Problems with American healthcare - Too many drugs/too many screening tests

[Anonymous]

Anonymous wrote:

Anonymous wrote:PP, thank you for posting that. They recommend every 3 years for women age 21-65. I've been to several different OBs over the past few years and they all insist on yearly paps.

I wonder why there is a disconnect. It can't just be about money. How much money can OBs possibly be making on a pap smear?

I will definitely save that link and use it the next time they want to scrape away at my cervix.

Because its a relatively inexpensive and relatively non invasive that could save your life.

Pap screens are invasive, I'm not sure where you are getting that it is not. It is the internal scraping of your cervix. Cervical cancer is very rare compared to other diseases that kill women. False positives are common and lead to further invasive procedures that carry risks.
I read an article discussing the possibility of the yearly scraping increasing the risks of premature delivery in women. This is one of the reasons they recommend that pap screens start at a later age and not at 18.

http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html

[Anonymous]

Anonymous wrote:I've seen this even with the other moms in my mom's group.

Out of 5 moms, 3 have had workups for their kids to 'rule out' problems.

One's son was sent to the urologist for a workup. It ended up being nothing.

One's daughter was sent for a workup regarding digestive issues, simply because she was underweight. It ended up being nothing.

One's son had tons of workups for allergies. It did end up he had a minor allergy, so that was something.

I have no doubt that they can catch problems earlier, but for the kids who ended up not having any problems, is it really worth all the stress and hardship of dragging your 2 year old all over town for blood work, doctor's appointments, etc. I also feel that the younger MDs seem to be more quick to refer things out at our particular pedi practice. The older pediatricians seem a bit more laid back. So, maybe it has to do with experience. Knowing when exactly something could be a big problem, versus knowing when you can just do 'watchful waiting'. Or, maybe the younger docs are trained to do more testing, and are more worried about lawsuits?

This is what happens in the hospital as well. Test after test, then repeat the test in case it was wrong and by the way, none of these tests are 100% accurate. Patients leave having been poked to death and overradiated by repeat xrays and CT's. Final diagnoses: nothing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PP, thank you for posting that. They recommend every 3 years for women age 21-65. I've been to several different OBs over the past few years and they all insist on yearly paps.

I wonder why there is a disconnect. It can't just be about money. How much money can OBs possibly be making on a pap smear?

I will definitely save that link and use it the next time they want to scrape away at my cervix.

Because its a relatively inexpensive and relatively non invasive that could save your life.

Pap screens are invasive, I'm not sure where you are getting that it is not. It is the internal scraping of your cervix. Cervical cancer is very rare compared to other diseases that kill women. False positives are common and lead to further invasive procedures that carry risks.
I read an article discussing the possibility of the yearly scraping increasing the risks of premature delivery in women. This is one of the reasons they recommend that pap screens start at a later age and not at 18.

http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html

I was going to say the same thing. Not sure about the PP, but I find pap smears pretty invasive!

Definitely capitalism at play here also. The companies who manufacture/assess these screening tests (Pap smears/PSA tests) want patients and doctors to do more and more of them so that they can make more money! Radiology centers that have spent tons of money on mammography equipment or CT machines need to get a ROI. If they have the CT scans, and the people to run them, the more of them they do a day, the more profit they are making. Having the machines sitting there unused is useless.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PP, thank you for posting that. They recommend every 3 years for women age 21-65. I've been to several different OBs over the past few years and they all insist on yearly paps.

I wonder why there is a disconnect. It can't just be about money. How much money can OBs possibly be making on a pap smear?

I will definitely save that link and use it the next time they want to scrape away at my cervix.

Because its a relatively inexpensive and relatively non invasive that could save your life.

Pap screens are invasive, I'm not sure where you are getting that it is not. It is the internal scraping of your cervix. Cervical cancer is very rare compared to other diseases that kill women. False positives are common and lead to further invasive procedures that carry risks.
I read an article discussing the possibility of the yearly scraping increasing the risks of premature delivery in women. This is one of the reasons they recommend that pap screens start at a later age and not at 18.

http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html

I was going to say the same thing. Not sure about the PP, but I find pap smears pretty invasive!

Definitely capitalism at play here also. The companies who manufacture/assess these screening tests (Pap smears/PSA tests) want patients and doctors to do more and more of them so that they can make more money! Radiology centers that have spent tons of money on mammography equipment or CT machines need to get a ROI. If they have the CT scans, and the people to run them, the more of them they do a day, the more profit they are making. Having the machines sitting there unused is useless.

Here is an article about the possible negative affects of yearly scrapings.


http://abcnews.go.com/GMA/OnCall/guidelines-ditch-annual-pap-smears/story?id=9131632#.T3i0xNlRGuI

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PP, thank you for posting that. They recommend every 3 years for women age 21-65. I've been to several different OBs over the past few years and they all insist on yearly paps.

I wonder why there is a disconnect. It can't just be about money. How much money can OBs possibly be making on a pap smear?

I will definitely save that link and use it the next time they want to scrape away at my cervix.

Because its a relatively inexpensive and relatively non invasive that could save your life.

Pap screens are invasive, I'm not sure where you are getting that it is not. It is the internal scraping of your cervix. Cervical cancer is very rare compared to other diseases that kill women. False positives are common and lead to further invasive procedures that carry risks.
I read an article discussing the possibility of the yearly scraping increasing the risks of premature delivery in women. This is one of the reasons they recommend that pap screens start at a later age and not at 18.

http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html

I was going to say the same thing. Not sure about the PP, but I find pap smears pretty invasive!

Definitely capitalism at play here also. The companies who manufacture/assess these screening tests (Pap smears/PSA tests) want patients and doctors to do more and more of them so that they can make more money! Radiology centers that have spent tons of money on mammography equipment or CT machines need to get a ROI. If they have the CT scans, and the people to run them, the more of them they do a day, the more profit they are making. Having the machines sitting there unused is useless.

Here is an article about the possible negative affects of yearly scrapings.


http://abcnews.go.com/GMA/OnCall/guidelines-ditch-annual-pap-smears/story?id=9131632#.T3i0xNlRGuI

Well, shit. If you don't want the test, don't do it. You can refuse any test, medicine, or procedure you want. No one is forcing you. Just don't blame the doctor for not diagnosing your illness sooner.

[Anonymous]

Anonymous wrote:

Well, shit. If you don't want the test, don't do it. You can refuse any test, medicine, or procedure you want. No one is forcing you. Just don't blame the doctor for not diagnosing your illness sooner.

I don't find this exactly true. I've asked if I could skip it, and I've had OBs that definitely aren't willing to skip it.

Also, it shouldn't be up to the patients to have to decide what tests are necessary. You should be able to go to the doctor and assume that the doctor won't run unnecessary tests. I'm the PP who's really happy with my pedi. If you find a doc that you can trust, that's the ideal situation because you know he/she isn't ordering unnecessary tests. But, sometimes it's tough to find a good doctor that you can build a relationship with (insurance changes, etc) and then you really want to be able to trust that the doc's ONLY motivation is your well-being.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Well, shit. If you don't want the test, don't do it. You can refuse any test, medicine, or procedure you want. No one is forcing you. Just don't blame the doctor for not diagnosing your illness sooner.

I don't find this exactly true. I've asked if I could skip it, and I've had OBs that definitely aren't willing to skip it.

Also, it shouldn't be up to the patients to have to decide what tests are necessary. You should be able to go to the doctor and assume that the doctor won't run unnecessary tests. I'm the PP who's really happy with my pedi. If you find a doc that you can trust, that's the ideal situation because you know he/she isn't ordering unnecessary tests. But, sometimes it's tough to find a good doctor that you can build a relationship with (insurance changes, etc) and then you really want to be able to trust that the doc's ONLY motivation is your well-being.

Thank you, PP. I totally agree with you. I also have a ped who is the same way. If she tells us we need a test, I trust she will do it and there is a real reason she believes it's necessary. She actually evaluates the situation instead of jumping quick on the million dollar workup.
I also have asked to skip the yearly pap and follow the recommended every 3 years (meet all of the requirements) and basically the OB was looking at me as if I had lost my mind and he refused. No other reason than that he just wanted all of his patients do it every year, regardless of risks factors or previous results and he didn't care about the new guidelines.

[Anonymous]

that should be, "I trust her..."

[Anonymous]

Anonymous wrote:
Well, shit. If you don't want the test, don't do it. You can refuse any test, medicine, or procedure you want. No one is forcing you. Just don't blame the doctor for not diagnosing your illness sooner.

Like the PP said, you sometimes can't just simply refuse tests. Doctors can decide that they won't treat you if you don't follow their recommendations.

I'd even be fine signing a waiver each time I wanted to refuse a test. If docs are worried about lawsuits, just have a document on hand saying 'I understand the risks of deferring this test, and choose not to have it done at this time.'. That wouldn't seem too difficult and it should somewhat put the docs at less risk for lawsuits.

I think as more information is easily accessible to the public, the public will demand even more say in their healthcare procedures versus just going along with what the doc wants.

[Anonymous]

I think we're over-testing. Take the case of my daughter: they thought she might have pneumonia, so they did a chest xray. She did. They prescribed antibiotics. Thing is, they would have given the abx ANYWAY. The symptoms could have been caused by a bacterial infection (though viral is more likely), so the treatment would have been the same no matter what the xray showed. Why go through the expense and radiation exposure of an xray, when the course of action would be the same?

[Anonymous]

PP, that's exactly what happened to us. And the specialist we saw later said the same thing - he would've treated with antibiotics either way and we could've skipped the scan. Why expose the kid to unnecessary radiation?

That experience made me more wary and I will no longer consent to any and every test they want to do on my kids. Definitely makes me think twice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:
Well, shit. If you don't want the test, don't do it. You can refuse any test, medicine, or procedure you want. No one is forcing you. Just don't blame the doctor for not diagnosing your illness sooner.

Like the PP said, you sometimes can't just simply refuse tests. Doctors can decide that they won't treat you if you don't follow their recommendations.

I'd even be fine signing a waiver each time I wanted to refuse a test. If docs are worried about lawsuits, just have a document on hand saying 'I understand the risks of deferring this test, and choose not to have it done at this time.'. That wouldn't seem too difficult and it should somewhat put the docs at less risk for lawsuits.

I think as more information is easily accessible to the public, the public will demand even more say in their healthcare procedures versus just going along with what the doc wants.

The problem with that is when that recommendation seems to be based on fear, or money and not science, evidence by recent studies and updated guidelines.

[Anonymous]

I'm not sure why insurance companies don't get more aggressive about unnecessary testing. It'd seem in their best financial interest if docs didn't call for excessive testing.

From what I understand about medical billing, the doc can determine a diagnosis code, and based on that diagnosis code, there are a bunch of procedure codes that are supported and allowed. So, if the doc suspects a diagnosis, he can get paid for any of the tests that he's allowed to do.

In the case of Urgent Care centers or ERs, they have all this equipment and staff there on hand anyway, it benefits them to do x-rays, CT scans, etc. as much as possible. And, as long as insurance is willing to pay for it, there is no reason not to. Even if it's not in the best interest of the patient. It's definitely in the best interest of the center.

[Anonymous]

http://health.yahoo.net/news/s/ap/new-effort-by-mds-to-cut-wasteful-medical-spending


An article about how doctor's are trying to cut wasteful medical spending.

[Anonymous]

Anonymous wrote:PP, thank you for posting that. They recommend every 3 years for women age 21-65. I've been to several different OBs over the past few years and they all insist on yearly paps.

I wonder why there is a disconnect. It can't just be about money. How much money can OBs possibly be making on a pap smear?

I will definitely save that link and use it the next time they want to scrape away at my cervix.

It is not a disconnect. They know, but for young women who are having sex with multiple partners it can be tricky. Twenty years ago the fear was normal pap today then new boyfriend then abnormal pap in three months. (or boyfriend has another girlfriend). So some said every 6 months for sexually active young women. There are still nightmare cases of metastatic cervical cancer. The death rate has come down because of the pap smear. The question is, who is going to do it first. One big suit around here and they will run back to screening every year. Speak to the lawyers and ask them how much we should screen.