This is a common point of view. However, it’s wrong.
Manifestly, a problem focused visit is not the time to be ordering tests and whatnot, but the idea of prevention of disease is at a stage before it officially becomes recognized as such (as with ASCVD and dyslipidemia the subject of the OP) especially when that recognition has been…and still is…the first fatal heart attack or stroke.
Interestingly, I just got a new PCP after my old one retired. We’ve had one appointment to establish care (which took about six months to get). She did not order blood work.
Since my 40s, I’ve been getting annual exams. It looks like I get a blood screen about every two years.
Well, since you’re manifestly now 40+, right, I’d suggest thinking hard about doing what @WendyBG does if this practice is going to be your medical home.
Not necessarily because such bloodwork has a high chance of showing up something serious if you’re totally symptom free…but rather missing out on the window of opportunity to head off something really consequential in the future if your confidence is misplaced.
FWIW, the main reason I mentioned a CAC scan to my doctor at the time I asked for the advanced lipid testing and circulating insulin was because I expected it to be zero, just like the guy in this article (with a similar lipid profile to mine)
How Coronary Calcium Informed a Sexagenerian Flaneur’s Decision on Statin Therapy – The Skeptical Cardiologist https://share.google/AEWCJxIv94mQxybTR
It was not. Decisively not. Window of opportunity missed decades ago
That’s called an “Advance Benefit Notification” where if you continue, tney’re going to charge you 10 times the Medicare Reimbursement (in October they wanted to charge me $344 for a Ferritin test). I get one of those about a third of the time when I visit the lab.
I always decline the test, and tell them I’ll come back when everyone agrees what the right diagnosis and procedure codes are.
It’s a lot easier to come back, than try to fix it after they’ve charged you for the test.
intercst
You could go bankrupt paying out-of-pocket for all the tests required to prove you’re healthy.
intercst
Well, I guess that depends upon how close to the edge a person is. The handful of meaningful biomarkers with sturdy evidence to back up their predictive value probably wouldn’t cost that much out of pocket.
And remember, these test don’t “prove you’re healthy” but, rather, have the potential to give a person a heads-up at a point that may well save them the “cost” of tens (hundreds) of thousands of dollars for treatment further down the line…even if it’s covered in full by a third party payer
For example, I absolutely do not want a free stent or 6, or experience state of the art emergency care for a heart attack…not even if I got paid for it. The amount of money I ponied up for my CAC scan (even though I expected a result that said “healthy”) seems to me a pretty good investment so far, rather than a rip off.
Thats introductory while she gets to know you. She has the past bloodwork, and you are not high risk.
This idea there was no prior bloodwork is not true. Npr just ran with what was told to them by a young person. What do most reporters know? The link is up top. Npr is more fiction than objective news.
@JLC nowadays, broad screening tests ordered as a panel are very inexpensive. $100 covers CBC, lipids, kidneys, liver and thyroid plus electrolytes. A healthy person will get a list of “normals” in which case there’s no issue. An “abnormal” reading should be a signal to go to the doctor.
Without these tests a fatal condition, like the non-alcoholic fatty liver disease that killed my mother-in-law, can be missed for months even when the patient doesn’t feel well. How do I know? Her internist left us for half an hour in an examination room with the practice’s computer where I looked up her records. I was furious but what could I say? That the doctor didn’t bother running a $100 test and missed a diagnosis for 6 months?
If she had run her own annual Wellness blood screen (which my parents did and I also do) it would have been detected early.
Wendy
@Wendy, people are poisoning themselves. There are different ways to do that. Taking fish oil for cholesterol will bring the numbers down. But if you bring the numbers down without solving the problem, the mortality rate does not drop. People taking fish oil are hiding their problems.
My friend, with his vitamins, met a podiatrist for foot pain that recommended vitamins he had not thought of taking, but not for the foot. He went to my PT to solve his sciatica, and the foot pain got solved as well. It was nerve damage. Meanwhile, my friend has organ failures, and plenty of vitamins. Really, the way he eats and takes vitamins is toxic to his body. It is a vast overkill in vitamins. He’d never see it that way.
He is not alone. There is no medical context for most people. It is ruinous to assume reading studies gives you a medical context.
I have left you alone, but you harm only yourself when you relentlessly slander sources just because they report facts you don’t like.
Which test did your MIL’s doctor fail to perform? Whilst I’d be the last person to deny that Red Flags can be missed by providers who are too locked into looking for horses and miss the zebras when they hear hoof beat, according to the transplant hepatologist in the family and researcher into this very condition, MAFLD…metabolic dysfunction associated fatty liver disease…is diagnosed by a clinical picture rather than an isolated blood test.
The name change …from non-alcoholic to metabolic dysfunction associated…tells the story of the underpinnings of this overweight/obesity associated disorder. It’s another of those conditions that are strongly associated with the departure from healthy homeostasis that a rising HbA1c can act as a giant Red Flag for. Contrary to the confident opinion expressed in another thread … that prediabetes doesn’t come with consequences of its own … MASLD/MASH and associated cirrhosis very frequently does occur along side this Canary in the Coal Mine.
There’s a postulated hypothesis for the actual mechanism in this paper…
The effect of obeticholic acid on hepatic blood flow in isolated, perfused porcine liver: Correction of oxygen‐nutrient mismatch might be a putative mechanism of action in NASH - Lake‐Bakaar - 2022 - Clinical and Translational Discovery - Wiley Online Library https://share.google/WyPisP2p0xO94RBw3
and a nifty visual from a poster session at a Digestive Diseases Week a few years back…
OXYGEN-NUTRIENT MISMATCH: A NOVEL CONCEPT TO EXPLAIN THE MECHANISM… - Lake-Bakaar G - - May 24 2022 OXYGEN-NUTRIENT MISMATCH: A NOVEL CONCEPT TO EXPLAIN THE MECHANISM... - Lake-Bakaar G - - May 24 2022
Signed,
Mrs. Lake-Bakaar
No it won’t. For sure plenty of folk are taking all manner of alternative remedies because of statin/Big Pharma phobia (one of the most frequently discussed topics on the old H&N board) Such nostrums are generally a poor idea because they just don’t work, not because “people are poisoning themselves”. The 150,000 I.U. Vit D bloke, or your friend’s strange habits notwithstanding.
Let’s keep it simple. The $100 test includes, among other things:
Glucose
BUN
Creatinine
eGFR
BUN/Creatinine
Sodium
Potassium
Chloride
Carbon Dioxide
Calcium
Protein,
Albumin
Globulin,
Bilirubin,
Alkaline Phosphatase
AST
ALT
The tests on the list that could indicate a liver problem are Bilirubin, Alkaline Phosphatase, AST, ALT, Albumin, and Total Protein. These are commonly used in liver blood panels because they can reflect liver injury, bile duct problems, or reduced liver protein production.
Also, non-alcoholic fatty liver disease is now called metabolic dysfunction associated fatty liver disease for a reason. If MIL had high glucose, even if it was lower than a diabetic level, that could have been a clue.
I don’t need to be overwhelmed with research to know that a pattern of abnormal glucose and liver enzymes is better than NO DATA AT ALL. Then it’s up to the doctor to follow up. Which he didn’t do.
As it was, MIL collapsed, developed hepatic encephalopathy and had to be put into a nursing home.
Wendy
So your MIL didn’t have those standard tests done along with other routine to me stuff…like fasting glucose, A1c etc? Then, I’d have to say she was definitely a victim of supervised neglect. Like I’ve said many times, there’s a distinct lack of critical thinking…especially at primary care level…but I meant in the context of response to Red Flags in an otherwise healthy set of results. Not failing to do basic bloodwork.
As I believe I mentioned on the “Goodbye to prediabetes” thread along these lines …all those you listed there (and more besides) are tests I cannot remember not having. Have a specific panel ordered, the blood drawn goes through an automated process…and the results roll out in full.
Criticisms are not slander.
The frm ceo of npr wrote a report with the same criticisms.
Still in context of ordering ones own blood tests or requesting some more atypical testing…or requesting bloodwork actually be done if stuck with a PCP who cannot be arsed/believes it unnecessary for whatever reason…here’s a bit more on specifically getting a heads-up on metabolic dysfunction. A condition that is associated with a heck of a lot of chronic conditions…including, but not limited to, steatotic liver disease/steatotic hepatitis.
Only just stumbled on this…along with a few more marketing sites for health and wellness clinics … but it has a neat, concise description of just how early the onset of this driver of chronic disease can be detected, if it’s actually looked for
I’d asked the family transplant hepatologist on our walk yesterday if he could recall the lowest A1c in MASLD/MASH patients referred to him. “I check insulin resistance over A1c…that’s why I suggested looking at your circulating insulin levels back when you were worriting about your LDL”. OK. So, in order to save myself a tutorial, I used the prompt Is it possible to have an A1c of 5.4 and have metabolic dysfunction and did a bit of Googl8ng. Per the AI overview, the answer is a resounding NOT no. I stepped over the scholarly articles cited for an easy read…
Why A1c Isn’t Enough to Assess Metabolic Health Why A1c Isn't Enough to Assess Metabolic Health
I’m going to suggest that it matters nought to the body if this condition is romping away under the hood undetected (didn’t look) or in full knowledge (looked, but didn’t respond because it’s “only” prediabetes)
Sure, and NPR should have fact checked by calling up her doctor’s office and asking. Oh wait. That’s illegal. The only health information NPR has access to is what she gives them.
Other than that part, your story makes perfect sense.
Well, if she actually was a patient of record (the inference most readers are going to draw on first blush), it would be perfectly possible to double check…with her permission, of course…on her patient portal. That’s where most folk these days double check their lab results…and, if they have any gumption double check their listed diagnoses to verify the information comports with what they know or think they have (as I’ve suggested many times in the past) That’s. where such a glaring omission in competent doctoring would reveal itself
My “patient portal” has been active for abjout 4 years (?). I checked it once, I have never been back. Too much hassle getting past all the security stuff, and I don’t know what any of it means anyway. I rely on the Doc to interpret in my semi-annual visit. Mrs. Goofy does get in somehow, and she knows what to look for with a couple of the numbers, but the rest is a mystery.
If somebody asked me to open up “my patient portal” I would be mystified.