Medi-Dopers: How does one know when to go to the doctor?

In My Humble Opinion
1

I’ve been thinking about starting this thread for a while, but recent circumstances have prompted me to do so now. On Friday, I found out that my father has to have open heart surgery ASAP (possibly tomorrow; they’re doing the cardiac cath now). The thing is, my father is 50 years old, in great health, they just happened to find this when doing routine “turning 50” physical stuff - he had a (known) hereditary heart murmur which apparently caused an aneurysm.

So, to my question: is there is system of scheduled maintenance that people are supposed to get? I’m in my mid-twenties, and other than getting the lady parts checked out, I don’t know when I last visited the doctor. I don’t even really have a doctor, as my husband’s GP died a couple months ago and we haven’t chosen a new one. One the one hand, I want to make sure that if I develop cancer, heart problems, etc., I catch them early; on the other hand, I’m a bit scared that once I start going to the doctor for some things, I’ll start going for every last little rash or ache or anything.

TLDR: How do you decide when an ache or pain is no big deal, and when you should make an appointment? And are adults supposed to do regular physicals or checkups or something?

2

Doctors are different by specialty, but I have found (from working in doctors’ offices) that most internal medicine doctors (general practictioners for adults) will do a “complete physical exam” once a year for most generally healthy people. This will include routine blood work, a pap smear and pelvic exam for women, and a rectal exam for men over 50, stool guiacs to check for hidden blood in the stool, a chest x-ray, and an EKG. Hope that helps.

With regards to when to go in for aches and pains, I go by how affected my life is by it. If I can control it with otc pain relievers, I will mostly suck it up until my next scheduled appointment. If it’s causing me to change the way I live, i.e. call in sick to work, then I’ll go in just for that.

3

My GP recommends a yearly physical. She does my pap at that time as well as some routine blood work and a manual breast check since I’m under 40. I try to go every 12 months on the dot, just to make sure my cholesterol, blood pressure, etc. are all good and that nothing has come up wonky in the past year.

This also ensures I have a standing relationship with a doctor I trust, so that if I do get ill getting a quick visit or a referral has been easy. She knows me and my health history and I like having that relationship with a doctor.

I know a lot of other ladies only do the once-yearly gyno visit; is it uncommon for an internist to do your pap? I’ve had this same doctor since I turned 18 and I only had to find an OB/GYN when I got pregnant.

4

No, it’s not uncommon for a GP to do your pap. I think it’s fine, as long as they are using the up-to-date method, such as Thin-Prep. If they are still using the old-fashioned slide method, then I’d be wary.

5

I have a PCP that I see twice a year, an OB/GYN that I see once a year in combination with a mammogram [I have a pair of lumps we are watching] and a cardiologist I see twice a year. Though I just got a call from the GYN oncologist for a 2nd year followup and a dexascan [though Yale-New Haven Hospital, they have my baseline dexascan from several years ago.]

On the plus side, when he did the hysterectomy, he tiptoed through my innards inspecting so I don’t need anything slid up my ass with a camera on it for another couple years. I hit the big 50 this October.

6

I’d suggest going to a primary care doctor (family medicine or internal medicine) to establish care and then once the doc has had a chance to evaluate you he/she will decide when she needs to see you back. If you’re healthy, they probably won’t need to see you again very soon. If you have chronic medical problems, they may want you to check back in a few weeks or months.

There is nothing wrong with making an appointment with your family doctor to ask about a rash or an ache even if it’s nothing serious. If something is bugging you and doesn’t go away on its own within a few days, go ahead and ask the doc about it. We who work in medicine understand that laypeople can’t always tell if something is serious or not, so even if it is a minor thing, the doc isn’t going to be upset you had it checked out.

The perplexing and frustrating thing for those of us who work in medicine is when people wait until they’re on death’s door to come in and get something checked out (older men seem to be huge fans of doing that and it often ends badly for them).

7

And the perplexing and frustrating thing for those of us who don’t work in medicine is that there’s no way to determine the cost of getting something checked out. The physician will often ask for thousands of dollars worth of diagnostic tests, but has no idea what they will cost me.

8

All of the doctors I’ve worked with have been real people, and certainly capable of being understanding and compassionate with regards to patients’ financial situation. Just talk to them about it and see what can be worked out, if it comes up.

9

I’m aware of three models (as a lay observer of others):

  1. Regular examinations (yearly, with more required if the doc finds something.)
  2. You go over every little thing and become the doc’s worst nightmare
  3. You wait until your entire body is literally falling apart, most major organs are shutting down and you can’t move from bed to go to a GP.

Most men in my family 1-2 generations older than me chose the third model.

10

My mother is 70, and a nurse, and never goes to the doctor. Which kind of pisses me off, since I don’t know what I’m at risk for if she doesn’t know what she has. But then, I guess since she’s 70 and still working, she must be fine. ??

11

I think one of the things that’s really bad about the “wait until you are on death’s door” approach is you will often end up having to go straight to an E.R., and statistically speaking going to a hospital is something you want to avoid unless you really need to be there. Tons of people die from infections they get at hospitals, so it’s much better to catch things early at a GP’s office where hopefully you will be less likely to catch something from another patient.

12

In America we’re conditioned not to go to the doctor. Insurance is confusing, so even if you have it, you’re never really sure what will be covered. If it isn’t covered, it can be expensive. But because of all this, we never go nearly enough. The answer to the question “Should I go to the doctor?” is, if you ever think maybe there’s something that possibly could be something worth thinking about asking a doctor about, GO. That’s their job and the more patients they see, the more they get paid. Unless you’re there on a weekly basis, they’ll be happy to see you.

If you don’t have a GP, get one. That way, if something does develop that you need to see someone about, you have someone to call. I didn’t have a GP for a long time, and when I developed Crohn’s disease, I waited around for a couple months because I didn’t know who to talk to about it. Then when it finally got unbearable I went to the emergency room.

That delay probably didn’t change my outcome because of the way that disease develops (although maybe it did). But what if it had been stomach cancer? That would quite likely have been the difference between life and death. Now I have a GP. I get a physical every two years, my insurance pays for it (and under the Affordale Cara Act/health reform law, new insurance plans have to provide much of these services for free). But most importantly, when something comes up, I call, I get in within a day or two, and then we can go from there.

–Cliffy

13

You’re asking two different questions.

The first is about routine surveillance and check-ups.

A healthy 20 something woman doesn’t need to see a doctor more than once a year (at most) for a blood pressure check and a chat about contraception, mood, diet and lifestyle and appropriate sexual health check ups and smears.

Once you hit 40, you should think about annual cholesterol, glucose, bowel, and breast/prostate checks as well.

Personally, I don’t feel an annual screening ECG is useful, but I understand SOP in the USA is to have one.

Bloods are optional- ideally should only be done if you have symptoms (tiredness, heavy periods etc) rather than as a screening exercise or fishing expedition, but local policies differ.

Your second question is about when to see a Dr if things aren’t right.
Rule of thumb- if something is affecting your ability to carry out work, leisure activities or simple self care, or is a change from your normal pattern, or going on for more than a few days- see a Dr.

Bleeding from any orifice unless an entirely normal, expected, regular period is not good.
Chest or abdominal pain is not good.
Coughs lasting more than 2 weeks are not good.
Rashes that don’t go away with simple creams from a pharmacy aren’t good.
Unintended weight loss or unexplained weight gain is not good.
Altered bowel habit persisting more than a week or two is not good.
Headaches that don’t quickly settle with simple analgesia aren’t good.
Funny turns of any description aren’t good.
Mood disturbances aren’t good.
Urinary problems aren’t good.
Joint swelling is not good.

Any of the above are perfectly acceptable reasons to see a doctor.

Reasons not to see a Dr (sadly, from personal experience with various patients):

You couldn’t sleep last night
Dental problems (see a dentist)
You had a mild headache 3 weeks ago and wonder what it might have been
You have a really bad hangover
You can’t reach your toenails and wonder if a doctor could cut them for you (chiropodist, please).
Your friend was recently diagnosed with an extremely rare illness and you want more information about it (Google, no?)
You’d quite like to bitch about your wife, but can’t be bothered paying for marriage counselling, and think the Dr wouldn’t mind listening instead.

14

One reason to see your Dr, somewhat regularly, especially as you get older, is that should you have any kind of incident, that lands you the ER, they have a baseline to go from. That saves a lot of guessing and testing when trying to arrive at a diagnosis. It helps them to know what’s ‘normal’ for you. That’s how my Dr explained it to me, anyway.

My Dr wasn’t that picky about me having regular physicals, when I was younger. She saw me pretty regular for flu, or rashes, or travel shots, and had a chance to check the basics. Same with my hubby.

But as we get older she is more insistent about the regular physicals.

Of course, I’m in Canada, where most everyone, is covered for most everything, and there are no confusing forms etc. We save a lot of money from people seeking immediate care, for their issues, instead of waiting till it’s much worse, and way more expensive to treat.

15

Thank you, everyone, for your help and advice. I agree with Cliffy that there is so much extra “stuff” around going to the doctor: I worry about how much it’s going to cost (I do have insurance, but it’s hard to know what exactly will be covered or how much of it will be covered), I worry that I’m just being a wuss or a hypochondriac, I worry that it’s going to turn out that I have exploding organ disease or something.

Irishgirl, that “when things aren’t right” list was particularly helpful; part of my concern about when to go to the doctor is that I’m not really sure what’s normal and what’s not. In the past year, I’ve known two women in their early forties who had a persistent cough for around a year, and by the time they finally got it checked out, whatever was going on had weakened them to the point that in each case the woman died in the hospital after undergoing testing. That kind of thing, coupled with my father’s pending heart surgery, has really opened my eyes - I doubt I would think to go to the doctor for “just a cough”, so it’s good to know when things are not normal.

16

I see my MD once a year. Every second year it’s for a complete physical with bloodwork, etc, the other year it’s just a quick check-up.

If you have insurance, a physical should be covered with a small co-payment. Call your insurance company and see, they may even have a MD to suggest. Insurance co- in general-* like* you going in for a check-up.

17

As DrD says, you can always call your insurance co and ask what’s covered. Physicals usually are, at least every two years, and even if not, it’s probably less than $150 if you have to pay out of pocket.

–Cliffy

18

A cough that lasts for a year is not “just a cough.” It’s one of the 7 warning signs of cancer. Especially if you don’t have any ready explanation for the cough, such as smoking or allergy-related post-nasal drip. (I keep a cough about 3 months of the year due to the second, and I don’t bother going in for it because all they can do is tell me to keep taking my allergy meds and come back if the cough changes character in any way. Coughing for any significant length of time outside that window, however, gets a trip in.)

19

Hypothetical:

Otherwise healthy 15 year old male passes out a few seconds after standing after having been seated for the past 1.5 hours with his feet up. He came to in about 5 seconds (max) and had no other symptoms at all after coming to. Stood up without any other dizziness. There were two other “dizzy” spells in the past 18 months, but never lost consciousness.

Do you take them to the doctor for that or no?

(yes, I did take him in to be checked out. Dr. says it was just that he tends to have low blood pressure so nothing to worry about. I’m just wondering if taking him in was really the right thing to do.)

20

It’s not a hypothetical, if it really happened. And hell, yes, I would take my son to the doctor to check it out- dizziness and fainting can signal some serious heart problems. It doesn’t hurt to get it checked out, so why wouldn’t someone?