| Lifelong Health: Resolve to Learn More About Medical Testing With the arrival of the new year, many of us will have put health at the top of our resolutions list. But this year, look beyond just fitness and nutrition and think about your relationship with medicine. How can you use your physician to prevent and detect disease? Believe it or not, that isn't a simple question.
For baby boomers, it's time to be more active and empowered about your regular medical checkups. Unfortunately, with the decrease in reimbursements, the demands of seeing too many patients and the need to maximize revenue streams, the annual physical is becoming shorter, more rushed and less likely to be an educational experience.
Today, the annual physical involves blood tests, perhaps a cursory examination by a nurse and -- if you're lucky -- a session with the doctor explaining the results. If any abnormalities arise, referral to a specialist is all too quick. This approach is particularly prevalent in 50 clinics where the primary care physician refers to expert colleagues within the clinic to deal with identified problems.
In the worst cases, these clinics generate revenue from tests run within their facility, including blood tests, X-rays, imaging studies and other highly sophisticated investigative procedures. The examination becomes a production line to detect problems.
When it comes to early detection of disease, it is vitally important that patients understand the complex relationship between tests and reimbursements, risk and benefit. As long as physicians are paid for the number of procedures and tests performed, the care received will never be sufficiently low cost or based on sound scientific evidence of benefit.
Tests costing as little as $10, when done too frequently, can become a huge burden on our health care system. Hundreds of millions of these "cheap" tests are done daily. Simply cutting out unnecessary blood work and lab tests could save billions of dollars.
Cost is not the only reason to limit tests. X-rays and CT scans provide additive irradiation risks that have been shown to increase incidence of cancer. And a routine blood test can often find an insignificant abnormality, which leads to further tests, imaging studies and, on occasion, biopsies or even surgeries.
An empowered patient should understand what is involved in the annual physical examination, which tests are recommended to screen for disease and which tests are likely unnecessary. Although medicine is a science and an art -- requiring appropriate tweaks and treatment plans for each individual -- there are some good guidelines to follow.
The evidence is compelling that everyone should have their cholesterol and blood sugar measured first at age 20 and every decade thereafter until 50. After 50, repeat measurements may be needed every five years and every few years after 60.
Screening for anemia and other blood cell abnormalities as well as assessment of liver and kidney function in otherwise healthy individuals are of no value unless indicated by a particularly clinical problem. For example, regular evaluation of liver and kidney function is only needed in individuals with high blood pressure, cardiac problems or on medications that could affect the kidney or the liver.
There is an array of other tests that can be done on occasion, such as the C-reactive protein -- when elevated, a marker of inflammation that indicates increased risk of heart attack and stroke.
Everyone should have blood pressure measured annually or even more frequently. Every so often, a combined measurement of pressure in the arm and leg is of value. If the leg value is significantly lower than the arm, you may have peripheral vascular disease. But further testing on your legs is only needed if you are symptomatic. A positive test means that you almost certainly have generalized vascular disease, and aggressive treatment to prevent heart attacks and strokes is warranted.
You must understand the value of each particular test recommended by your physician. Before seeing your physician, visit the website of the Agency for Healthcare Research and Quality (www.ahrq.gov). The site provides information on appropriate approaches to screening and preventing disease as well as guidelines and questions for your physician.
In 2010, resolve not only to eat right and exercise more, but also to be more educated about the tests necessary to prevent and detect illness. By becoming a more empowered consumer of medicine, you will make huge strides in ensuring health and happiness for years to come.
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Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com. Copyright 2010 Creators Syndicate Inc. |
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