Finding the balance

More tests or fewer, more meds or fewer. Does this mean fewer diagnoses and more deaths? I don't think it has to. We just need to find the balance.

We need to focus on finding, not what is the most we can do, to what is the best thing that can be done for the patient. Go read this article to learn more. I strongly agree with this theory.

I can't tell you how many times I have felt over-tested, -poked, and -prodded, because of 'my medical history, they have to be sure'. I can't tell you how annoying that is. Really? Can't they just say that's the best thing for you? Or is that not what they mean?

There is a current leaning in the medical/insurance world to cut down on the amount of tests, scans, and medications for patients. American medical costs are the highest in the world and American patients are blasted by ads and mailings from manufacturers on the newest, most expensive treatments, which are often unnecessary. And patients ask for more scans.

I get it. I have asked doctors why no more scans or tests? And the answer is 'there are no reasons to have any scans, there are no changes'. I can live with that. And I get mailings from Pfizer to go on Xeljanz, which is probably no better than my current drug combinations. And that new drug costs a fortune.

There is a tiny part of my brain that screams 'cure me', give me more tests, find a fancy pill, do something so I can go back to my former healthy self. But the rational part of me knows that isn't a reality. I can dream can't I?

Are any of these people who are so upset about not enough testing and medications patients? If my doctor says this is what's best for you, I'm happy. Its the right balance for me.

As patients we need to accept what our doctors say is enough. And we still need to be vigilant against under treatment, but that's another story.

Stop taking pictures of me please!

I hate how I look in pictures so I am never enthused when someone starts snapping away. I have been known to make my mean face on occasion when included in a picture. I like taking pictures of things - my cat, garden, things I find in nature, etc. But I really do not like it when doctors want pictures of my insides!

In late 2008, I started having back pains. They took x-rays, tried PT and then an MRI and found all sorts of fun things going on with my spine. Five years later I asked my pain management doctor if there was any reason to do any more imaging and he said no because there was no reason to believe anything had changed. I can live with that.

But to my other doctors, do we have enough pictures yet? I would be happy if my visits to the Radiology Department could be limited. And there is proof that some hospitals take too many pictures.

Back in 1981 with my first cancer go-round, they took x-rays and thought there was a thingy (that's the technical term) in my lungs. So for the next 30 or so years, I had an annual chest x-ray to see if the thingy had changed. Then all of a sudden my doctors told me that it was no longer protocol to do annual chest x-rays in cases like me. (Thank you!)

The real concerns are in cases of breast and prostate cancer - how many images are needed? Do we really need that many? And the answer is no we don't. A study looked at how many X-ray, MR, PET, CT and bone scans for breast and prostate cancer. While it seems that use has gone down in recent years, there is some evidence they are still overused. Its a case of 'just because we can, doesn't mean we should'.

If you are diagnosed with breast cancer, should they do more scans to see if there is cancer anywhere else if you have no symptoms? Or how many should they do? How often should they follow up with more pictures?

Its not just time, expense, stress on the patients, but also does it really matter? If there is no reason, don't bother. Thanks. I'm good without more pictures.

Those other second opinions

So you get diagnosed with any not-so-fun ailment because you had some tests and the radiologists or pathologists read your results and told your doctor what the diagnosis was. However, as a new study points out, not all test results are black and white.

This new study found that pathologists only agreed 75% of the time when reviewing breast biopsy results, until they met and discussed the results. The study recommends in the end that perhaps a second opinion is warranted if the results are not clear cut. Sometimes your doctor can be the one who gives the second opinion but other times, you may need a second pathologist to review the results.

I had never thought about this ever. I know I have had x-rays, biopsies, scans, etc where the doctor has added comments to what the radiologist or pathologist has said. When I was diagnosed with rheumatoid, my rheumatologist waited to get back to me on the results of my x-rays because she wanted a specific radiologist to review them because they were very good at detecting RA in x-rays.

But I had never thought of asking if I could have a second pathologist or radiologist look at my biopsy or scan results. It would never have occurred to me. But it completely makes sense. If something is subjective at all, maybe more than one person should look at it. A new point to ponder. And this study also says to ask your insurance company if this is covered... which sounds like some might cover the second opinion.

They made a bad rule

Back in 2012, all sorts of doctors were saying there are too many medical tests, standards, and treatments going on for all sorts of disease. There hundreds of recommendations from the official medical societies - Pediatrics, Oncology,o etc. At the time, I agreed with them for the most part. One of them in particular - stop over prescribing antibiotics.

But another one, I am not so sure. I consider it a bad rule. This rule is stop Imaging for Metastases in Early Stage Breast Cancers. They were not people who had walked the walk before they made that rule.

Allow me to use examples here. I have a friend who was found to have a relatively early stage II breast cancer except for the metastases to her liver which made her stage IV. She received the full gamut of chemo and had her liver ablated a couple of times. She is doing fine. But what if they hadn't found the liver metastases? She would be long gone by now.

The claim is over treatment and over imaging raise costs and are unnecessary for most early stage women. But if they can figure out whose cancer has spread and whose has not spread without imaging, then I am happy to accept the change. Until then, women who need the imaging should continue to get it.

Go make some other rules and stop being surprised that doctors who treating these concerned patients are looking out for their patients best interest.