I have some questions about medical practice these days after a frustrating morning with a new docto

[Trailrider1951]

doctor. Some background: until the time I retired last year, I had health insurance from my employer. I saw my doctor whenever I had a problem, and he had no problems treating me for my complaints, including a broken leg and several infected spider bites from the brown recluse spiders that inhabit my house and yard. After I retired at age 62, I lost my insurance and went with an offering from the ACA. So, now my regular doctor is out of network and I would have to pay $120 for a visit with him, instead of $25 to someone in network.

Last May, I got another spider bite which became badly infected, so I called my new health care network and was assigned to Dr. D. When I met her at her office, she seemed professional and personable. I showed her the prescription bottle from my previous doctor's prescription for a tetracycline type antibiotic which he had given me for the bite. She said she would call in the prescription for me that day, as the bite infection was about 4" in diameter and getting worse. At that time, she asked me if I would like to be a regular patient of hers, and, since I had no other in network doctor, I said OK. Then the next thing she said was that she was going to get me scheduled for some bloodwork. Also, how long has it been since I had a mammogram? And have I ever had a colonoscopy? Well, lets get you scheduled for those as well. And I asked, "For a spider bite?" And she told me that in order to be a patient of hers, I needed all those tests. I told her that I thought that these were at this time unnecessary, and I would let her know if I had any symptoms that warranted further exploration. I did get my prescription for the antibiotics.

So, this week I was running low on my blood pressure medication that has worked well for me for five years, reducing my BP and not causing any side effects. I again called my new health care network and was again assigned to this Dr. D. This morning, I went to the office and when the med assistant checked my BP, it was higher than usual, 170/88. When Dr. D came in, she asked for the reason I was there, and I told her I needed to renew my BP prescription. Again she told me that in order for her to treat me, I would have to have bloodwork done. I again refused, because I have small veins and they have to stick me with the needle 4 or 5 times to get the amount they need. To me, this is torture. I will have it done only if necessary to treat any symptoms or illness I might have. She then told me that she would not prescribe my medication without any further tests. I asked if I could have my medical records (including previous bloodwork) faxed to her from my previous doctor, and she said that this was unacceptable. At this point, I was getting frustrated and angry. She decided to check my BP again, and of course it was higher than before. At this point, she decided I needed an ecg, "to see if my high BP had damaged my heart". At no time during this visit did she check my heart with a stethoscope. I asked her how much this would cost and she said she had no idea. I asked her again if she would give me a prescription for my medicine and she refused. At that point, I got up and left.

I went home and called my previous doctor's office, and they had no problem calling in the prescription refill. Because I had not seen my previous doctor for about a year, they wanted me to come in for a routine visit, and I went ahead and made an appointment for next week.

Is that what being a patient has become? Am I now just a cash cow to be milked for every last dollar? Have any of you had this much "salesmanship" from your doctor, old or new? Dr. D's attitude reminded me of extortion: you must submit to these unnecessary yet profitable tests in order to have your life-saving medication. In times past, when I went to my doctor, it was for specific complaints which were addressed in a timely and professional manner. No suggestion of any unnecessary tests or treatments, just accurate diagnoses and timely treatment. Did I get a bad one with Dr. D? I'm certainly not going to give her another chance. Please give me your thoughts and comments. Thanks for reading this!

[Shrike47]

1. I've gone through a similar series of tests with a new doc this summer. My old doc retired.

I appreciated the testing, myself. My old doc had been out of commission for over a year and basically, I was no getting no medical care from anybody other than refills on my 11 prescriptions. I'd rather have somebody paying attention than nobody.

[leftofcool]

2. I would agree with your new Doc on the blood tests.

The rest not so much. My husband has a new blood test every 6 months before our Doc will refill his blood pressure medicine. I think I would keep my old Doc because it does sound like the new Doc may want to use you as a cash cow. Please, however, consider the blood test sometime in the near future.

[mnhtnbb]

3. Find another doc and do not go back to Dr. D

She's looking for reasons to milk the system.

I don't do mammos and I don't do colonoscopies, either. I have a doc that has no problem with me
refusing tests. He gives me the spiel and I say 'no thanks'.

Find another doc.

[raccoon]

29. THANK YOU. I feel the same as you do about some of those tests. nt

[zipplewrath]

4. She's following "protocols"

roughly speaking, she's covering her butt. Basically, she's following protocols that says you don't just keep refilling prescriptions. You have to have certain test (mostly blood work and apparently an ECG) to fullfill the protocols.

Some doctors are a tad more flexible than others, but few are going to just "do whatever you say". It's not really so much about money as it is about avoiding liability.

[femmocrat]

5. I think she is just being thorough.

I have been going to my PCP for over 20 years. He orders blood work and an EKG every year and I've had two colonoscopies during that time. I get an annual mammogram (they are free now).

I think she would be remiss if she didn't have all of your test results before handing out prescriptions. I do understand your frustration, though. From your account, she did seem to pressure you. If it is worth it to you, then stick with your old doctor. If you go to another doctor in the same practice as Dr. D, the procedures would probably be the same. Your co-pays on the tests could be as much or more than the $120 for an office call. While you are seeing your old doctor, you can ask about his recommendations for those diagnostic tests.

Can you get an exterminator to eliminate the spiders? That sounds dangerous as hell!

[Trailrider1951]

9. Thank you for your thoughts

About the spiders, they are a real problem here in Texas. The poison the exterminators have has no residual effect on the spiders. Unless they get a direct hit from the spray, it does not help the situation. I have had good luck with glue traps and the fly swatter, but I usually end up getting bitten once or twice a year. The bites occasionally get infected, but not always.

[WillowTree]

14. Agreed.

The new doctor was ordering a panel of fairly routine tests as a baseline by which to measure your health going forward. I wouldn't go back to a doctor who didn't do so. I've been going to my doctor for years and he orders such tests every year. (Not the colonoscopy........that's less often.) And what she was requesting would all come under the heading of a routine annual physical, so should be covered in full by your insurance.

She was doing her job. Sounds as if she was doing it pretty well.

[tavalon]

52. She was coercive and abusive

The tests were correct and her methods unsupportable. It's sad that more people don't get that you hire a doctor and you can just as easily fire a doctor.

I'm a nurse and one of my baseline requirements for a healthcare provider is that we dialog as the colleagues that we are. I've fired a few doctors in my time and remained very loyal to others.

[Skittles]

6. I don't think it is unreasonable for a doctor to want to know the health of a new patient

[Nay]

7. IMO, Dr D asking you to provide blood for a baseline blood workup is pretty

standard; nearly every doc does the blood workup once or twice a year to keep on top of things. And she may have wanted to see your white blood count level because the bite was infected.

If you have not had a mammogram or colonoscopy ever, she is just suggesting tests that are normally done as a baseline at age 50. The EKG seems way over the line, though, unless your BP is always around170/88 - that is high for already being on BP meds, but some people get high BP readings just by being in the doc's office. Do you have a BP meter at home and know that your BP is normal most of the time? If not, then the doc had a good reason to investigate your BP.

Having said that, however, you as a patient can refuse testing of any kind for any reason. Plenty of patients do. Some docs don't like patients who won't do the tests, tho, and don't want them as patients. You might want to call your ACA provider and ask to be assigned a doc that respects the fact that you don't want all those tests right now, you just want to see a doc for acute things like your spider bite. There are docs that won't push you even if they feel you are being foolish. She was being a bit aggressive, though, by throwing all those tests at you at once. She should have asked that your med records be forwarded to her; she could look at them and talk to you later about what tests you should consider.

Good luck!

[Warpy]

13. Right, and having a baseline EKG after 55-60 is probably a good idea

so that it's in the file and changes can be monitored.

It's frustrating to be faced with a complete workup when you just came in for something you've been on for years for a known problem, but we live in a litigious society and any new doc you see, especially in a new system, is going to be thorough.

[LisaL]

20. EKG is a very simple test. It's not invasive. How is it over the line for someone with high blood

pressure and over the age of sixty?

[Nay]

25. Well, only in the sense that the doc has yet to see her transferred med

records; the patient may just have 'white coat syndrome' that day; the doc is already recommending so many tests that the patient is already recoiling from the idea of so much testing, especially since she's only come in for treatment for a spider bite.

There is nothing wrong with an EKG. It is easy and non-invasive. But that is probably the ONLY test the doc should have asked her to take right that day at the appt. if the doc was worried about liability, since an EKG would be related to her BP symptom. Ease in the rest of those tests at future appts. I guess I'm surprised at this doc's giant steps into testing the first day she's seen this lady.

[LisaL]

51. I don't find anything unusual in what doctor wanted to do.

In fact, OP's old doctor should have been doing these tests.

[pnwmom]

61. You are conflating TWO different appointments. There were two, not one.

It was on the second appointment, which was scheduled because the patient was concerned about her elevated blood pressure, that the doctor wanted to order blood tests.

And this was good medical care because they needed to find out what was causing such high blood pressure and rule out things like kidney issues, diabetes, etc., before prescribing medication.

It would not have been sufficient just to get her old medical records. Her blood pressure is newly elevated. They need to find out what is causing the new elevation, so she needed current blood work.

[tammywammy]

68. The doctor told her during the spider bite appointment that she would need to get blood work,

Colonoscopy and a mammogram, since after asking the poster if she wanted her (Dr D) to be her new primary doctor. The OP declined.

Then when she went on for the blood pressure medicine the doctor brought it up again in addition to an EKG.

[pnwmom]

75. The doctor said that AFTER the woman agreed that she would be her primary care doctor --

and primary care doctors are supposed to treat the whole patient, not just a piece. And since the doctor would have known she was taking BP meds ( because there is always a medical history), the doctor was complying with standard medical care to ask for blood work at the first appointment (as well as to recommend the ACA paid-for mammogram and colonoscopy). But the OP hates needle sticks, so she declined.

Then the OP came back with very elevated BP and needed a refill. But no ethical doctor would just do a refill when the prescribed medicine obviously wasn't controlling symptoms.

[TexasMommaWithAHat]

86. Completely agree with you.

You can't just walk into a doctor's office and tell her you want "x, y, and z" prescribed without routine tests allowing the doctor to make her own assessment about the efficacy of those drugs for the patient. Frankly, that's bad, bad medical practice, and I would run from a doctor who did that.

[Yo_Mama]

84. You didn't read the post - she was coming in for BP medication.

And since her BP was high (the lowest measure that day was 170/88), it was obvious that the old medication was not sufficient.

So WTF would you want a doctor with any ethics to do?

Without blood tests, the doctor can only represcribe the same medication at a higher dosage, or pick one at random, without knowing what it would do to the patient. That is not medicine - that's comparable to getting prescriptions by consulting a psychic.

And an EKG is a very important if one is going to prescribe high dosages of BP meds, because if the heart is impaired enough, too much BP medication will potentially kill the patient. If the patient has significant blockages, the high BP may be compensatory. You never knock out a patient's compensations.

This is the most bizarre thread I have ever read on DU. It reminds me of that girl who encouraged her boyfriend to kill himself, and even sent him a text to get back in the truck to continue dying from carbon monoxide poisoning. That's what you are all telling this poster to do. Just continue to go to doctors who will agree to not treat her.

You don't think a doctor needs to rule out the causes of high BP, and look at organ function indicators before prescribing more aggressive treatment? What if this lady has impaired kidney or liver function? What if this lady has hyperglycemia? What if this woman has very high lipids?

The first visit - the one in which the patient did come in for a spider bite - the doctor did prescribe the antibiotic which the patient said she could tolerate and worked in the past. The doc then recommended the missing basics to this patient who hadn't had insurance and now did.

This visit, the presenting problem was high BP not controlled by current treatment, and how looking at prior records would tell the doctor what the problem is now I cannot imagine, especially since the patient said the treatment had been working in the past. Obviously, something has changed for the worse.

If this person were to come into the clinic at which I volunteer, with or without insurance, here's the minimum protocol we would follow:

1) Full lab panel, including CBC, Chem, UA, GGT, thyroid cascade, H1AC, and lipids plus sed rate. Based on familial history and physical, we might also test for rheumatoid arthritis factor and ANA.

2) EKG.

3) If the EKG came back normal but the lipids looked off, or if peripheral circulation appeared impaired or H1AC was over 5.8, an ultrasound of the carotid arteries, which is an excellent indicator for whether the patient is blocking up. It's relatively cheap and non-invasive and highly accurate in predicting clinically significant stenosis elsewhere in the body.

4) If the ultrasound of the carotid arteries showed incipient blockages but the EKG was normal, a 24-hour Holter, which would further assess cardiac function and would also check to see if there is stress during sleep - sleep apnea is underdiagnosed and causes a range of problems.

5) A long (one-two hour session) for lifestyle modification with one of the volunteers. This is generally free to the patient and often not covered at all by insurance, so we eat it. This session would include questions and suggestions for diet, exercise, sleep and other personal stressors (like recent death of close relative, job problems, etc). If blood glucose control wasn't excellent or triglycerides were over 170, the first thing we would do is try to flatten that curve, because usually these patients have steeper blood sugar curves and those will affect everything else negatively. Rather than overmedicating on the rest of the issues, flattening that blood sugar curve will help them all, and the BP. We often succeed with three exercise intervals of ten minutes or so spaced throughout the day.

6) Then, based on all of this, the patient would be prescribed a starting regime of medications with periodic reevaluation, which would probably include at least a statin/aspirin therapy, and new BP medication. The patient might be coming in every two weeks for a while, especially if there were lipid problems along with the BP, or thyroid problems. And the next mandatory blood test would be one to three months.

7) If the carotid artery ultrasound showed any degree of stenosis or the some of the kidney function indicators were off, the patient would probably get a KUB ultrasound to look to see if there appeared to be abnormalities of the kidneys/bladder, etc.

At the end of all of this, the doctor would have a pretty good idea of the patient's current situation, and a plan for safely trying to correct it. If some of these tests showed other problems, there might be other referrals.

Note that undiagnosed heart disease is a very, very common problem in women:
http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/2597

[REP]

8. You need routine tests

First, you should have been on Clindamycin for the infected spider bite, not tetracycline. Wrong spectrum being targeted.

Second, yes, you need routine blood work when you take prescriptions daily. As we age, our kidney function naturally declines (for one); you may need a lower dose of your medicine to achieve the same results.

Third, when was your last colonoscopy? Colon cancer usually has zero symptoms. Polyps, both benign and precancerous, can be found and removed during a colonoscopy, which is a lot easier to deal with than a colostomy. During a colonoscopy for something else, five precancerous polyps were removed from me when I was in my 40s - and I have no risk factors. Well, I didn't.

[Ms. Toad]

31. I agree with everything but the clindamycin.

Use that only as a last resort. It is one of the antibiotics most likely to cause c diff infections. C. diff infections are dramatically increasing, including becoming more prevalent in healthy populations (populations other than frail elderly/hospitalized/gut compromised) - and increasingly harder to get rid of.

I'm holding my breath that recent GI symptoms aren't a 5th recurrence of c diff in a year, triggered initially by short prophylactic course of clindamycin following a tooth extraction. My father acquired c. diff from me when we shared the same bathroom for 3 days and he was coincidentally on clindamycin.

C. diff is evil stuff, and clindamycin is evil by association. There are other antibiotics targeting the same spectrum that are less likely to cause c. diff. - perhaps the penicillin or cephalosporin families (both have been prescribed to my daughter by her infectious disease doc for treatment of cellulitis).

[REP]

35. Clindamycin isn't always enough

I was just treated for MRSA-infected spider bites. With Clindamycin. The protocols have changed for treating skin wounds and tetracycline isn't recommended anymore. A bunch of protocols have changed; Cipro is now used for URIs instead of Erythromycin is one that comes to mind (I'm allergic to penicillin and sulfas and my infections are usually resistant to those anyway).

(Unfortunately the dose of Clindamycin I was put on was too low and I had to be hospitalized to receive IV Vancomycin and then Xyvox. I'm in Stage III kidney failure so you can imagine how sick I was if those drugs were used.)

[Ms. Toad]

70. That's the excuse for giving me clindamycin (penicillin allergy).

I'm really kicking myself for not insisting on cephalosporins (I don't have the cross-reaction with penicillin, but the nurse who was pulling the prescriptions together couldn't be bothered to pull the oral surgeon in for a consult.)

My point was to avoid clindamycin if there is any alternative because it causes c.diff, and not enough medical providers consider that complication when prescribing it.

[TexasBushwhacker]

72. Yup, I got C diff!

But it is the first choice for certain infections. I had to take it after a root canal.

[Ms. Toad]

80. Generally, though, they are not testing to determine

whether the infections are caused by the bacteria which make clindamycin the best choice - they are just prescribing it, and mostly without considering the consequences.

When I still had c diff 5 months after the tooth extraction, by oral surgeon was flabbergasted - and kept trying to find some other reason that his short course of clindamycin wasn't the cause. I hope it causes him to be more judicious about reserving it for the very few cases in which there aren't equivalent antibiotics which are less likely to cause c. diff. Certainly, it should not be the first choice as a prophylactic treatment following either a root canal or a tooth extraction, given the high risk of c. diff, and the relatively low risk of infection.

(My c. diff was also a particularly virulent strain with atypical symptoms - so it was not initially diagnosed until after I had a colonoscopy because of symptoms that seemed more like IBD, and two rounds of vanco and one of Dificid are extremely costly, So the use of clindamycin increased the cost of the tooth extraction by a factor of at least 10.) Not a good first choice against the relatively small chance of infection.

[REP]

85. I'd post photos of my leg wounds but I don't want a hide for graphic content!

Even though I'm in the "no such thing as a simple cold" category of compromised immune system, I'm hesitant to get antibiotics - but there are times when it's really obvious that's what's necessary. Unfortunately I've had enough serious skin infections to be really up-to-date on what the current protocols are. Frankly, I'd rather risk c diff (and the rather gross treatment) than lose a limb, which I came a bit too close to for my liking. Again. Usually it's a thumb, or my non-driving foot, but my driving foot? Oh HELL no!

[Ms. Toad]

88. Since my daughter was treated numerous times for cellulitis,

that's something I'm intimately familiar with, as well. Out of the half-dozen or so treatments, her infectious disease doc gave clindamycin once - and only because she had a drug reaction to the one they started her on while the inflammation was still increasing.

Given that it cost me a 8 months, a colonoscopy, and 3 rounds of medication which cost $2000 - $8000 per treatment (not to mention my grandmother died from it (unrelated to mine) and I gave it to my father (also on clindamycin)). If you haven't spent time with people with intractable c. diff, you may not be really aware of how vicious this disease is. Gross treatment is not an issue - it is the possibility of never being able to get rid of it & dying from it that is.

I'm not messing with c diff if there are other comparable medications - and according to my daughter's ID, the vast majority of the time there are. Doctors are too prone to just hand out the candy being pushed hardest by the drug companies, without considering the risks and alternatives. It was a *#%! nurse who made the decision in my case - just following protocol and couldn't be bothered to check with the oral surgeon when I raised concerns.

[Lil Missy]

10. colonoscopy's and mammogram are done routinely and repeated periodically

As preventive/screening. You should go back and have them done. Blood work before ordering another refill is justified too.

Sounds like you had a very good physician. Do what they say next time.

[mcar]

30. They are also covered under ACA regulations

So there is no out of pocket.

[tavalon]

54. Please don't propagate the MDiety problem

A good doctor suggests and dialogs and doesn't coerce. A good patient asks questions and dialogs with the doctor. Doctors are not our parents and we are not obligated to "do what they say".

We are purchasing their expert advice, not their imperialistic abuse.

[tularetom]

11. I dumped my "primary" doctor 5 or 6 years ago

I would go in there for a physical and get referred to two or three labs for this test and that procedure and the end result was I wound up spending hours sitting in waiting rooms. It wasn't even a question of cost, I'm covered by Medicare and a supplement. But I live 35 minutes from the nearest GP and 60 minutes from the labs and even at my advanced age, I actually have stuff I'd rather do. Got fed up with all the bullshit and just quit going. Well, they wouldn't renew my BP prescription. So i just went without for a couple of years, no doctors appointments no waiting rooms, no referrals.

About a month ago, I also got a spider bite. After a couple days' it looked pretty ugly and probably infected so I went to one of these urgent care places and got a prescription for some sulfa medication. While I was there they took my BP and it was elevated at 140/85, so I asked them if they could write me a scrip for some medication, which they did, no labs , no tests, no referrals, no come back in a week for another appointment.

I'll never go back to a regular GP. I'm convinced that the system of ongoing referrals, tests and lab work is just a way to squeeze a few more bucks out of medicare and insurance.

[jwirr]

47. Just to squeeze a few more bucks - these tests are

quite reasonable compared to the cost of treating the diseases they are meant to prevent.

[Tess49]

12. My doctor retired and I needed a new one. My new doc did a very thorough physical and history

as well as lots of lab work. I'm glad he did.

[Yo_Mama]

15. IMO, you're in the wrong.

You are in your sixties. BP that high is not something to be laughed off, and routine labs plus the ECG are pretty much the minimum. It's obvious that you need a change in medication, because your BP is not controlled!! Before prescribing it, the doc needs to know how your kidneys and liver are working.

I don't follow the colonoscopy/mammos recs myself, but I wouldn't want to go to a doctor who wouldn't at least do the bloodwork and and ECG.

She doesn't get paid for the mammo or the colonoscopy. So it's not a matter of using you as a "cash cow". Those are standard recommendations for someone your age. Labwork is sent out to a commercial lab as well, so she's not making any money on it.

The bloodwork and the ECG - well, if she is just handing out medication without any clue as to whether it is what you need, she is committing malpractice, IMO.

I am sure Dr. D. does not want you back!

No, labwork from years ago does not fit the bill when you have a medical problem now.

Furthermore, if you are on an ACA policy she could set that up as a routine physical, so that you wouldn't have to pay anything.

You don't want medical care, but you don't have the right to expect a doctor to write prescriptions when they could be either insufficient or actually harmful to you.

[TexasBushwhacker]

73. I agree

I think it would be irresponsible for a new doctor to refill another doctor's prescriptions without doing baseline tests.

Women over 50 should be getting a mammogram at least every 2 years. My mother was diagnosed with Stage 2 breast cancer when she was 60. Her tumote was over an inch in diameter, but it was soft, so it couldn't be felt. Even her surgeon had a hard time feeling it. I asked her when she had gotten her previous mammogram and she said 5 years. I asked her why she waited so long and she said the one before had hurt. Her doctor said it probably took 2 to 3 years for the tumor to get as big as it was and spread to her lymph nodes. Chemo and radiation put her in remission for a couple of years, but it cane back in her bones and spread to her brain. She died when she was 69.

So I'm 58 and I get my mammo every year. I've even had to have biopsies in both breasts, but so far, no cancer.

Suck it up and do the tests. If you're lucky, anything they find won't be too advanced. If you're really lucky, you'll get a clean bill of health.

[Trailrider1951]

16. Thanks everyone for your thoughts

I really appreciate you taking the time to write your replies. I will see my old doctor next week, and go from there. There is one thing that has occurred to me: the last time I refilled my BP prescription, the little tablets were pink instead of the white. Maybe these generics are not as effective as the ones I was taking in the past. I'm going to discuss this medication change, as well as my experience with Dr. D. I just do not understand why she refused copies of my records.

[840high]

19. I was just put on the pink ones, they

are very effective. Stay with the doc you are most comfortable with and trust. Regular exams including blood work are ok. That's how my colon cancer was caught.

[pnwmom]

23. She probably wanted to see your CURRENT bloodwork, so your old bloodwork

wouldn't give her the information she needed to know.

In fact, she'd be derelict in her duty as a doctor if she relied on old bloodwork to make a decision on your BP medicine now.

[Lurks Often]

27. Likely for liability reasons

Dr D may very well be over cautious, but if the worst happens it's HER medical license and practice at risk if your prior doctor missed something and she doesn't catch it.

[Ms. Toad]

34. Or, perhaps Dr. D. cares about her patients.

Stale tests tell you nothing about your current conditions - so whether the prior doctor missed something is not really relevant. What is relevant to your health (not liability) is what the blood tests reveal about how well medication is treating the ongoing health problems - and about undiscovered conditions that might have developed since the last set of tests - conditions that are not detectable except through bloodwork.

Preventative care saves money, and lives, by catching asymptomatic diseases early when they can be treated - or at least treated more economically. That's the whole concept of preventative care.

I'm pretty shocked by all of the people in this thread who attribute very routine testing that should be done annually (or every 6 months if you have certain diseases) for their own as being done to protect the doctor's rear end. (As in - your post was the straw that broke the camel's back after reading through post after post in this thread of people saying the same thing.)

[zipplewrath]

38. Prove it

Preventative care saves money, and lives, by catching asymptomatic diseases early when they can be treated - or at least treated more economically. That's the whole concept of preventative care.

There have been several efforts to support this claim and in many cases the data doesn't support it. HMO's started in the '80s on just an assumption, that they could save costs with preventative care and it didn't really pan out that way. There are arguments right now within the scientific community about PSA's and breast exams because of the false positive problem. Again, it is hard to find the data to support the assertion that in the aggregate it "save lives" or "saves money". Specific diseases possibly, but only ones with a low false positive rate and a risk exposure to a large portion of the population.

The harder part, and the part here that speaks to this posters issue, is that these studies are on populations and the first rule of statistics is that they are meaningless to an individual. It really matters what risks to which you are prone to decide which procedures are "useful" and which are counter productive. The frustration on many peoples part is that too many doctors don't communicate that there is any individual consideration in their recommendations, and instead project a certain "knee jerk" approach to these tests. "You're here, you're 60, and it's covered" is what tends to come across.

Of course this can possibly be entirely a perception and "bedside manner" problem. Sadly, it could be one that was easily solved by a moment of explaining the characteristics of the patient that make the recommendation applicable to that specific patient. I do find that if I can get a word in edgewise, I can often extract that kind of information from the doctor. It is appalling on many a case when the doctor rattles off a set of "risk factors" that don't actually apply to me. Many are often embarrassed enough to back pedal to a "well, it's up to you" position.

[Yo_Mama]

42. It's a shitload cheaper to treat high blood pressure before your kidneys fail.

And a whole lot easier on a patient!

This is nonsense in this context. The woman walked into a doctor wanting a refill on her old BP meds. The new doctor checked her BP and found that it was very high. She has a problem - this is not just some random testing.

This is not some speculative problem - it's a real problem facing this doctor and this patient. Controlling the problem so that it does not become a morbid condition is of course going to be massively cheaper.

The mammography and the colonoscopy are good ideas that statistically will save lives. Alternatively, an occult fecal could be substituted for the colonscopy.

The labwork and the EKG are indicated because of a current clinical problem that is not going to go away on its own.

[zipplewrath]

44. Maybe

The blood pressure was being treated. You don't have the data to support the claim that in this case an additional blood test would have resulted in either lower costs or longevity. It could have improved condition somewhat, and possibly affected the future, but you don't have the data to support that. (And it probably couldn't be detected). Oh, and the sad fact is that a morbid condition can result in lower costs, if the patient dies you don't have to treat them any longer. And treating them is no guarantee of not developing into a morbid condition in the longer run. So sooner or later you spend the money. The best claim you might have would be some "quality of life" issue (fewer associated symptoms/diseases/etc.).

This is what I meant about the statistics. On a population level, there are a lot of factors and the apparent result over the years is that it is hard to improve outcomes, especially fiscal, through preventative/testing means. As I say, there are exceptions for conditions which have small false positives and large affected populations.

[pnwmom]

63. It makes no sense to prescribe blood pressure medication without finding out why

blood pressure was suddenly elevated. It could be diabetes-related, or kidney problems, or many other things. Each one would require a different treatment.

This woman is afraid of needle sticks so she wants him to rely on outdated blood work from before -- when she wasn't having the elevated blood pressure. That makes no sense.

She needs to either get over her fear of needles or quit complaining about being offered standard medical care from a conscientious doctor.

[Lurks Often]

39. Or both

In our sue happy country I can certainly understand someone taking steps to protect themselves as much as possible from getting sued.

We don't know how old the tests from the previous doctor were so maybe they were "stale" and maybe they were not, depending on the test and the suggested interval on when a specific test should be repeated.

[Ms. Toad]

71. At least a year -

based on the OP's stated last visit & general description of being seen to treat specific problems.

If it would have shown up on a standard set of tests as of the day you took over care, and you fail to do the standard set of tests, the fact that another doctor previously missed it is not going to change your liability. The point is that you need to be exercising appropriate care for your patient to detect things that cannot be detected merely by patient reported symptoms.

[Ms. Toad]

33. Copies of your medical records should supplement,

not replace, regular testing.

[KT2000]

17. don't put off the lab work

a very healthy friend in his early 60's had routine blood tests and found out he had advanced leukemia. There are conditions such as this that do not have noticeable symptoms but need treatment. After 60 there are many age related conditions that can be caught in time with such preventative care.

What Dr. D asked of you is routine.

[elleng]

18. You're a patient,

and your 'new' doc wants to have info about your medical status. Sounds perfectly reasonable to me.

[phylny]

21. Regarding the mammogram,

I'm 57, and when I was 55, a routine yearly mammogram found what turned out to be stage 0 cancer. My mammogram found it years before I or anyone else would have been able to feel it. (many small masses, the size of a grain of sand or salt, or even smaller). I had a lumpectomy, reconstructive surgery, and radiation. My prognosis is excellent.

I urged one of my coworkers to have a mammogram because she hadn't had one in about three years. She did, and had stage 3 cancer. After a mastectomy, removal of many lymph nodes, and radiation, she is on drugs and is doing great.

There is a good reason your new doctor asked you to have these tests - they save lives.

[pnwmom]

22. Most good doctors will want their new, regular patients to have standard screening tests

like mammography and colonoscopy.

She could be saving your life with the free tests (covered by Obamacare) she wants to schedule. The only charges you will incur will be IF they find something -- a tumor or cyst -- that needs followup.

You were the "victim" of a conscientious doctor. Your old doctor has been failing to recommend screening treatments that the ACA covers in full because they can discover cancer while it's still in the early stages.

And no responsible doctor will order changes in medication without finding out what your CURRENT blood work shows. Kidney problems, for example, would show up in blood work, and could be the cause of your increased blood pressure. So could diabetes.

You think you have a problem with needle sticks? Good luck with ever being a cancer patient -- which you probably have a 50/50 chance of being, statistically. And good luck if your high blood pressure has damaged your kidneys, or if it's being caused by untreated diabetes.

Improve your odds. Be brave enough to get the blood draws now. Or you could be facing much worse later.

But if you just don't want to, because you don't like needle sticks, quit complaining about your good doctor's good care.

P.S. What you have been doing is equivalent to only going to the dentist when you're suffering so much pain you need a root canal -- and then complaining when the dentist points out four other teeth that have cavities that need filling, so they don't turn into more root canals. This is what a good dentist would do.

Preventative medicine will cause you less pain over the long run.

[tammywammy]

24. Dr D sounds like a good doctor

Your previous doctor should have been doing or at least recommending these things too. Colonocopy and mammograms are routine. You should be getting blood work done at least annually. EKGs are recommended for persons with heart issues like high blood pressure.

And of course your over a year old blood results aren't acceptable to determine your condition now.

[Lee-Lee]

26. Writing scripts and providing care without a baseline of tests

Would probably open a doctor up to malpractice claims for not exercising basic due diligence in providing care.

Likewise, had she not recommended the mommogram and colonoscopy, then you develop cancer, you could make the claim it would have been caught sooner had your doctor provided proper treatment. By bringing it up she put the decision on you.

You seem to be the unreasonable party here.

[WinkyDink]

28. I truly hate to say this, but the ACA, it seems to me, requires much more doctor control and

involvement to the point of intrusion than before. Blood tests are only part of it.

One of my 2 major local hospitals has even signed a contract with CVS, which, if you are in "the network," you'd be well-advised to use.

Also, doctors of different "networks" will not communicate with each other. YOU must do that.

So it is partly about the $$, but also about the new regs.

[jwirr]

48. Question: these networks are not part of ACA - what

I see happening is competition between networks who provide healthcare which is then paid for by an insurance company which may or may not be included in the ACA market place.

In our area this started out with a lot of small HMOs being bought out by a larger HMO to provide services. Then ACA was created and these providers were offered to the public in an insurance program (Medica, Humana, etc) that was in compliance with ACA and thus included in the market place.

ACA set the minimum requirements the insurance company most provide, as well as the services it most provide. ACA does not own the insurance companies or the networks.

[yellowcanine]

32. Bloodwork needs to be current, particularly for chronic conditions - and high blood pressure is a

chronic condition. What worked last year may not be working now. You can change doctors but the new doctor, if at all competent, is going to still need to have current blood work. Someone who tends to have high BP should probably be having an EKG done yearly in addition to the blood work.

I understand the insurance issue but it is not really reasonable to say "for a spider bite?" when you are behind for regular check ups such as a colonoscopy. You really do not want to be waiting for symptoms before having a colonoscopy. Colon cancer is one of the most treatable cancers if caught early but if not it can be deadly.

[Cal Carpenter]

36. As a new patient, she likely needs to have an overall physical/checkup with you

It may even be a requirement of insurance, if not just their own protocol (for the clinic or hospital group or whatever).

I understand it is frustrating especially since you were happy with your old doctor and comfortable with your current medicines etc, but I don't think it is necessarily a matter of seeing you as a 'cash cow'. I think it is more likely that she is thorough and wants to know what she needs to know to treat you properly.

Of course some docs are jerks and some docs are greedy jerks and maybe she is one of those, but it's not like she personally makes money off the tests.

[Vinca]

37. Some doctors treat "patients," others treat "customers."

If I were you I'd pay the extra money to see the first doctor and investigate insurance options that might include your preferred doctor in the network. Just one more thing that makes obtaining decent healthcare in this country a pain in the ass.

[pnwmom]

65. There is nothing in the OP to suggest that she was being treated as a customer.

Doctors are supposed to do physicals on new patients. It's good medical practice: know your whole patient. And they are supposed to be offering the free colonoscopies and mammograms provided for by the ACA.

And they should never prescribe blood pressure medication without making sure there isn't a cause that needs to be treated -- like diabetes or kidney problems. Her old records wouldn't help her new doctor figure out what was causing her newly elevated blood pressure. Her new doctor was just being a good doctor when she asked for current blood work.

And the OP needs to get over her fear of needle sticks. If she avoids needed preventative care, she could have many more needle sticks in her future.

[Vinca]

81. Doctor #2 had no interest in getting records from Doctor #1 which might avoid some testing.

That tells me Doctor #2 is getting a piece of the pie . . . tests for everybody!

[pnwmom]

83. Not true. Her new doctor wouldn't accept the old records as a SUBSTITUTE

for getting current blood work. That would have been a very stupid idea, because the patient suddenly has very high blood pressure. The doctor has a medical responsibility to see what's causing the problem. Her old records could be useful but only COMBINED with current data, not substituting for it.

The woman's BP prescription is probably about a year old because that's how many refills doctors typically order for BP medicine and she was almost out. You can't have blood work one year and expect that to be the last blood work you'll ever need.

[J_J_]

40. just logged on to mention...turmeric

Turmeric is awesome for treating high blood pressure ...

Turmeric

Turmeric, also known as curcumin, drastically decreases inflammation throughout the body. Inflammation is a primary cause of hypertension, so turmeric, by reducing inflammation, improves cardiovascular health and helps maintain a normal blood flow.

When coupled with black pepper, turmeric expands blood vessels and sweeps any build up that may have accumulated within them.
- See more at: http://www.thecurvyvegan.com/high-blood-pressure.html#sthash.H9tryjTK.dpuf

Turmeric is a kitchen staple in India, found in just about every dish that crosses the table — a fact that has not been lost on researchers, who observed 30 years ago that the incidence of chronic illnesses among people in India is significantly lower than in most Western countries, especially the United States.

Turmeric owes its preventive and curative characteristics to its active ingredient curcumin, a compound so diverse and powerfully rich in antioxidant and anti-inflammatory actions that thousands of studies have shown that it protects and improves the health of virtually every organ in the body.

May also help prevent and treat:
Acne, allergies, Alzheimer’s, arthritis, asthma, cancer, cholesterol problems, colitis (inflammatory bowel disease), cystic fibrosis, depression, dermatitis, type 2 diabetes, eczema, eye infection, flatulence, gallbladder disease, gout, gum disease, heart disease, high blood pressure, itching, liver disease, macular degeneration, obesity, pain, Parkinson’s disease, pollution side effects, psoriasis, rash, scleroderma, stroke, wounds.

https://experiencelife.com/article/5-healing-spices/

[CBGLuthier]

82. I eat turmeric every day since we eat predominantly Indian food.

I also take a very small dosage of BP medicine but who knows what my BP would be like if I did not eat turmeric every day.

[J_J_]

41. also for the spider bite infection

google colloidal silver & infection....works wonders, even on MSRA

Your story is precisely why I seek out alternative treatments.

[PasadenaTrudy]

43. This all sounds acceptable and normal to me n/t

[jwirr]

45. One of the issues you are facing is that ACA no longer

emphasizes treatment only for existing problems like our old insurance programs did. The emphasis is on preventative medicine.

I recognize several of the tests she is asking you to take and they are supposed to be free preventative tests. The mammogram and the colonoscopy are definitely preventatives and most of us are asked to have them. I would assume that a blood workup would also fall into this program.

Did you tell her about the problem you have with blood tests? My disabled daughter has very small veins as well and they now use only the smallest needle they can use for her. She needs blood level tests often.

IMO you are not a cash cow - they are saving money through the use of preventative medicine and as far as I know that is working. They used to give us more tests regardless if we needed them. Only they gave them AFTER we got sick.

[shanti]

46. blood tests

fyi, there are different places that the docs can take blood if you have hard to find veins (as i do too). i'm diabetic and have regular blood tests, so i have them taken from the vein next to my thumb, AND they use a butterfly needle, which is smaller diameter. i've had zero problems with blood tests now, and can barely feel it when taken.

also, until i was about 55, i almost never had a blood test, and always thought i was very healthy...until i wasn't.

get the blood test!

[cbdo2007]

49. You may also want to get some bug spray and spray for spiders.

If you are getting multiple spider bites per year, from Brown Recluse spiders, the best thing you can do for your health is to probably invest in a $10 bottle of bug spray per year and spray. Sounds like it could save your life.

[tavalon]

50. No, you just got a crap doctor

While she is correct about the importance of each of those tests, she stepped over the line with her coercion.

IMO, you should fire her and pick another doctor.

And, later, when you have time, research the tests she wanted. She wasn't actually wrong about desiring that you get important screening exams, just completely wrong by being coercive to the point of abuse.

[pnwmom]

58. It sounds more like the old doctor was a crap doctor

who wasn't recommending standard preventative tests.

This one is doing everything she should be. No one should be ordering prescriptions for new blood pressure medication without some blood work to help determine the cause of the rise.

[Gloria]

53. If you're older you need checkups, and follow chronic illnesses

At least once a year you need basic bloodwork and there may be some on an as needed basis.

An EKG is basic and needs to be done as a baseline. The stethoscope doesn't reveal what an EKG does.

You are a new patient and she doesn't know you as well as your old doc. She sounds like she is thorough and is also interested in catching up with your history and getting you on track for regular monitoring exams.

I think you should give it more time...when my old doc retired, I had a new one who was completely a 0...I have several conditions, she barely looked at me and told me to come back in a year...I switched to another group entirely.

Personally, I get monitored regularly, 3-4 times a year...I see the nurse practitioner for the basic visit. I am specialized out for thyroid and kidneys, so I see them. I also get bloodwork a few times a year from my doctor who monitors the details on my blood cells and supplements. I'm happy to do this to stay alive longer!

[LeftyMom]

55. You're long past the age where those routine tests are necessary.

If you just want somebody to write you a prescription for antibiotics without doing the basic tests and preventative care for a person your age, then go to a doc in the box or the ER.

Your doctor is a professional, let her do her damn job.

[pnwmom]

59. There are two ways of reading your subject line.

The way I read it at first was that this person was so old she no longer needed colonoscopies, etc. -- which would be true if she was 80 and had never had a polyp.

But that's not what you meant, right? You're assuming that this person is well past 50 and therefore needs the tests.

[abelenkpe]

56. Call your healthcare network

Submit a complaint about Dr. D and ask to be assigned to a new doctor. And feel better!

[pnwmom]

64. And say what? That the new doctor followed standard care guidelines

and was unwilling to prescribe medication for blood pressure without finding out what was causing the high blood pressure?

What a waste of time. Unless you're suggesting that she file a complaint against her OLD doctor. That might make sense, if he was failing to provide proper medical care.

[abelenkpe]

66. No they need to stop recommending that particular

Doctor for that patient. There's no trust there. Patient feels like she's being bullied and doctor should hear that they could stand to be less forceful. She went for a spider bite. The other things should be recommended not demanded in order to take care of the spider bite.

[pnwmom]

67. You didn't read the whole thing. On her SECOND appointment she went for high blood pressure.

The doctor would have been derelict not to order tests to rule out serious causes of such high blood pressure. She wanted a refill of her old medication but the old medication was no longer controlling her blood pressure well enough.

This had nothing to do with the spider bite of the first visit. This is what she said:

So, this week I was running low on my blood pressure medication that has worked well for me for five years, reducing my BP and not causing any side effects. I again called my new health care network and was again assigned to this Dr. D. This morning, I went to the office and when the med assistant checked my BP, it was higher than usual, 170/88. When Dr. D came in, she asked for the reason I was there, and I told her I needed to renew my BP prescription. Again she told me that in order for her to treat me, I would have to have bloodwork done. I again refused, because I have small veins and they have to stick me with the needle 4 or 5 times to get the amount they need. To me, this is torture. I will have it done only if necessary to treat any symptoms or illness I might have.

She says she will only have blood work done only if she has any symptoms or illness -- high blood pressure IS a symptom and can be an indicator of a serious condition like diabetes or heart or kidney disease. And untreated it could lead to a stroke -- and a whole lot of needle sticks.

[abelenkpe]

69. She needed her prescription refilled

Doc wouldn't unless she agreed to more tests. Her blood pressure was high because she was off her mess, no?

Either way it's an antagonistic relationship that the healthcare provider needs to know so they aren't paired up again. Who wants to see a doctor they feel doesn't listen to them? There are other doctors who she may get along with better.

[pnwmom]

74. No, she doesn't say she was off her medication. She said she was running low, which is when most

people get refills. Running low occurs before you run out.

But in either case, with BP that high, the doctor had a responsibility to get current blood work so she could rule out causes that would need treatment -- and there are lots of serious potential causes.

I doubt that this person would listen to any good doctor, since any good doctor would recommend blood work to a new patient with very high blood pressure. And the bottom line is the person hates needle sticks.

[TexasMommaWithAHat]

87. The patient is also responsible for half of that relationship

If you walk in and state that you won't do bloodwork, and you just want the doctor to prescribe what you've been taking in the past, and what's running through your mind is that the doctor is treating you like a cash cow, I can assure you that the relationship is already off to a very bad start.

It's like walking into a pediatrician's office and declaring that you won't get your kids vaccinated. No, not real conducive to a productive relationship.

The OP is getting some very bad advice from a few posters, imo.

[SummerSnow]

57. A few years back I had to take my daughter to see a Nuerologist for a sleep study she was ...

going to have. After the neurologist examined her he told me he wanted to introduce me and my daughter to a few physicians on his team in case I needed to make another appointment if he was unavailable. We walked down the hallway and by the elevator he introduced me and my daughter to another neurologist who was getting off the elevator, he told them about my daughter sleep study etc and then we parted ways.

A week later I received in the mail a $600 bill from the neurologist we met in the corridor by the elevator . I hit the ceiling. I called the number on this bill and went off. I said to his office, ' you expect me to pay a bill to a doctor that was not my daughters doctor and we just happen to say hello to by an elevator? I told them they were running a scam and I was calling the hospital chief of staff etc. They immediately disregarded the bill. However i still wrote a letter to the hospital complaint dept about it. I also threatened that if this bill shows up on my credit report I will sue. It never showed.

It seems like many doctors are all about the money nowadays. You're not even a person anymore , you're a patient number. I remember having to tell my doctor to wash his hands before touching me, he scoffed . I left the exam room and switched doctors.

[Codeine]

60. Medical Malpractice for along proper care of a patient

and doing the needed tests to ensure that you're being given proper medication?

This fuckin' place.

[taught_me_patience]

62. the new doctor is probably happy you're leaving

And going back to your old doctor. She's ordering basic stuff for a senior and you go around accusing her of milking her. If anything, your old doctor is negligent.
Pretty Damn ungrateful.

[cheapdate]

76. My doctor is terrific. Had him for 15 years.

He has a small practice. Just him and one other doctor (and their staff). My wife's doctor is part of much larger group. They seem to have more of the kind of inflexible rules and such that you've described. Try to find a another doctor with a small practice? Of course easier said than done. That concludes my knowledge of doctors and the practice of medicine.

[dem in texas]

77. The new Doc was right and you were wrong

The new doc wanted some tests so she could have a starting point on your care. I wouldn't go to a new doctor that did not want these tests. At your age and with high blood pressure, you should be getting a complete physical every two years. Blood work is important, it can check for diabetes and many other things. A blood test found that I had gout which I didn't connect with the knots in my arms and hands, they did not hurt, so I was not concerned about them. I am now on medication for my gout and the knots have about gone away. Don't overlook the other tests, the older you get, the more health problems you will have, and many will not show up until they are advanced. That is why you need these tests. I can speak from experience about skipping a mammogram and then finding a lump in your breast. I had to go through treatments for almost a year and am just now getting my strength back.

[bananas]

78. There is a big shift in how doctors are paid, to "outcome based"

and it's not necessarily a good thing.

Good news article and discussion of it here:

http://www.democraticunderground.com/1014998441

Mon Jan 26, 2015, 04:09 PM
Star Member DonViejo (17,104 posts)

The Obama administration wants to dramatically change how doctors are paid
Source: Washington Post

The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.

Rather than pay more money to Medicare doctors simply for every procedure they perform, the government will also evaluate whether patients are healthier, among other measures. The goal is for half of all Medicare payments to be handled this way by 2018.

Monday’s announcement marks the administration’s biggest effort yet to shape how doctors are compensated across the health-care system. As the country's largest payer of health-care services, Medicare influences medical care generally, meaning the changes being initiated by the administration will likely be felt in doctor's offices and hospitals across the country.

“As a very large payer in the system, we believe we have a responsibility to lead," said Health and Human Services Secretary Sylvia Mathews Burwell in a press conference. "For the first time, we’re going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system.”

Read more: http://www.washingtonpost.com/blogs/wonkblog/wp/2015/01/26/the-obama-administration-wants-to-dramatically-change-how-doctors-are-paid/

[bananas]

79. Obama Signs Medicare Bill Encouraging Outcome-Based Compensation

http://www.benzinga.com/news/15/04/5417473/obama-signs-medicare-bill-encouraging-outcome-based-compensation

Obama Signs Medicare Bill Encouraging Outcome-Based Compensation
Laura Brodbeck , Benzinga Staff Writer
April 17, 2015 3:10pm

On Thursday, President Obama signed the H.R. 2 Medicare Access and CHIP Reauthorization Act of 2015, a bill that revamps the payment scheme for Medicare doctors and supports the growing push for quality-based doctor compensation.

The bill reflected a rare moment of bipartisan cooperation in Washington, after a year of messy battles between Republicans and Democrats over the U.S.'s healthcare system. Upon signing, Obama commented that the bill was designed to encourage innovation in healthcare and expressed hope that the two parties will continue working together in the future.

<snip>

A Win For Insurers

Insurance companies are likely cheering the new bill, as any move toward quality over quantity as a metric for physician compensation models is to their benefit. Anthem Inc. (NYSE: ANTM) and Humana Inc (NYSE: HUM) have already created new outcome-based payment businesses that are aimed at making the transition to a new model easier for healthcare workers.

Many worry that developing a way to measure the quality of care for an outcome-based compensation scheme will be difficult, while others wonder whether or not doctors will be able to shift the way they practice in order to fit this new model.

<snip>