Thursday, November 20, 2014

$185 Worth of Medical Advice

     I had my annual physical the other day. I decided to go to my primary care physician (which my medical group told me would cost $185) rather than a physician's assistant (which would have been free of charge), for two reasons. I went to this doctor last year for the first time, and there were a few little issues that came up, and so I wanted to follow up on them with the same doctor. The other reason? Well, to be blunt, I figured a doctor would know more medicine, and give me a more authoritative checkup.

     The long and short of it is ... I'm fine. I have no idea if the doctor gave me any better service than a PA would have done. Still, I like the idea of developing a relationship with my doctor, however slight, so he knows my body and my history, and therefore is more likely to sense if and when something is "off." I had that kind of relationship with my old doctor, who I'd been seeing for about 20 years. Unfortunately -- and tragically -- my old doctor, who was the same age as me, got an aggressive form of cancer a little less than two years ago and he died within six months.

     So last year I found a new doctor in the same medical group. He's in his early 40s, and looks very young to me, but I have to believe he knows what he's doing.

     Anyway, I'll pass on a couple of insights from my visit (at no charge!). First, I went in looking for a shingles shot. My sister has been pushing this on me for a while. She got the shingles vaccine a couple of years ago. "You know, Dad got shingles before he died," she reminded me. "So I got a shingles shot, and you should get one too." (In case you're wondering, she's my older sister, and so has no reservations about trying to boss me around.)

     But instead, I came out of the doctor's office with a shot for pneumonia. My doctor said I could get the shingles shot, and yes, he did recommend it for people my age. But his enthusiasm for the shingles shot seemed somewhat measured, while he thought the pneumonia shot was more of a must-have. Honestly, he thought my risk profile for either disease is very low. Nevertheless, he said, if you get shingles, it can be painful. But pneumonia can kill you.

     I could have had both vaccines at the same time. But I decided to get the pneumonia shot now (it's a one-time vaccination); and do the shingles shot next year.

     The other thing he told me is that the scholarly literature has suggested that annual physicals do not, in the aggregate, extend our life expectancy. There are two theories. The annual physical approach is based on early detection. The doctor catches something early, and therefore is more likely to be able to cure it, or at least manage it. The problem is that there are many false positives, resulting in a lot of unnecessary medical tests and treatments, which (again in the aggregate) can often cause more harm than good.

     The other theory says you wait until something goes wrong. Then medicine runs it down, and in most cases is able to treat it successfully.

     All that may be true. But here's my story. I had my first colonoscopy at age 51, and the doctor found a precancerous polyp. He removed it, and I went on with my life. If it hadn't been detected, and was left to develop into cancer, I'd probably be dead by now. So I am firmly in the camp of early detection.
     The other advice the doctor had for me? He said that all we know about improving and extending our lives can essentially be boiled down to one paragraph. Eat a good diet with plenty of fluids, fruits and vegetables, and get a decent amount of exercise on a regular basis.

     And so with that ... I'm heading to the gym.


Anonymous said...

A comment about PAs and NPs (nurse practitioners).

I had the privilege of working with and supervising two of each when I worked at a major military hospital.

Fabulous would be an understatement of the quality of care they delivered. In general, they have more time to spend with you than your PCP. More importantly, IMHO, they are clearly in touch with their limitations...something that escapes most MDs.

Yes, my PCP is a physician because my former PCP retired. I will be going to his NP in the future.

As always, YMMV.


Stephen Hayes said...

My doctor insisted I get a shingles shot, and a flu shot. My arm is still sore.

Olga Hebert said...

I got the shingles shot two years ago--know two people who have had it this past summer and it does not seem like much fun. Also fot the pneumonia shot last year. I go for the annual visits-doctor, eye doctor, mammogram mostly for peace of mind I guess. I would add to your doctor's list regular trips to the dentist though. I personally believe that oral hygiene is as important as diet and exercise. ( I am not a medical professional, of course, but I have watched them on TV)

Meryl Baer said...

My doctor gave me the same advice about shots - I got the pneumonia shot, and he was neutral on the shingles shot. I will probably get it next time - I hear too much about people's pain with shingles...There is definitely some mathematical formula calculating age, doctor's visits and the number of doctors visited. Some kind of geometrical increase, I think.

Tabor said...

When I went in for my flu shot they said I would also might need to get a pneumonia and a shingles shot...they said that they would call me after my doctor got back from vacation...that was over a month ago!!

Anonymous said...

I am in my late 50's, and have been going for an annual check up since I was about 40. I have lived in my current town for 26years and have had 4 different internists. One moved, one is retiring, and one I just did not like! It seems to me that as the years have passed, the physical exam has become less and less physical! My current doctor does not even gown me! He used to give annual EKG, but no longer. I am sure it is an insurance issue. No urine test. Nothing. Just listens to me breath, checks blood pressure, talks and asks about any complaints, etc. and gives me script for bloodwork. When I had it done and it came back high for cholesterol (no surprise, it has been borderline high for 5 years), his nurse called and suggested statins. When I told her I wanted to talk to a cardiologist,they did suggest a lipid clinic here in town. Going in a feds weeks. But I guess my point is, my internist does less and less. Almost feel as if I don't need one, and should just deal with the specialists! My gynecologist is more hands on!!!!

Hattie said...

My husband had a pre-malignant polyp removed at age 60.This probably saved his life. His father died of cancer of the rectum at age 62. Colonoscopies are unpleasant but so worthwhile,especially if you have a history of colon cancer in your family. It's a very common cancer in both men and women.

Linda Myers said...

I have an annual physical to check in - even more important than usual because my old doc retired and I wanted to meet the new one before we leave for four months in Arizona - we can do most of our talking on email.

Blood work always comes back normal. Aches and pains are "normal for your age".

I still get a little anxious from time to time.I'm what known as a "worried well."

Kathy @ SMART Living said...

Hi Tom! good for you for taking your health into your own hands and reminding others to do the same. My sister just had colon cancer surgery because she didn't have a colonoscopy until forced to by a bad blood test that revealed something was wrong. She is only 62. Hopefully she caught it in time to live on but it could all have been avoided by having a colonoscopy at at 50 as recommended. I don't think we need check ups every single year but I do believe that some should not be avoided. Eating right and exercising is good, but sometime prevention is a trip to the doctor too. ~Kathy

Anonymous said...

Two or three thoughts...

1/ I have had physicals for over 40 years and know some things are better because I did.

2/ My doctor doesn't necessarily know more than I do about my body. He does ask me what I am reading and he remembers I have parrots.

3/ Yes a PA can do quite well, but sometimes its good to see the doctor.

4/ My doc always tells me to lose weight followed up by his recipe for cabbage soup. So far, I have lost 41 pounds. Some day I am going to have him look at me and tell me I need to gain weight. Cant wait!!

DJan said...

i had the shingles shot and the pneumonia shot a few years back (I'm in my early seventies now) and have a flu shot every year. I see my doctor once a year, get the blood work on line, and hope everything will be okay. My doctor is good, but since I'm pretty healthy, he doesn't find anything wrong. We all know we will die someday and nobody can predict what will go wrong first. You're doing all the right things, Tom. Good for you. :-)

Juhli said...

As I recall the pneumonia vaccine lasts for 5 years so you will probably need it again (or at least that was the limitation last time I got one). Both my parents suffered shingles and I have absolutely no desire to go through that. I got my shingles shot the day after I was old enough. It is not a guarantee you won't get shingles but if on the less likely chance you do then it is supposed to reduce the severity of the pain. That is all good IMO. By the way, if you want it sooner than a year from now that PA or a nurse can probably administer it. My insurance covered it 100% so yours might too.

Bob Lowry said...

A colonoscopy last week (last one 10 years ago) found two tiny polyps. Like you, Tom, out they came. My youngest brother just went through a terrible experience with colon cancer so I am now extra vigilant.

I had never been told much about a shingles or pneumonia shot - sounds like I'd better ask during my next visit.

June said...

I have a PCP, but I have never spoken to him. I have seem him at the clinic, and I've heard a lot about him. Based on that information, I'm glad to have always seen his PA. The PAs around here seem to be more thorough and more knowledgeable, not to mention way more fun, than that PCP!

Karen D. Austin said...

Thanks for raising awareness about preventative medicine and early detection. I just had my first colonoscopy this year at 52. I have an uncle who had a significant portion o his colon removed due to cancer. I was glad to learn that things looked good this time. I'm glad things are going well for you.

Anonymous said...

my husband had shingles in his 50s on his back. the pain radiated around to his chest and they thought he was having a massive heart attack . dr sent him home with cream and pain was so bad we went back to the hospital in a few hours. next dr said he should have been given pain meds. 3 years ago my dr said to get shingles and pneumonia shot. got both at same time,no big deal, no pain.
my current NP was an emergency room nurse at one time, and he spends way more time with me and i can get in to see him any time if needed.which i don't, just had artery scan and after being a vegetarian for 20 yrs, at 67 my arteries like a babies. wish i could say the same for my face. I would just go get the shingles shot from the NP before next year.

Anonymous said...

I totally agree with one of the other anonymous commenters when it comes to PAs and NPs. In my 76 years, I've only had one MD who impressed me as much/helped me as much as PAs and NPs have done.

I have a friend who has been suffering with shingles for the past 9 months and it is awful. Having had a case of shingles in my 40s, I got the shingles shot when it first became available. My MD (the great one!) recommended the pneumonia shot and I followed her recommendation.

Now...the MD (Internist) whom I have seen lately recommended that IF I went to buffet-type restaurants, I should get the hepatitis A shots. I plan to do so, but got my flu shot & wanted to wait awhile.
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