Are Most Doctors Targeted And Focused Or Do They On A Reflex Basis Order Tests?

[rothbear]

Originally Posted by suzy_q2010

For any tests recommended, ask why. If the doctor is getting reimbursed by insurance for ordering the test, it is because the insurance company expects to spend less money overall by getting patients tested. That is usually through an incentive program and the amount of money is small. No insurance company is going to pay for a test it deems to be medically unnecessary. That includes Medicare.

And this is why I keep questioning my PCP on why their office orders Hgb A1C tests on EVERYBODY, no matter what your fasting glucose runs. A1C is not a diagnostic test, it is a test that follows a patient that has already been diagnosed with diabetes. There is a protocol to follow for that diagnosis and it is not by using A1C. I know what I am speaking about because I am a MT(ASCP)... BS degree and nationally certified Medical Technologist. In other words, I am very well versed in laboratory protocols, tests and their purposes. The lab that she sends people to for the tests will tell you right up front that Medicare will not pay for it unless it is for follow-up and properly coded as such. We have fought with her office over and over again and they basically just recode it and send it back for reprocessing by the lab. In other words.....they lie. I was planning on changing doctors because she doesn't listen to anything and is absolutely tunnel visioned on diabetes, no matter what your symptoms or any other problems you may want to ask her about. Unfortunately I developed another health problem and am facing another surgery (first one was through the ER and she doesn't go to the hospital) and the surgeon insisted that I had to visit her for continuity of care. Got a call today telling me I had to pick up blood work orders and sure enough, there was the A1C again. I would be tempted to not get it done by I am relying on her to clear me for this surgery and if I don't do it I wouldn't put it past her to not clear me just to be contemptible. That's what I get for procrastinating in choosing another doctor.

Because of my medical background I absolutely despise going to doctors. In fact I have what is called "white coat syndrome". My BP automatically goes up when I have to go to one. I have to tell them that every time because the one time my doc (not this one) insisted on giving me meds I almost passed out the second day I took them because my BP went too low. I can take the reading at home and it is fine but near a medical facility it rises. And the current doc makes it worse with her attitude and crummy bedside manner.

[suzy_q2010]

Originally Posted by rothbear

And this is why I keep questioning my PCP on why their office orders Hgb A1C tests on EVERYBODY, no matter what your fasting glucose runs. A1C is not a diagnostic test, it is a test that follows a patient that has already been diagnosed with diabetes. There is a protocol to follow for that diagnosis and it is not by using A1C. I know what I am speaking about because I am a MT(ASCP)... BS degree and nationally certified Medical Technologist. In other words, I am very well versed in laboratory protocols, tests and their purposes. The lab that she sends people to for the tests will tell you right up front that Medicare will not pay for it unless it is for follow-up and properly coded as such. We have fought with her office over and over again and they basically just recode it and send it back for reprocessing by the lab. In other words.....they lie. I was planning on changing doctors because she doesn't listen to anything and is absolutely tunnel visioned on diabetes, no matter what your symptoms or any other problems you may want to ask her about. Unfortunately I developed another health problem and am facing another surgery (first one was through the ER and she doesn't go to the hospital) and the surgeon insisted that I had to visit her for continuity of care. Got a call today telling me I had to pick up blood work orders and sure enough, there was the A1C again. I would be tempted to not get it done by I am relying on her to clear me for this surgery and if I don't do it I wouldn't put it past her to not clear me just to be contemptible. That's what I get for procrastinating in choosing another doctor.

Because of my medical background I absolutely despise going to doctors. In fact I have what is called "white coat syndrome". My BP automatically goes up when I have to go to one. I have to tell them that every time because the one time my doc (not this one) insisted on giving me meds I almost passed out the second day I took them because my BP went too low. I can take the reading at home and it is fine but near a medical facility it rises. And the current doc makes it worse with her attitude and crummy bedside manner.

It is acceptable to use the A1C for screening. The advantage is it does not require fasting. Insurance coverage is a separate issue. I think you need a different doctor because you are obviously not on the same wavelength.

ADA Diabetes Management Guidelines A1C Diagnosis | NDEI

"Criteria for Diabetes Diagnosis: 4 options

• FPG ≥126 mg/dL (7.0 mmol/L)
  Fasting is defined as no caloric intake for ≥8 hours
  
• 2-hr PG ≥200 mg/dL (11.1 mmol/L) during OGTT (75-g)
  Using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water
  
• A1C ≥6.5% (48 mmol/mol)
  Performed in a lab using NGSP-certified method and standardized to DCCT assay
  
• Random PG ≥200 mg/dL (11.1 mmol/L)
  In individuals with symptoms of hyperglycemia or hyperglycemic crisis "

Have you checked your BP while you are working?

[coschristi]

Originally Posted by jbgusa

Then they wanted a baseline neurological. I asked if this was to test for MS, the doctor said "yes." I asked if the way I spent the next day would change based on the results, and he said "no." I got out of the chair, told him to "jump in a lake" and walked out.

But a baseline neurological isn’t diagnostic for MS.

A baseline neurological is just that: It establishes a baseline of your neurological functioning.

It can indicate the need for further diagnostic tests. It can be used in conjunction with other tests.

Neurological exams are used repeatedly over years or sometimes months; to assess the rate of function loss, improved functioning & cycles or patterns of functional losses & gains. A neurological exam done a year after diagnosis with MS gives a doctor zero indication of your prognosis.

It’s the 1 year post diagnosis exam as it compares to the baseline neurological exam that is relevant.

I’m not sure that when your doctor answered “Yes” that he understood what you were asking. Does it test for MS? No (it will not serve to confirm nor rule out MS).

Is it a test used for MS patients? Yes. First, a baseline is established & then; depending on your complaints or the doctors observations; they may want another test in 4 weeks. Or 3 months. Or every 6 months. Every patient may be different.

Some patients with a confirmed MS diagnosis can go into remission from 10-20 years; so the fact that you haven’t had any further symptoms until recently doesn’t mean the doctor was wrong for suspecting MS. A baseline neuro isn’t usually painful & they are non-invasive. I suppose they are a bit tedious but I’d rather have that first than to have to get a lumbar puncture (spinal tap).