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Doctors can only do so much, people have to take control of their own health and keep healthy on their own. To depend on doctors, good grief!!!! I do to a point and have gotten some help over my long years, but mostly NO HELP.
10 yrs of trying to get thyroid help and slapped with A/D's. My older D.O. saved me, no labs nadda, just called in and 4 days depression lifted....10 yrs of depression.
You really have to watch doctors. After a recent bloodtest, a doctor prescribed potassium. I looked at the test results and asked him why. My level was normal. He actually said, I don't know, I just thought you might need some. Too much can be deadly, and at the very least make you severely ill. This seems to be common to prescribe unneeded medication.
I had a doctor prescribe an antibiotic 3 times a day for 21 days, for a mild sinus infection. I knew that was way beyond the norm, 10 days is the norm. The pharmacist even warned me that it could cause a myriad of problems. You really must watch doctors. Remember that someone had to finish last in their class.
You really have to watch doctors. After a recent bloodtest, a doctor prescribed potassium. I looked at the test results and asked him why. My level was normal. He actually said, I don't know, I just thought you might need some. Too much can be deadly, and at the very least make you severely ill. This seems to be common to prescribe unneeded medication.
I had a doctor prescribe an antibiotic 3 times a day for 21 days, for a mild sinus infection. I knew that was way beyond the norm, 10 days is the norm. The pharmacist even warned me that it could cause a myriad of problems. You really must watch doctors. Remember that someone had to finish last in their class.
There is low normal and high normal. Potassium is important, too much is not good. The RDA for daily intake is about 4700mg...you think you get enough. I come in on the low end of range, so I take extra daily as I KNOW I don't get the RDA with foods. Low potassium = fatigue. BP meds and others pull potassium from body. Maybe your doctor looked and you were on lower end. I was told my thyroid was NORMAL for 10 yrs and depressed for 10 yrs. We are NOT numbers.
Before all the major labs which hit us in the 70's or so, it was all symptoms MD's went with.
There is a wealth of info at our fingertips, working on healing ourselves before running to a doctor is what I do always. If I only didn't do the hip replacement, maybe I'd be better off today. I surely had faith in the surgeon and he botched me up, but good.
There is so much pressure to bring down costs, but doctors are forced to risk everything in order to do it. Here we have a case of someone being awarded $28 million dollars because an MRI was not immediately ordered for her back pain, and it turned out to be caused by a tumor.
Yet, if we start immediately ordering MRIs on anyone who walks into our offices with back pain, we will be spending tens of millions of dollars for every ONE person that might be helped by the MRI. Quite the predicament. I see this type of thing every day in my practice. Sometimes I order the test, and sometimes I don't. But when I don't, I always have an uneasy feeling that this could come back to bite me one day.
How do we ever bring down costs when this risk is out there? And how do we remove the risk without some sort of public outcry?
I found this blog article to be very on point and accurate...
The article doesn't provide a lot of details about the patient. Imagine that. If after 3 months the tumor was so extensive that it ended in amputation, I'm raising the BS flag.
I suspect the patient wasn't properly examined. I'm talking about a COMPLETE physical examination of all systems from head to toe. Check ALL systems ALL of the time. Avoid missing things. Leave the DAMN statistics AND look at the patient.
There ought to be a diagnosis for physician's arrogance and laziness. THERE, I SAID IT.
My own PCP barely looks at me. He likes to quote statistics and he keeps his nose in the computer. He does not examine me. I'm in the process of looking for a different physician.
I'm also in the process of teaching my husband how to assess a patient. That's how bad it has gotten.
Each patient is different. The patient is a human being and not a frigging statistic
There is low normal and high normal. Potassium is important, too much is not good. The RDA for daily intake is about 4700mg...you think you get enough. I come in on the low end of range, so I take extra daily as I KNOW I don't get the RDA with foods. Low potassium = fatigue. BP meds and others pull potassium from body. Maybe your doctor looked and you were on lower end. I was told my thyroid was NORMAL for 10 yrs and depressed for 10 yrs. We are NOT numbers.
Before all the major labs which hit us in the 70's or so, it was all symptoms MD's went with.
There is a wealth of info at our fingertips, working on healing ourselves before running to a doctor is what I do always. If I only didn't do the hip replacement, maybe I'd be better off today. I surely had faith in the surgeon and he botched me up, but good.
No he even admitted that my potassium was normal. I also take thyroid meds. Most people don't realize that a thyroid test is NOT part of a normal blood test. Like you, I suffered for years, before I was diagnosed by an old country doctor. Then most doctors only run the TS3 test instead of both the TS3 and TS4. They need both to diagnose.
There is so much pressure to bring down costs, but doctors are forced to risk everything in order to do it. Here we have a case of someone being awarded $28 million dollars because an MRI was not immediately ordered for her back pain, and it turned out to be caused by a tumor.
Yet, if we start immediately ordering MRIs on anyone who walks into our offices with back pain, we will be spending tens of millions of dollars for every ONE person that might be helped by the MRI. Quite the predicament. I see this type of thing every day in my practice. Sometimes I order the test, and sometimes I don't. But when I don't, I always have an uneasy feeling that this could come back to bite me one day.
How do we ever bring down costs when this risk is out there? And how do we remove the risk without some sort of public outcry?
I found this blog article to be very on point and accurate...
The article doesn't provide a lot of details about the patient. Imagine that. If after 3 months the tumor was so extensive that it ended in amputation, I'm raising the BS flag.
I suspect the patient wasn't properly examined. I'm talking about a COMPLETE physical examination of all systems from head to toe. Check ALL systems ALL of the time. Avoid missing things. Leave the DAMN statistics AND look at the patient.
There ought to be a diagnosis for physician's arrogance and laziness. THERE, I SAID IT.
My own PCP barely looks at me. He likes to quote statistics and he keeps his nose in the computer. He does not examine me. I'm in the process of looking for a different physician.
I'm also in the process of teaching my husband how to assess a patient. That's how bad it has gotten.
Each patient is different. The patient is a human being and not a frigging statistic
A full exam is still only going to give you differentials, and with something as common a low back pain, a pelvic tumor is going to be very low on your list. The point of the article is that when you chase zebras with MRIs, you are a big part of the health care affordability problem. At the same time, if you don't, you leave yourself open to liability. You are damned if you do and damned if you don't.
Are you really going to trust your physical exam to be so precise that you will catch something completely out of left field? Every time? Because that is what your post seems to be suggesting. The whole reason we have all this technology is because even the best physical exam is still imprecise. I'm old enough to remember when the physical exam was held in much higher regard than it is today, so I understand what you are saying. I just have my doubts about whether a different examiner would have made much of a difference in this case. Maybe they would, maybe not. As you said, there is not a whole lot of information here. And as you probably know, these cases are a lot of he said/she said anyway.
As it stands, I have to agree with the other docs on the thread who said until the system changes, just keep overtesting. But as long as we do, don't expect health care costs to go down anytime in the near future.
A full exam is still only going to give you differentials, and with something as common a low back pain, a pelvic tumor is going to be very low on your list. The point of the article is that when you chase zebras with MRIs, you are a big part of the health care affordability problem. At the same time, if you don't, you leave yourself open to liability. You are damned if you do and damned if you don't.
Are you really going to trust your physical exam to be so precise that you will catch something completely out of left field? Every time? Because that is what your post seems to be suggesting. The whole reason we have all this technology is because even the best physical exam is still imprecise. I'm old enough to remember when the physical exam was held in much higher regard than it is today, so I understand what you are saying. I just have my doubts about whether a different examiner would have made much of a difference in this case. Maybe they would, maybe not. As you said, there is not a whole lot of information here. And as you probably know, these cases are a lot of he said/she said anyway.
As it stands, I have to agree with the other docs on the thread who said until the system changes, just keep overtesting. But as long as we do, don't expect health care costs to go down anytime in the near future.
Yes, I have worked with and for older physicians. I remember one physician whom I'm certain would have found it. He NEVER missed anything. His exams were very thorough. I used to translate for him during his examinations. When I went to Nursing school I aced my assessment class without much effort: I had learned a lot from him. It's too bad he's retired now.
As far as over testing, it all depends on whose life or extremities you're talking about, doesn't it? Your life or someone else's.
Yes, I have worked with and for older physicians. I remember one physician whom I'm certain would have found it. He NEVER missed anything. His exams were very thorough. I used to translate for him during his examinations. When I went to Nursing school I aced my assessment class without much effort: I had learned a lot from him. It's too bad he's retired now.
As far as over testing, it all depends on whose life or extremities you're talking about, doesn't it? Your life or someone else's.
There is no denying that defensive medicine drives up costs. And in recent years physicians are constantly being told we are overtesting. It seems like that is what people want, and that is fine as long as they know it isn't free.
And there is the problem. Americans want the cost of the system to be adjusted, but they don't want the consequences. In the article, this patient got $28M for a 3 month delay in getting her MRI. But in Canada, the average wait time for an MRI is 18 months. Canada spends less on health care, but I'm not sure most Americans want to do what it takes to get there.
As to the patients being a cash cow to the medical profession, my practice made more money 10 years ago than it does now, yet health insurance costs have skyrocketed. I don't think many people understand that physician reimbursements only make up about 10% of health care costs. Even if I worked for free, your health insurance would still be extremely expensive. There are many places you can cut costs that would have little to no impact on the quality of your health care. Cutting physician reimbursements isn't one of them.
That's weird. I just moved to the U.S. last year and being in ministry I encounter people from all walks of life in need of medical care. The longest I have ever heard of someone waiting for an MRI was 7 days for a non-urgent situation. In urgent and emergent situations, getting an MRI is done immediately.
This is based on my experience in various parts of Canada, over at least a decade.
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