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Basically the reason for tests is to set a base line to follow so each time you see the doctor he can evaluate your situation to see if you're improving or if there is a problem that you're not aware of. My cardiologist sees me every 6 months for monitoring and adjusts (if necessary) meds and makes recommendations for a healthy normal life.
Yes, he mentioned that it could be used as a base-line. This turned me off even more as it implied that I would be getting this very high radiation test on a regular basis which I absolutely will not do, unless there is a very, very good (i. e. obvious) reason for it. For the uninitiated, of all medical exams, it is the nuclear stress test that gives the patient the highest dose of radiation — 100x more than a mammogram; 10x more than a colonoscopy.
In my discussion with the doctor, I compared the radiation dose from radiation to industrial pollution. Just as pollution is an externalized negative not traditionally counted in the profit/cost ratio, so too this kind of bodily pollution is frequently overlooked in health decisions. Let’s say I don’t get the test, and ten years from now I have a heart attack. In this case, we will certainly suspect that I will have made the wrong decision about forgoing all those nuclear stress tests. But let’s say I get a nuclear stress test every year or two years and eventually wind up developing some kind of thoracic cancer. It could very well be that this cancer was caused or aided and abetted by all the high radiation scans, but there would be no concrete proof of it and hence no sure way to say that in my case the costs certainly outweighed the benefits (even if it were the absolute truth).
In other words, there is good reason to believe that there are relatively high invisible costs associated with this particular medical test.
Look, I'm also inclined to take a conservative approach to both testing and treatment. At some point the cost-benefit ratio just doesn't balance out. It would have been totally reasonable to just politely and firmly say "thanks, but no thanks" to this whole thing. But look at how this situation actually played out from the scheduling nurse and the electrocardiologist's points of view.
The nurse looks at your paperwork and sees someone who's been referred by a doctor for a specialist visit, a someone whose file indicates a pile of life-threatening health issues. She'd be remiss in her duty if when you called to cancel she treated it as casually as though you were cancelling a manicure. She has to assume that if you were scheduled, it was for a good reason, so she encourages you keep the appointment. (Of course, she couldn't actually stop you from cancelling, let alone make you show up - you chose to do that.)
Then you go see the doc, having kept and attended the appointment even though you'd decided ahead of time that you weren't doing further testing and you're already doing everything perfectly so you don't need any advice from a doctor. So he's got this patient who came to an appointment, who doesn't want any testing, doesn't want any additional information about their condition, doesn't want any medical advice...he has to be wondering why you're there, so he starts asking follow-up questions, and then you get irritated that he's questioning you. It's as though you went into a restaurant and got angry when a waiter started telling you about the specials of the day - how dare he not realize you weren't hungry?
"No" is a complete sentence. If you don't want to go, don't go. If you don't want a test, don't have a test. But it's not really fair to hold it against someone that they attempted to provide the service they're being paid to provide, when you went to them. It's not like the doc randomly showed up at your house uninvited and tried to strap you to a tilt table.
You know, there are actually requirements for seeing doctors at certain intervals if you want to remain a patient and not be bumped back into “new patient” status. (And being a “new patient” can mean everything from being restricted to certain appointment slots to essentially being dropped as a patient if your very in-demand specialist is not taking new patients anymore.) They won’t actually tell you that (unless you ask directly) so I found that out the hard way. I stopped seeing my GI specialist regularly when it was clear he had nothing to offer me. He would even say: “Well, there’s nothing more we can do. You’re on your own here.” Still, the office sent me letters to come in for follow-ups. I ignored them for about three years, until I developed an entirely new digestive complaint. But when I tried to make an appointment, it was much more difficult for the above-mentioned reason.
I believe this is what the nurse was trying to get out when we had our pre-schedule chat. BTW, I didn’t call to cancel “as casually as though I were cancelling a manicure,” as you say. We had a long discussion about the situation. I really did not want to come in. And yet she insisted. In her arguments, she did not once mention all my health conditions. Instead, she kept mentioning the elapsed time since my last visit specifically with the doctor. “But when was the last time you saw the doctor? A whole year! ... No, really you need to come in ... you haven’t seen him since last September!” (What I didn’t say was that one reason it was “a whole year” since the last time I saw the doctor is because the last time I went in with a relatively urgent problem (back in December), the doctor was unavailable and I had to see a PA instead.)
In retrospect, I suppose I should have asked her point-blank about the unspoken requirements for seeing the doctor within a certain timeframe just to “keep up the relationship.”
Also, it was not like I was coming in out of the blue to make an appointment I didn’t want. I had to go to them, because I had to cancel an appointment I had made a long time ago when I was still having problems. In essence they wouldn’t let me cancel the appointment. Well, OK, they let me cancel and reschedule a few weeks later, but they didn’t let me just plain cancel. I suppose I should have said: “I’m going to cancel now, but I’ll call you back when I have a better sense of my schedule.” Then not call back. Or, again, ask point-blank about their visit frequency policy.
Last edited by Jill_Schramm; 09-11-2020 at 05:56 AM..
Yes, he mentioned that it could be used as a base-line. This turned me off even more as it implied that I would be getting this very high radiation test on a regular basis which I absolutely will not do, unless there is a very, very good (i. e. obvious) reason for it. For the uninitiated, of all medical exams, it is the nuclear stress test that gives the patient the highest dose of radiation — 100x more than a mammogram; 10x more than a colonoscopy.
Thank you for that enlightenment of the high dose of radiation of the nuclear stress test!
From the Harvard site you provided:
"Consider a lower-dose radiation test. If your clinician recommends a CT or nuclear medicine scan, ask if another technique would work, such as a lower-dose x-ray or a test that uses no radiation, such as ultrasound (which uses high-frequency sound waves) or MRI (which relies on magnetic energy). Neither ultrasound nor MRI appears to harm DNA or increase cancer risk."
As a cancer patient, YOU have really weighed the pros and the cons for yourself.
Patients really need to learn MORE about tests and other modalities. One really has to be their own advocate.
Thank you again for sharing.
Last edited by InquiringOne; 09-11-2020 at 06:19 AM..
You know, there are actually requirements for seeing doctors at certain intervals....
Remember the Seinfeld episode where George wanted to change his appt with the therapist?-- "Well, it's our policy that..." as if Moses came down from Mt Sinai with that chiseled in stone.
The only real "preventive medicine" would involve a crystal ball....other than that, they're just playing the odds. Most of the recommendations for follow up visits & testing is for liability purposes, with a little bill padding thrown in for good measure.
While it's true that most of us don't (well, I do, but not most of yuse) have the training or experience to make fully informed, independent medical judgements on our own medical care, we should ask "Why?" and "How will that change anything?" about the doc's recommended tests & treatments. ...Consultants don't make decisions--they make recommendations.
You're right, Jill-- this ain't China (at least until the next election. Then we'll see. ) I'm with you.
I don’t blindly follow doctors either. It’s your body and you are making an educated decision.
I'm not looking forward to the appointment with my new PCP next week. I had a breast MRI last month because I'm in a high-risk group (family history). That was negative but they found "possible cardiomegaly" (enlarged heart). My dear mother, may she rest in peace, used to say you should never let them scan your body because they'll find all kinds of stuff that wasn't bothering you.
So of course I consulted Dr. Google about possible causes. COPD? Nope- I'd ridden my bike 16 miles the morning of the test and that's normal for me. High BP? No, mine is on the low end of normal. Result of an athletic lifestyle? Yeah, probably. I spoke with my sister, an OB-GYN and she wasn't very excited. She thinks it's just my long history of rigorous cardio workouts. She said an echocardiogram might be in order but not a stress test or, heaven forbid, a cardiac catheterization. It will be interesting to see what they suggest but I'm not doing anything risky or invasive.
My dear mother, may she rest in peace, used to say you should never let them scan your body because they'll find all kinds of stuff that wasn't bothering you.
.
I'm fairly libertarian in my outlook on life, and keep very few rules: the main one is The Golden Rule. Next comes "Don't fix what ain't broke."
(The third one is "Never get in the witness chair with five minutes left in the hour."...Perry Mason always pins the murder rap on that guy.)
One of the links I posted previously mentioned a supplement, which is fine for magnesium and CoQ10, but the 99 mg of potassium they put in them is a long way off from the recommended daily of 4700 mg.
There are restrictions for including higher doses because of kidney patients. Have to go the food route on potassium.
Beet greens 1 cup - 1309mg
6oz salmon - 1068mg
large white beans - 1004mg
avocado - 975mg
potato - 926mg
My PCP has his office staff ask all his patients fill out a sleep study form. If you answer yes to more than one question he suggests a sleep study and these days everybody who has one seems to be diagnosed with sleep apnea and have to get a CPAP machine. Guess what? My PCP is part owner of a sleep study center. Hmmm.
The last time I went to him he told me all my blood test results looked good except for my cholesterol which is usually a little high. I always ask for a copy of my blood test results to see how I am doing. I get home and one of the tests show a "critically high" level but he never said a word about it. I had to call his office to talk to a nurse to find out what the deal was.
I've been seeing this doctor for about 18 years but I think it's time to find someone else.
P.S. - as for mammograms, they're not worthless. I'm alive today because a mammogram caught my breast cancer in time.
I see nothing at all wrong with a person making an appointment with a doctor for an evaluation and recommendations and then, after hearing and considering the evaluation and recommendations, rejecting some or all of them. The doctor shouldn't take it personally if his recommendations are rejected, but many of them do take offense at it.
Many doctors (and their staff) are so accustomed to patients just sheepishly going along with whatever they recommend that it's a jolt to them when a patient actually decides they don't need or want what he's recommending.
If I take my car in for a checkup and the mechanic recommends a long list of things to be done, I have the right to reject some or all of his recommendations. Why should it be any different with my body? After all, it belongs to ME!
Dont want to go to the doctor then dont go. Pretty simple, no?
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) I'm with you.
