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Why go in for a checkup? AND doctor-conference news.

By | February 26, 2012

Why should you go to your doctor for a checkup once a year? Even if you feel fine?

If you are totally sure you are totally healthy, you do not need to go see your doctor.

But if you had an issue your doctor had some suggestions about, last time, and you haven’t seen the doctor for a while, it’s a good idea to check in, because things can change.

~ Your doctor might have changed their mind about what they said before.
~ Your doctor might have new information that didn’t exist before.
~ Your doctor might have new resources for you that weren’t available before. You never know!

…So I went to a week-long doctor conference, and it was okay.

It’s Oregon, not New York, and mostly family practitioners (docs, nurses, PAs), not radiologists/ cardiologists/ surgeons. (I imagine their conferences are held on yachts, over caviar and champagne.) So the crowd had a huge preponderance of ponytails, fringey scarves, fleece vests, and sandals-with-socks.


What the screen says: “Punch versus shave.” Scintillating stuff, folks. No, really.

A lot of women brought their knitting, and I missed mine. I was impressed that all the knitters were working on advanced-level projects, using fine yarn, throwing with their left hands, and doing intricate color and texture patterns. Well done!

During the classes, a fair number of folks were reading the newspaper (sports or money sections), reading novels, or playing Angry Birds on their phones. I frowned upon this. Even on the first day of medical school, doctors always try to appear above listening to lectures. Personally, I’m delighted to hear an expert talk about what they dig.


My home sweet home, in the International Hostel. Cozy and fun!

Here are some of the things I went to interesting classes on:

Thyroid disease:
~ “Apathetic hyperthyroidism” (causing weight loss, depression, and palpitations
~ “Amiodarone-induced thyrotoxicosis,” in which heart-attack medicine, containing “therapeutic overdose” of iodine, backfires
~ Why “natural” thyroid, from pig glands, typically causes overdosing of one form of thyroid hormone and underdosing of the other. (Hint: storage form is not same as circulating form, in humans, physiologically.)
…and much more.


It was in this swankish hotel. There’s Sacagawea!

~ Dealing with plantar fasciitis. Leg-length discrepacy can cause it.

~ A new ‘standard of care’ (i.e., rule) for ejecting kidney stones. Use prostate medicine! For girls and boys of all ages, prostate or no prostate!

~ Everything I knew about testing for anemia is wrong (almost). (I wrote down the newer, smarter instructions.) I was pleased to hear this talk, because the very smart hematologist giving it was not only entertaining, but was someone I had consulted on the phone with last month, as well. Nice guy!

~ Pessaries and bladder training. If you don’t already sense what these may mean, you probably don’t need them.

~ Pulmonary arterial hypertension, abbreviated PAH – if you have it, you want to say it loudly and kind of spitting: “PAH!” If you don’t have it, you just impress people at cocktail parties by saying “Pulmonaryarterialhypertension” with a tone of authority.

~ “Spells.” (No, this was’t the pagan conference down the road. This is about episodes caused by hormonal surges producing fainting and pallor and dizziness and red-faced-ness and other such weirdness.)

~ Vasculitis. You don’t want to know.

~ Vestibulodynia. You do want to know, but we won’t talk about it right here.

~ The major new changes in the diagnostic cristeria for autism-spectrum disorders: why so many people are celebrating and so many others are protesting.

~ Lung cancer screening, pap tests, new drug warnings. Just gangs of stuff.


Family doctors purely love oatmeal, everywhere you go. Offered every morning.

I am a shy person who did not know anybody there, so I mainly eavesdropped during mealtimes and breaks. There were some interesting themes. For example, “Medicaranoia” (my term) – lots of theorizing and dire predictions about what is going to happen with the trifecta of aging baby boomers, the primary care shortage, and the fact that Medicare reimbursements are lower than most docs need to stay in business.

Some or all of this is expected by Oregon office-based family docs:

1. Congress won’t allow Medicare reimbursements
to become commensurate with other medical care
payors.
(For me, it’s about 1/3 of what insurances pay.)

2. In fact, Congress may make Medicare reimbursements
much lower than they already are.
(A 24.7% “Medicare pay cut” is currently pending.)

3. Doctors will stop “taking Medicare,” that is, will
terminate their contracts with Medicare (as most
have already done with Medicaid, which reimburses
even lower; for me, it would be about 1/4 of what
insurances pay). This is happening all over.
(For example, in Colorado, only a third of primary docs
will take new MCare patients. A 2009 survey in Oregon
found that only half of family docs are “open” to all new
MCare patients; 20% are open to none.)

4. The nation will freak out, and pass laws requiring
doctors to sign contracts with Medicare and accept
whatever they’re paid.
(Massachusetts tried to make this a requirement for
licensure.)

5. Doctors will just quit. And that will be the end of
family practice, as physicians are replaced with nurse
practitioners
.
(That 2009 survey found that 1 in 5 family docs were planning
to quit by 2014 anyway.)

I heard a phrase I hadn’t heard before, and I heard it several times: “the worried wealthy.” These are the people whom doctors reassure themselves will make up for their Medicare burden. The “worried wealthy” will come in to the office once or twice a year, for a physical exam or a mole check, and the resulting reimbursements will make up for the 10 yearly visits of one MCare patient with diabetes [and glaucoma and underactive thyroid and chronic bronchitis and migraine headaches and acid reflux and ringing in the ears and high blood pressure and depression and needing to pee ten times a night - absolutely not exaggerating].

These doctors were not talking about actual wealthy people. (If they had been, they’d have been doing it over caviar and champagne on that yacht.) They were referring to people who have what used to be considered normal health insurance.

Even in this already-gloomy context, there was a lot of resentment amongst older docs regarding the high turnover of younger docs. At one table there was a long series of exchanges about communities where new doctors moved in, didn’t join the doctor club properly or at all, performed poorly, and left abruptly. (Of course, this is a phenomenon that’s been going on since forever; the typical first primary-doctor job lasts a year, and the job-changing rate yearly is about 10% across all specialties.)

These docs mainly blamed “bean-counters” and clueless administrators at giant group practices, for offering bad jobs, with hidden pitfalls, to gullible youngsters.

In some cases, they noted that their communities – Oregon is mainly composed of small communities, thickly sprinkled over the Western half of the state, it seems to me – were just too conservative for the newbies. In others, they noted that patients aren’t comfortable with anyone who has brown skin or an accent. It was easy for them to openly discuss this, since in all (by my count), there were just one brown skinned person and ten Asian looking people at the entire conference. I really didn’t hear any accents.

One of the things that surprised me most at this conference was considerable contention about statins. Statins are medications used to lower blood cholesterol, in hopes of thereby reducing risk of heart attack or stroke. I heard them discussed, in no uncertain terms – conflicting, but never uncertain – at five different classes (on cholesterol management, heart disease, how to read an EKG, obesity, and drug safety).

About a third of the time, people gave strong cautions, warning of the terrible things that could happen as a result of taking statins (muscles fall apart and byproducts kill kidneys; people get diabetes).

Another third of the time, people stated shortly and firmly that statins are perfectly safe. “They ought to put them in the water.”

Another third of the time, people gave very elaborate debunkings of the scaremongering around statins, with the take-home message: statins are safe, and here’s a ton of science why. (For example, study results showing muscle pain is mainly seen in people with vitamin D deficiencies; ditto, in people with underactive thyroids.) It’s nice to hear some interesting science amongst all the opinionating, but wouldn’t you think that same science would have already unified the field?

I know patients always suspect that doctors probably are given ten$ of thousand$ of greenback dollar$ by Big Pharma to say nice things about dangerous drugs. In this case, however, I doubt it. There were only about six drug-company vendors, with folding tables set up in the afternoon snack area (cupcakes!) – they offered pamphlets and, I believe, some pens. They looked a little bored and lonely. They were dressed much more nicely than the doctors. I bet they wished they’d been assigned to the radiology/ cardiology/ surgery conference on the yacht instead.

So, in any case, I went to a week-long doctor conference, and it was okay.

If you haven’t seen your doctor for a long time, it’s worthwhile checking in, because you never know, your doctor might have some new suggestions for you about…
~ Taking azithromycin for chronic bronchitis (and not because it’s an antibiotic)
~ Getting off of thyroid medicine (half of people with mild low thyroid regain normal function after 3 years) – and off of dessicated pig thyroid in particular
~ “Blister beetle juice” for plantar warts
~ Drinking only very expensive fine imported or microcrafted wines – if you have a fatty liver
~ Staying away from “no-flush niacin” (it’s not actually niacin!)
~ Using lidocaine gel to deal with unpleasant pelvic (and/or prostate?) exams
~ The proper use of lube – to reduce friction in relationships


Hurrah for lifelong learning!

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