Know your family health history

Tomorrow is Thanksgiving Day.

Did you know it’s also National Family History Day?

Each year since 2004, the Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or at other times when families gather, the Surgeon General encourages Americans to talk about, and to write down, the health problems that seem to run in their family. Learning about their family’s health history may help ensure a longer, healthier future together.

As a nurse, I have taken hundreds of patient histories and I am always surprised by how little most people know about the health … Continue reading

Confused by mammogram guidelines?

October is Breast Cancer Awareness Month, so I can’t let it pass without commenting on the American Cancer Society’s (ACS) recently updated screening mammogram guidelines.

Before, the ACS recommended annual mammograms starting at age 40.

Now they recommend annual mammograms for ages 45 to 54, with screening mammograms done every other year after age 55.

But, they add, women should still have the choice to start screening at age 40 and have yearly mammograms thereafter.

The confusion arises not only because the ACS is a bit wishy washy on its guidelines, but because the American College of Obstetricians and Gynecologists … Continue reading

A routine urinalysis is unnecessary

This week the National Kidney Foundation (NKF) started a public health campaign called “Everybody Pees.”

The highlight is a short video featuring a catchy song and colorful South Park-esque kidneys peeing in all sorts of places—parks, swimming pools, on top of a car, etc.

OK, it’s cute, kind of. But here’s my problem with this video (other than the it’s a cartoon more appropriate for six-year-olds): a routine urinalysis is NOT recommended to screen for kidney disease.

But that’s what the song seems to tell us to do:

The smartest place to pee

Is at

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Atul Gawande – Overtreament, “Overkill”

A friend of mine who is an avid reader of both The New Yorker and my blog sent me the following link: Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

The author is Atul Gawande, MD, one of my favorite surgeon/writers. It’s a long article, but if you are interested in saving money on your health care (and possibly saving your health), I encourage you to take time to read it.

I have posted many times about America’s obsession with overtreatment—too many tests, too many specialists, too many … Continue reading

Healthism, medicalization and overdiagnosis

Healthism is a term coined in the early 1990s that describes the government’s use of propaganda and coercion to establish norms of health” and its attempts “to impose norms of a ‘healthy lifestyle.'”

Think about the cities that have chosen to ban smoking or trans-fats or super-sized sodas.

Or the new federal school lunch program’s rather rigid nutrition standards.

Or the Affordable Care Act. It mandates coverage of multiple “essential benefits” such as annual “wellness visits” and screening exams of debatable value. It also requires health care providers to document that they’ve talked to every patient about weight … Continue reading

Better patient education for mammograms

I’ve mentioned in several posts that I think screening tests, especially mammograms, are used too widely in this country. Every woman over age 40? Every year? It’s overkill.

Even the US Preventive Services Task Force (USPSTF) only recommends a screening mammogram every other year between the ages of 50 and 75.

But most women still think the yearly mammogram is health care at its finest.

Related post: Screening mammograms—benefits vs harms

The British medical journal, Lancet, recently published a study that shows women who are better informed about the risks and benefits of screening mammograms are less likely to … Continue reading

Number Needed to Harm

I’ve written a couple of posts about the Number Needed to Treat, aka the NNT. That’s the number of people that must be treated with a drug, a procedure or a screening test to save one life.

The lower the number, the better.

Related post: Number Needed to Treat

Well, the dark twin of the NNT is the Number Needed to Harm, or the NNH. How many people can be treated before one person is harmed? In this case, the bigger the number, the better.

Aaron Carroll, MD, of The Incidental Economist blog, wrote a terrific piece in The New Continue reading

Screening mammograms – benefits vs. harms

The Journal of the American Medical Association (JAMA) published a short article on screening mammograms that included a spiffy infographic on the benefits vs. the harms.

Looking at the graphic I can easily see that if 10,000 50-year-old women are screened, 10 will be “saved”, but 940 will undergo an unnecessary biopsy and 57 will be overdiagnosed. (For copyright reasons I can’t reprint the graphic here, but you can view see it yourself by clicking on the above link.)

The author of the article explains:

Another possible harm of screening is overdiagnosis. This means finding something on a mammogram

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Lack of transparency keeps medical costs high

Profits stay high, too

On Monday, the New York Times published another brilliant piece by Elisabeth Rosenthal in her series “Paying Till it Hurts.”

Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue.

And American doctors, clinics and hospitals tend to order lots of tests. “It’s one of the most lucrative revenue streams they

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Vitamin D testing and supplements

Lack of support for vitamin D

I’ve written several posts on vitamin D. That’s because it’s one of my pet peeves.

Why?

Because there was a lot of hype surrounding it several years ago when it became the latest health care fad. Suddenly a low vitamin D level was suspected of contributing to many types of cancer and chronic diseases. Physicians began testing everyone’s vitamin D levels and recommending vitamin D supplements, either over-the-counter or a stronger prescription form.

Further research on vitamin D, however, has not provided evidence that general screening for low vitamin D levels is helpful, … Continue reading

Harvoni, Solvadi and hepatitis C screening

harvoni hepatitis c treatmentNew treatments for hepatitis C

I read an article online the other day in which the author practically shouted at her readers to “Run as fast as you can to your doctor’s office and get screened for hepatitis C!”

OK, what she actually wrote was:

Overall, the outlook for patients with hepatitis C is much better than it was just a couple of years ago. So if you’re a baby boomer who hasn’t been screened for hepatitis C yet, don’t wait. 

Still, let’s step back and look at the big picture.

Hepatitis C screening has been in the news a … Continue reading

Three questions to ask your physician

demand-evidenceBe a proactive patient

In addition to talking to my doctor friends, I spend a lot of time reading various doctor blogs because I want to better understand our health care system from their unique point of view.

The majority of those I read seem to agree with me that the industry has morphed into a giant profit-making machine—profits first, patients second. Many physicians write of their loss of autonomy and the ability to treat patients in a thoughtful, patient-centered and cost-effective way.

More than ever, they say, patients need to be informed and take control of their health care. … Continue reading

The demise of annual exams and the doctor-patient relationship

Are annual exams a waste of money?

Based on the most recent evidence, I would argue yes. I posted about annual exams a few months ago, and quoted the following from the Society for General Internal Medicine (a primary care specialty group):

Routine general health checks are office visits between a health professional and a patient exclusively for preventive counseling and screening tests. In contrast to office visits for acute illness, specific evidence-based preventive strategies, or chronic care management such as treatment of high blood pressure, regularly scheduled general health checks without a specific cause including the “health maintenance” annual

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Do you need an annual pelvic exam?

annual pelvic exams unnecessaryYet another screening exam found unhelpful

Earlier this month, the American College of Physicians (ACP) published its recommendation in the Annals of Internal Medicine that routine annual pelvic exams are unnecessary for healthy, non-pregnant women with no gynecologic symptoms (bleeding, discharge, pain, etc.).

The ACP looked at evidence on pelvic examinations dating back almost 70 years and concluded:

… no data support the use of routine pelvic examination (excluding cervical cytologic [Pap] examination) for reducing the morbidity [disease] or mortality [death] of any condition. Furthermore, limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety,

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Do you need an annual exam?

The yearly reminder

The other day I received in the mail a form letter from my physician’s office reminding me that I am due for my annual “well woman” visit. The letter also pointed out that if I have an ACA-compliant health insurance plan, the cost for the exam would be 100% covered as a preventive benefit.

I have three problems with this letter.

  1. Although my current physician is part of my new insurance plan’s network, the hospital she works out of is not. What if I needed to have surgery or be hospitalized? My care would then be given
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