Guest guest Posted December 19, 2008 Report Share Posted December 19, 2008 This is a great example of idiocy. I saw a new couple yesterday, they wanted flu vaccine and pertussis vaccine as their daughter’s pediatrician recommended it, she is 5 months. SO I do the complete physical, history, etc. Go over recommending health maintenance; it was a really quiet day so take probably 2-1/2 hours with the 2 of them and playing with the kids a little. Give the shots. All is fine. Husband had mentioned that he had left some paper at home that gave all the recommended health exams for a man his age (41). I advised them what they were, etc. Wife was second and she asked if husband got EKG as this was recommended on a flyer they got from the health insurance company (Horizon BCBS of all plans). I advised that screening EKGs are really never recommended and particularly not on anyone with no risks for heart disease. She promised to fax me the flyer, well I am in shock! I can’t believe they are willing to pay for all for this. They say these recommendations come from the Men’s Health Network. Testicular self-exam Monthly (no ages) Blood Pressure Annually Rectal Exam Annually (again no ages) Physical exam Ages 20-39 q 3 years (yet they need annual rectal exams) Ages 40-49 q 2 years Ages 50 and older - Annually Blood tests and urinalysis Ages 20-39 q 3 years (screening for cholesterol, Ages 40-49 q 2 years DM, kidney or thyroid and Ages 50 and older - Annually other problems) EKG Baseline at age 30 Ages 40-49 q4y Ages 50 and older q3y Testosterone screening Ages 40 and older – discuss with your physician Chest x-ray Annually if a smoker and over age 45 Hemoccult Age 40 and older – Annually PSA Age 50 and older – Annually, earlier for African- Americans and those with a Fam Hx or Prostate CA Colorectal flexible scope Age 50 and older – every 3-4 years Screening TB skin test Every 5 years Tetanus booster Every 10 years Bone mineral density Age 60 and older – discuss with your physician (gee thanks) Sexually transmitted Sexually active adults at risk should talk to their physician Source: Checkup and Screening Guidelines, For Men and Women:Get it Checked! Men’s Health Network, www.menshealthnetwork.org; www. Nwhealth.edu/healthy/UfindBalance/mhealth.html And we do unnecessary testing? From: [mailto: ] On Behalf Of Wayne Coghill Sent: Thursday, December 18, 2008 2:17 PM To: Subject: Re: Re: Evidence-based Care I am curious as to how they determined that the screening cbc or cmp or rpr or hepatitis tests are unnecessary just because a perosn is asymptomatic. We've had asymptomatic chronic hep b patients come in and, since they were apparently told it was nothing to be done or to worry about (yes! they at least told us that they were told this) they didn't mention it. We found out from the blood test. They hadn't even told their sex partner! We've also had cases of syphills. We get elevated liver enzymes quite frequently. And we had one apparently young healthy female who just mentioned in passing that she had fainted while washing clothes in her dorm 3 months prior. Otherwise she felt fine. She later went to an ER where they did an EKG but didnt draw blood. Well we did, and received a call from the lab. She was dangerously anemic. Luckily, we were able to contact her and get her to an ER. Lucky she didn't faint while crossing the street or driving. Amazingly, even though we are in NYC we have yet to have an HIV screening come back positive (I'm now crossing my fingers and knocking on my wooden desk.) To: Sent: Wednesday, December 17, 2008 11:53:56 AM Subject: Re: Evidence-based Care So maybe my post wasn't food for thought - perhaps fuel for fire. Your experience in not seeing unnecessary tests and treatments doesn't line-up with national data. The variance and waste in care in this country is dramatic and well- documented - and primary care shares some blame. I dislike them as much as you - I think - but they have data based upon large pools of doctors and patients - we have anecdote. My friend was willing to place a lot of responsibility for the undervaluation of primary care at the doorstep of insurance companies, including his own. My question was whether primary care docs will accept some responsibility also. Always pleased when these kinds of things get discussed with passion:) Chad > > > As we spend a good bit of energy (myself certainly included) > > highlighting the way insurance > > companies mistreat primary care, I thought it only fair to relay this story > > in the interest of > > balance... > > > > I was talking with a friend of mine who works for a large insurance > > company. He told me > > that they could pay for every experimental protocol for end-stage cancer > > request they > > receive each year in the U.S. if they could only get primary care docs in > > Wichita (or any other > > city of similar size) to stop ordering non-indicated screening labs (lfts, > > cbcs, basic lytes, etc) > > and CXRs on asymptomatic patients. He said specifically " we love primary > > care when it's > > done right because it saves us a ton of money - the problem is our > > experience is that most > > primary care docs don't practice EBM - and for us that's a real hurdle to > > the logic of > > increasing what we pay them. " > > > > Food for thought... > > > > Chad > > > > > > > > > > -- > If you are a patient please allow up to 24 hours for a reply by email/ > please note the new email address. > Remember that e-mail may not be entirely secure/ > MD > > > ph fax > ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.