Perhaps also the tiniest bit condescending.
I’m not clear what it is you are urging a patient with zero medical training to do. Ask the doctor to justify every blood test and every specialist referral, without any background knowledge with which to evaluate what they say? Maybe I should quote some guy on the internet who said that many doctors are guilty of base rate fallacy when evaluating test results.
Not really the place for it, is it?
If it comes off that way then I am truly sorry.
In this case I have been very clear - you have a trusted provider who has actually examined you and who knows your specific story, keep the appointment.
IMHO is not the place? It really is just agreeing with your hot take, as a very general principle.
In this case the odds of it being a deep rabbit hole are low. It is a significant bulk of rheumatologist referrals and they will no doubt have a very nice patter to use. They are unlikely to require much more testing.
Your cynical old bastard side is justified. It wouldn’t be unreasonable to ask your orthopedist if the referral is really needed given your lack of any history or exam findings consistent with ankylosing spondylitis, or your internist if you have one you like.
This being the appropriate venue for my rant? Yes very much so.
Doctors hearing just as much patients asking if a test or referral is actually needed or worth it as much as they hear patients demanding more tests and more referrals would be a good thing. I LOVE when parents ask me if the medicine I am prescribing is really necessary or if watchful waiting is an option. That they read about the harms of too frequent antibiotic use. Much better than the parents upset that I am advising watchful waiting … And love when asked if the CXR is really needed.
No, this thread is not the place, in my opinion. Such a large topic warrants its own thread – it threatens to overwhelm this one.
My misunderstanding then.
It seemed to me that the context of what drives excessive test ordering, why even tests with good specificity are often false positives with low priors, the actual data justifying your “cynical” hot take, and how endemic of a problem the behavior pattern is, driven by both physicians and patient expectations (real and perceived), was relevant to the subject. It is IMHO why you very much should share with your doctor up front that you do not want to go down rabbit holes without very good cause.
But you are the OP!
Well, continuing @DSeid 's theme, but focusing on you: you should be aware upfront that approximately 100% of older people have disk abnormalities in their spine. Many have no functional problems or pain. And some people with pain don’t have any abnormalities that show up in scans. If you end up getting a scan of your spine, don’t get too excited about a bulging disk, or whatever.
Personally, I’ve had my ANA tested a few times, starting when i was a teenager, and it’s always been positive. But i don’t have any symptoms of autoimmune disease worth treating, so I’ve ignored that. I’m not sure why it was ordered, honestly. I think you are right to bee conservative regarding treating things that aren’t bothering you. (Except early signs of aggressive cancers and major infections. But that’s not what you are describing.) See the doctor. But don’t stress over it, and don’t sign up for a ton of treatment without a good reason to.