Asking for Results

You don’t have to read very many medblogs to discover that there are doctors who prefer giving patients a general “everything looks okay” report, rather than providing a copy of all the specific test results.  Not that there’s a problem with the information, but because without training people don’t know what matters and what’s not worth worrying about.

When patients see values outside the normal range, they get worried. 

Oh, no!  I’m not normal!  I’m abnormal.  There’s something wrong!

This can lead to frantic phone calls to the doctor’s office about things that aren’t medically significant.  Quite honestly, when there are people waiting who are sick and in pain and needing help, it would drive me crazy to instead spend time on the phone reassuring healthy people that they’re okay.  I can understand why it bugs doctors.

There’s another aspect to this, though.  The doctor gets to move on to the next patient, forgetting about anything even slightly unusual until it becomes obvious whether or not there’s a problem.  As a patient, I don’t have that luxury.  I have to live in my skin.  Every day I’m a guinea pig in the better-living-through-pharmaceuticals experiment.

Sometimes patients want their lab reports. Doctors don’t necessarily want to spend their time explaining normal results.  What’s a good compromise?  I hope I’ve found one.  Instead of phoning my doctor to get results, every time blood is drawn I ask the lab to send me a copy of the report.  It doesn’t take any time or resources from the doctor, but I have my information.  Having a copy of my results lets me relax; I’m not waiting, wondering if the doctor’s office will phone to say that something else has gone wrong.

LabTestsOnline is a pretty good reference.  Anyone can look up any test to learn what it measures and what it might mean if results are high or low.  This allows me to be reassured immediately when things are normal, and provides background so that I am better able to understand my doctor’s explanation when they aren’t.

What about phone calls?  My doctor knows what’s too far outside normal to ignore and notifies me if there’s a problem.  I never call for a free explanation over the phone.  If something is concerning enough that I really need an explanation, it’s worth making an appointment to discuss.

***

Guidelines

In the news recently:

  1. Health care is expensive
  2. The government is going to take control of healthcare to keep costs down
  3. Some people will die sooner because treatment might be considered a waste of money
  4. Women should wait an extra ten years before getting screened for the second-most deadly cancer they might ever face

Who planned the timing of this announcement regarding new mammogram guidelines?  The U.S. Preventive Services Task Force could obviously use some help in their PR department!

It is with bemusement that I note all the hoopla surrounding the new mammogram guidelines.

None of my friends and acquaintances look forward to a mammogram.  I certainly don’t!  Nobody waits with eager anticipation until they are again eligible for their next squishing session.  This is something that people postpone and do as infrequently as they can get away with.  I don’t personally know anyone who is upset about the new recommendations.  It’s more of a collective sigh of relief:  Whew!  Now we have a legitimate excuse to not go for that test!

When doctors claim, “studies show…” it insinuates that laymen are too stupid to understand the meaning of raw numbers.  It harks back to the days of paternalistic medicine.  I’d love to see the facts:

# of people in observation groups
# of people not getting mammograms
# of people getting mammograms – broken into two categories:
       -routine screening
       -in response to the discovery of a lump
# of those people who do self-exams
# of those people who do not do self-exams
# of people who found lumps doing self-exams
# of people who missed lumps in spite of doing self-exams…

# of patients whose mammograms led to biopsy
# of biopsies benign
# of biopsies malignant

# of people who had serious complications from benign biopsies (harmed due to mammogram)
# of people with malignant biopsies who were cured – break this out as to how many were discovered and treated due to routine screening vs how many of those biopsies were not because of a routine screening mammogram

Are we talking about one study or twenty?  Is this data on thirty people, or five thousand?  Show me that these studies were done on large groups of women in a variety of locals, and that the data is the same regardless of race.

An approach that presents the raw data can lead people to a logical conclusion.  Instead of being paternalistic, this method clearly states the facts and implies that people are capable of making good decisions (this might not be true – people frequently make bad decisions, but PR is about perception).

It is so much easier to respond to anecdotes when the facts are readily available.  Facts don’t belittle the heart-rending stories that are circulating; showing the raw data would acknowledge that some cancers are identified by routine screening.  However, it would also make clear whether those anecdotes are typical, or if they’re anomalous.  Make it clear – using incontrovertible numbers – whether more people are helped by routine screenings, or harmed.

(fwiw, this approach would be a good idea when presenting the facts about v.a.c.c.i.n.e.s, too)

__________________________________________________________
Happy Thanksgiving
So grateful to have gotten my flu shots
before getting together with family to share germs.
There are always people who show up sick because they wanted so much
not to miss out on the big get-together.
__________________________________________________________

 

 

Consulting Dr. Google

Last week I attended a potluck.  As we were eating, right in the middle of a nice conversation, one guy took a call on his cell phone.  His end of the conversation sounded something like, “What?  That’s all they think it is?  Well, go back in there and tell them you want a CT scan.  No, it’s important.  You need a CT scan.”

I’ve heard of this phenomenon, but this was the first time I’d seen it.  I shook my head in disbelief and said, “No.  Do not tell doctors what tests to order.  If you visit them for their expertise, then listen to them.”

I somehow had the idea that it was the alcoholic/welfare-dependent/ER-abusing/psycho dregs of society that were stupid enough to do that.  To hear an employed, seemingly sane person advocate that someone should demand an expensive medical procedure (one that is not without risks) was…  beyond belief.

It turns out that this guy decided, based on something he read on the internet, that a CT scan was appropriate for his friend.  The internet is a great resource.  There’s a lot of good information available.  There’s a lot of garbage out there, too.  Consulting with Dr. Google can provide just enough information to be dangerous.

The key is to filter out the junk.  It doesn’t make much sense to use a general search engine for reliable medical information.  Whether you like google, dogpile, askjeeves, or something else for general inquiries, doesn’t it makes sense to go straight to medical resources for medical information?  I used to use WebMD, but a doctor pointed out some errors there, so I’ve gone elsewhere.  Family Doctor, Mayo Clinic, Johns Hopkins, and Up to Date are all reliable resources.  Some doctors have started posting short, educational videos on YouTube.

Doctor D’s latest post addresses this very phenomenon.  Apparently people read things on the internet, then see their doctors and demand unneeded tests.  Insurance companies don’t like paying for all those tests, so they raise your premium to make up the difference.  People pay a higher premium, plus their portion of the fee for the unnecessary tests.  Everyone’s health costs go up when this happens.  Go visit Doctor D’s blog and click on the video he shared.

His closing question asks,

So what do you think? Does being an educated, web-savvy patient make you
cost the system more? Do you think reading Medblogs make your
healthcare cost more or less?

I tried to post a short response over there, but blogger kept eating my comments.  Four tries yesterday and one today.  The screen flashes, and my comment disappears.  I’ll just respond here.

I doubt that I count as web-savvy, but my vote is less.  Definitely less.

One example:  my PCP listed a few possible diagnoses and said that I could get an x-ray to find out which it was.  Based on what I’ve read on medblogs, I was able to ask, “What would be the difference in how this is treated?”  None at all.  My goal is not a specific label; my goal is to heal.  If the only thing that will help is giving it more time, then x-rays really aren’t necessary.  Test avoided, money saved.

I’ve learned a ton from medblogs.   Maybe someday I’ll make a list.  Getting the perspective of doctors is incredibly helpful. 

If people are demanding tests that they don’t need, then they don’t really count as educated patients.  More like half-educated.  Obviously they didn’t get enough information from Dr. Google.  Medblogs can help fill in the missing information.