Do you know what they call decision-making in the absence of data? A guess. Humans have very few idiot lights and gauges on their exterior. You sorta need to poke in there to know what’s going on in there. Whether poking with fingers, needles, ultrasound, or X-rays. Don’t ask, don’t know.
IIRC one of the best predictors for increased likelihood of a heart attack is … having had one already. Another predictor is being past the “spring chicken” stage of life.
So if you walk into an expert with two strikes against you and ask them (implicitly or explicitly) “Do I have a problem?” They might be reluctant to go on guesswork.
To be sure, you made a great point here:
Gathering data solely to satisfy curiosity is dumb. Gathering data is only useful if the resulting knowledge has some hope of weighing on an actionable decision.
But if your POV is you will refuse any / all surgery regardless of diagnosis or prognosis, that might be good info to share with the doc before they arrange a battery of testing.
More likely there is something of an excluded middle in there that I (and perhaps you) are unaware of. Which middle might be a reasonable tradeoff of risk / reward. Don’t ask, don’t know.
Most of the time, I don’t go to the doctor because I don’t want to spend hundreds of dollars to be told the solution to all my problems whether a sore knee, stage 3 stomach cancer, leprosy or anorexia is:
Eat less and exercise more.
Hubs refused to get Covid jabs. He got OG and was really sick for a couple of weeks and got better after about three and a half weeks. I got tired of him fucking with his health because I fucking love him goddamnit.
Once he recovered he said he didn’t need to get jabbed because he was immune forever. I paid 2500 bucks for a kitten.
He got Delta and I put down a deposit on another expensive kitten. He got jabbed and I lost a 500 dollar deposit.
We have saved and planned for retirement for over 35 years, I am sick of him not caring about his health because doctors are all quacks who are only in it for the money. I want his stupid ass around for another couple of decades.
@teelabrown your hubs is the only one who can make himself deal with his alcohol problem and I agree that you need to take care of yourself first and foremost. He’s not going to stop drinking until he wants too, so maybe wine, brandy and mead might be better when it comes to his gout.
My wife has more-or-less been failed by doctors for over 20 years. Shoulder impingement (both shoulders at different times), carpal tunnel, rheumatoid arthritis, pinched nerves, constant burning pain from her feet up outside of both legs into her back (neuropathy?), and a few other fun things. What stuns me (and if I hadn’t been by her side for all of it, I’d say she must be faking) is that nothing that has been tried has ever worked.
TENS unit. Alpha waves. Acupuncture. Physical therapy. Every possible medicine that multiple doctors in 4 different areas could try: none of them worked. Either did nothing, or made the pain worse, or the side effects were immediate and too severe to bear. We were always clear that we would refuse opiods, but doctors tell us it’s the wrong kind of drug anyway. Every doctor eventually told us something very similar to ‘There’s nothing else I can do for you.’ After almost a year, and half-a-dozen different meds, a pain specialist finally suggested CBD oils or wine (neither of which helped, of course).
I’ve severely abbreviated the journey, but I still boggle that nothing, not ONE treatment, has ever done anything for her. Her body has refused to cooperate with any of it, which frustrates us to no end. Trying to get her to do anything medical these days takes weeks of wheedling. I can’t blame her; what’s the point, when it’s likely to be a waste of time?
To the extent I can, I’ll give the opposite side of this. I was the one who wouldn’t go to a doctor.
I’m a 54yr old white male. Overweight, vaper (very low nicotine though - previous smoker and vape is how I gave it up, but dropping all nicotine is tough), and I drink more than is recommended. I have a family history of diabetes, severe polyps, cancer, and heart issues. Dad had the polyps and heart issues (6 inches of his colon removed and stints put in for his heart). Mom has diabetes and is a two time breast cancer survivor. Dad now also has myelodysplastic syndrome (a precursor to leukemia).
I didn’t go to a doctor for 14 years. My last visit was around 40. They detected blood in my urine. 4 tests later including putting a probe up a hole that isn’t supposed to have things go UP and they shrugged their shoulders - couldn’t figure it out.
When COVID hit, I got all the shots. When we were getting the 1st booster, my wife looked at me and said “You obviously believe in the science. I love you and the kids (16F, 15M) love you and we want you to be around. If I book you an appointment with my primary care, will you go?” She literally had tears in her eyes as she said it. That was in December of last year. I went in February. Since then, I’ve been back three times, am on HBP meds (lisinopril), have had a stress test, and a colonoscopy - where they found 3 large pre-cancerous polyps that they caught in time.
And you know what, they found a little blood in my urine. I explained the history and their response was “okay, we won’t worry about that for now unless it gets worse”.
Long story short (too late, I know) - get your ass to a doctor. Don’t wait until you get sick because it may be too late. It would have been for me on two fronts - the polyps and the fact that my BP was 184/105 the first time they checked it. But the colonoscopy got the first one and the pills are keeping the BP under control and my blood work is improving through some very minor changes in diet and exercise (it’s a great reason to tell your wife you’re playing golf this weekend - that counts as ‘activity’). They aren’t out to get you and if you don’t like your doctor/nurse, then switch to one you do like - don’t use that as an excuse.
My dad was a diabetic and an alcoholic. Never went to the doctor, for unspecified reasons, but I’m sure it was because he didn’t want to be told to quit drinking and watch his diet. He died at 61. Great plan, dad!
If enough people go for preventative maintenance, some percentage of them will have tests done that discover “problems” that look bad on paper, but don’t actually need to be treated, at least not yet. And of the ones that choose treatment, some percentage will suffer side-effects of the treatment that will actually be worse than what’s being treated.
The annual physical exam is beloved by many people and their doctors. But studies show that the actual exam isn’t very helpful in discovering problems and may lead to unnecessary tests.
Leading doctors and medical groups have called the annual physical exam “not necessary” in generally healthy people.
Keep trying. I’ve succeeded in finding doctors who either don’t do this to start with, or who can be shut down on the subject quite quickly and will address other factors. And they do seem to believe me when I tell them what sort of thing I’m actually eating (which includes exactly zero doritos and McD’s, and almost zero soda pop, which often seems to also come up; though I will admit to the occasional bit of other junk food, but not much of it).
I think at least some doctors have been seeing some of the research about the failures of weight loss diets, and are becoming more willing to hear that I’ve been there, done that, ain’t doing any more of that. Whether they’ll listen to people who are refusing to get on that upward-spiraling merry-go-round in the first place, I don’t know.
As far as do-I-really-need-to-go-for-that-test: I’m really glad I finally decided to listen to the doctor who kept telling me ‘I’m hearing a heart murmur’ when she said 'I’m really hearing a heart murmur, I want you to get an echocardiogram." Which led to a whole lot of other tests, and eventually a cardiac ablation, and requirements or at least strong recommendations for additional occasional tests going forward – but I can breathe now. Which I strongly suspect that I either wouldn’t be doing by now or would cease doing shortly if I’d kept saying “doctors have been hearing a heart murmur on and off in me ever since I was a child, I’m not going to worry about it.”
Turns out I’ve had a heart condition all of my life. It just took a long time to start producing additional symptoms.
I agree, however, that it’s always useful to ask about a test, ‘what are we going to do differently based on the results?’ If the answer is ‘nothing’, or ‘nothing that I’m willing to do’, then declining the test is entirely reasonable.
I’ll also admit to refusing further mammograms because I got three false positives out of the last five results; each of which led to a lot of further hassle, extra radiation exposure, and in one case a painful biopsy. It may be a useful test on some people, but it isn’t a useful test on me.
(Threatening to buy a kitten would have the reverse effect on me. I’d be, yay kitten! – but I’m already thoroughly inoculated.)
That I think is pretty common. They do have to check, the first time, and if it gets worse; but some people just sometimes have a bit of blood in their urine without its indicating any problem.
Some sorts of out-of-normal range blood test results are also like that: some people just normally run high or low in that particular indicator. It’s a really good idea to check for what might plausibly be causing it, but once that’s done, if nothing’s found, that might just be the way that person is. Others, of course, indicate a need for further treatment.
There are different types of Holter monitors, and the one my doctor likes is particularly evil because in addition to recording heart rate, it also measures blood pressure. It does this by inflating a cuff every 30 minutes. Fortunately it’s smart enough to cut down the frequency of measurements late at night so the victim at least has a chance to get to sleep, maybe. Anyway when all the ECG electrodes and the cuff is installed, I look like a goddam robot. I didn’t find it quite as bothersome at night as I expected, but I sure was glad to get rid of it. And now they’re supposed to call me to set up an appointment to get it installed so I get to do it all over again. My only escape at this point is to not answer the phone.
I think that would raise my blood pressure. ETA: I did have to wear a Holter at one point, but it wasn’t like that. And I was able to talk them into letting me mail it back, instead of making an additional four-hour round trip to return it in person. – later they did have me wear a different type, which didn’t take blood pressure but had to be worn for a lot longer and needed to be either stuck on your chest or attached by sticking on leads if you reacted to having it stuck on your chest. I switched to the leads after I developed a bright red horribly itchy area under the monitor. Then eventually I called them and pointed out that sticking the leads to me did the same thing, and I was running out of new non-inflamed spots to stick the leads to; and they said OK, that’ll have to be long enough, you can send it back in now.
That seems fairly obvious if you’ve actually had a physical. I’d guess (IANAMD) that 90% of the useful diagnostic information is in the bloodwork, not the actual exam. The other 10% is things like BP checks, prostate exams, and generally looking at the patient.
But it’s a way to get people in to see and talk to their doctor at least once a year. Many years that’s the only time I’ve gone to the doctor, not having been sick enough to feel like I needed to be there. And I also suspect that just by talking to the patient, doctors can get an idea of what’s going on, at least enough to see if they need to come in for a follow up about something they mention, or that the doctor observes watching the patient.
For a lot of patients, that once a year might actually catch an early case of hypertension before it becomes a problem. Or it might catch diabetes early before there’s a bigger issue. And so on.
Which means every year that you go in and by luck nothing bad was happening inside you, the visit was, strictly speaking, a waste. But you can’t know that until after.
Kinda like paying for fire or life insurance. The only premium you really NEED to pay is the month the house burns down or you drop dead. The rest of your payments are wasted. The hard trick is knowing which is which.
There are very few significant medical problems improved by ignoring them for multiple years. Maybe none at all.
Yes, because of this and other iatrogenic illnesses/problems, there is a nonzero chance that going to the doctor will leave a person worse off than if they hadn’t gone. Though that doesn’t mean that the risks of going to a doctor outweigh the risks of not going.
That’s me … when I sneeze it’s a full-body event, and a loud one, too. And it’s never just one, which if why someone says “God Bless You” after the first one, I tell them to wait until I’m finished. I think my record “string” was twenty- two, and I was exhausting. It’s usually not that many, though….I had a sneeze fit this morning and it stopped after five.
To all serial sneezers, I am one, too. A dozen in a row would not be out of the ordinary for me. And I’m quite expressive with them – I don’t hold back! Fortunately, it doesn’t happen often, but when it does, look out!
True, but “ignoring medical problems” is not an accurate description of us who (depending on your POV) are either “suffering from” or “blessed with” medicaphobia. In my view, at least, it comes down to a matter of making informed decisions about which diagnostic tortures or medical risks one is willing to put oneself through, assessed against actionable options.
To cite one example, I was a patient advocate for my elderly mother who lived to a very old age, and has since passed on – peacefully, and on her own terms. At one point when she was in hospital, well into her 90s, she had symptoms that indicated the possibility of gastrointestinal cancer, and they wanted to subject her to a screening process that involved drinking about a gallon of barium crap and other horrible prerequisites. I asked the attending physician what they would do if the test was positive. What were the intervention options? He acknowledged that there was not much they could do.
In short, they were robotically following a medical playbook without considering the tradeoffs in context. So as her patient advocate, I told them no, there would be no screening. No one even tried to argue. And in fact, when she finally passed on, it has nothing to do with that.
I had a similar experience for myself when I was hospitalized for chest pains that turned out (to my complete surprise) to have actually been a mild heart attack. I was taken to what’s called a catheter lab for diagnosis and possible treatment, and was returned to my room with the verdict that I was not a good candidate for stenting (a fairly non-intrusive procedure) and would be best served by coronary artery bypass grafting, commonly known as bypass surgery which is full open-heart surgery with all its attendant risks.
I whined to high heaven and my attending cardiologist convened a group of doctors to assess the situation, and they agreed that stenting was viable after all.
Now, if I had gone along with the original bypass surgery, I would arguably have been better off in the long run, maybe. Or I might be dead. Or, guaranteed, I would have had a long and miserable recovery. I’m absolutely convinced that the choice that I sort of forced the doctors to make was the best one for me, even if it didn’t follow the script of the official medical playbook.
This strikes me as the same sort of study/conclusion as the “flossing isn’t necessary” news a whlie ago. Maybe, but maybe not. At any rate, if annual physicals are too frequent, what’s the right interval?