher, sometimes a lot higher, and very occasionally a little lower. I don't use a statin and I'm perfectly happy with it the way it is.

Mandating a specific number for "most people" is not always the best policy.

 

[HI Bill]

I resisted taking statins for more than a decade, as my cholesterol was 'borderline'. I wanted to try diet and exercise. It worked for a while, but then with increasing age, my body's ability to make cholesterol began to win out, despite a decent diet and exercise. I started the lowest dose when I made it to the magical upper limit for 'normal'. In reading the book "Outlive", it seems that most need to take statins as they age, and even if your levels are mid-high 'normal'. The premise is that you want to take proactive approach, rather than waiting until you have a real problem. My total cholesterol dropped almost immediately into the 'normal' range!

 

[badatmath]

FWIW, I believe it's important to realize that people are different from one another.
The first time my blood cholesterol was measured was over 30 years ago, and the LDL has been somewhere around 200 ever since. Sometimes higher, sometimes a lot higher, and very occasionally a little lower. I don't use a statin and I'm perfectly happy with it the way it is.

Mandating a specific number for "most people" is not always the best policy.

+1. I am in a group statins are not recommended for either.

 

[Anakalia]

Science

As pharmacist and a physician, I scrutinize all drug usage especially the big dollar ones. Do your own research on statins rather than listening to any doctor. There is almost zero studies on them that were not paid for by the drug companies.

 

[shafer9]

25 years ago, I started taking a statin. Didn’t love it. I went from 10mg daily to 15mg a week, albeit very slowly. We checked the numbers often. They stayed within reasonable bounds.
The doc said, “well,I learned something.”
Lowest effective dose is what I was after. So far so good. I’m 78 and hit the gym 6 days a week. That helps, I’m sure.

 

[GaryInCO]

My cholesterol sometimes went as high as 280. My doc said she wasn't concerned, since my ratios were good. Then as I got into my late 50's she started saying "OK you're getting older now, we need to get this cholesterol under control."

I said "I'm not taking statins." Told her if she insisted, I would sadly look for a new doctor. Gave her a stack of meta-analyses that said statins did indeed lower cholesterol, but didn't help all-cause mortality at ALL. They improve one thing and break other things. And lowering cholesterol below 200 is a goal pushed by the statin merchants. I gave her several studies that said the best chol level for all-cause mortality was about 250.

Finally she said "OK, you won't take statins. I'd like to do a sonogram on your carotids, just to see how bad your atherosclerosis is." Sounded good to me.

She got the results back, looked at the report, and nearly fell off her chair. I was 56, and it said I had the arteries of a 28-yr-old. Absolutely clean as a whistle. She never bothered me about cholesterol again.

 

[Teacher Terry]

Gary, look at the money the drug companies are making for a drug that does more harm than good.

 

[meleana]

I resisted going on Atorvastatin but though I exercise regularly I still couldn't manage to go on a strict diet so I caved. I started to have pains in my arms and I was going through back issues as well, ending up with spine surgery, so after about 6 months decided to take the drug every other day. It's 10mg, so low dose and that did the trick somewhat in terms of muscle pain in my arms.


At first, taking it every day my cholesterol levels came down to perfect and the doctor was thrilled with it. Now taking half the dosage each week, the levels are ok but not as perfect as when I took the pills every day, but he hasn't said anything.


I just wish I could drink grapefruit juice in the morning. I miss it!

 

[NameTaken2]

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.

+1 My great long-time doc also retired, spring 2022. Very engaged, but wasn't the same the last couple of years. Seemed kind of beat-down, suspect by the national group that took over his practice/hospital.
To ensure my next doc is with me to the Finish Line, found a doc in his 30's who was recommended by a friend in the medical field.
Very disappointed based on the first couple visits. This new doc is very disengaged and distant -like someone wishing they were somewhere else and just trying to get through their day. At this point no confidence in them at all, but also leery of starting "musical docs" hoping the grass is greener and finding the effort futile.
I thought my long-term doc would be great to depend on later in life when I needed more care, but he retired earlier than expected.
Feel stuck with a new Captain who has little interest in navigating, just as the seas begin to get rough.

 

[hopeisconstant]

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.

Same thing happened to me. Although my cholesterol is within range apparently there are new studies that show how statistically taking statins will increase your life expectancies by X percentage

 

[Koolau]

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.

I had the calcium scan (on my own) with a huge number and my cardiologist said "I don't pay much attention to those." Two years later and 3 stents, he finally put me on a statin. It felt like it was "seat of the pants" medicine. My current cardiologist didn't even discuss with me the results of my latest echo which she insisted I take. When I questioned her about my increasing regurgitation and enlarging ascending aorta, she sorta shrugged. Didn't even notice I'd lost 40 freaking pounds since my last visit. Huh??

 

[Koolau]

Advantage of taking statins is you dont have to worry about eating junk food

My cardiologist doesnt have the same sense of humor has my PCP.

NONE, not even one of my 5 doctors, from PCP to heart specialist has suggested I lose weight - ever. When I did, not one of them noticed. I asked PCP why they take the weight if they don't pay attention to it. No answer.

 

[badatmath]

NONE, not even one of my 5 doctors, from PCP to heart specialist has suggested I lose weight - ever. When I did, not one of them noticed. I asked PCP why they take the weight if they don't pay attention to it. No answer.

A thing I have learned from the internet recently is that some patients are refusing to be weighed as they find it offensive if the doctor even suggests that losing weight would help their condition.

But I can see some overworked and disinterested doctors just not bringing up any topics that might upset the patient in order to get them out the door quicker.

 

[Katsmeow]

Gary, look at the money the drug companies are making for a drug that does more harm than good.

I am responding to this not so much to respond to you, but for the benefits of others. Statins do not do more harm than good. Most statins are generics. My statin prescription for 3 months is under $5. Of course, there are people who are statin intolerant and, for them, there are other options to lower LDL. Examples are ezetimibe (generic inexpensive) or PCSK9 inhibitors (expensive, usually reserved for those people who "fail" statins or need even more reduction).

But most people are not statin intolerant. I was once skeptical of statins. Now, I know what a miracle drug they truly are. Statins do a lot of things that are beneficial even beyond reducing LDL. This is not really a place for a statin debate as people tend to have fixed opinions on the subject. For people who are faced with the statin decision I will say to talk seriously about the issue (pros and cons) with a good cardiologist.

 

[Teacher Terry]

I am responding to this not so much to respond to you, but for the benefits of others. Statins do not do more harm than good. Most statins are generics. My statin prescription for 3 months is under $5. Of course, there are people who are statin intolerant and, for them, there are other options to lower LDL. Examples are ezetimibe (generic inexpensive) or PCSK9 inhibitors (expensive, usually reserved for those people who "fail" statins or need even more reduction).

But most people are not statin intolerant. I was once skeptical of statins. Now, I know what a miracle drug they truly are. Statins do a lot of things that are beneficial even beyond reducing LDL. This is not really a place for a statin debate as people tend to have fixed opinions on the subject. For people who are faced with the statin decision I will say to talk seriously about the issue (pros and cons) with a good cardiologist.

After seeing this post I googled how much money is made from statins. In 2019 Pfizer made 2 billion dollars from Lipitor in the US. I also have some friends that work in the medical field that have read the Pubmed studies on statins and except for a small group of patients that meet certain criteria statins can do more harm than good. It’s actually scary when some types of drugs are overprescribed.

 

[FI_RElater]

I am responding to this not so much to respond to you, but for the benefits of others. Statins do not do more harm than good. Most statins are generics. My statin prescription for 3 months is under $5. Of course, there are people who are statin intolerant and, for them, there are other options to lower LDL. Examples are ezetimibe (generic inexpensive) or PCSK9 inhibitors (expensive, usually reserved for those people who "fail" statins or need even more reduction).

But most people are not statin intolerant. I was once skeptical of statins. Now, I know what a miracle drug they truly are. Statins do a lot of things that are beneficial even beyond reducing LDL. This is not really a place for a statin debate as people tend to have fixed opinions on the subject. For people who are faced with the statin decision I will say to talk seriously about the issue (pros and cons) with a good cardiologist.

NOTE:ezetimibe ("zetia") has virtually the same side effects as other statins and at a rate of almost 3% of users .... no thanks

DW had irreversible side effect (neuropathy) after less than a months use. The treatment for alleviating that has other complications...which I won't go into.
Others that DW spoke to noted the muscle issues etc and hadn't considered that statins were causal- - - until they went off statins.

 

[Teacher Terry]

NOTE:ezetimibe ("zetia") has virtually the same side effects as other statins and at a rate of almost 3% of users .... no thanks

DW had irreversible side effect (neuropathy) after less than a months use. The treatment for alleviating that has other complications...which I won't go into.
Others that DW spoke to noted the muscle issues etc and hadn't considered that statins were causal- - - until they went off statins.

I looked at some of the pubmed statin studies and they showed which percentage of people were helped versus the percentage having side affects and guess which number was higher. Of course if you are a male with previous heart attacks then based on the studies statins are beneficial and you should probably take them.

One thing I have noticed in people that take them is often a decline in mental function. My mom noticed this within a month of her brother taking them and although usually compliant with what the doctor told her refused after seeing this. Also people reported feeling sharper after quitting the statins.