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Comment by nsedlet | Hacker News Reader

Yes! It's so infuriating. I usually go to Chinatown where they will sell you contacts without an exam or prescription.

I asked my optometrist once why a prescription was necessary to buy glasses or contacts, and why prescriptions expire so quickly, and she gave me the reason offered in the article: that it forces people to be screened early for treatable eye diseases. But I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want. It's hard to see it as anything other than a cynical ploy to extract money from people.

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>I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want.

Ha!! Many woman feel this way about birth control! It's held hostage until you get a pap smear. Yearly pap smear, mind you, evidence and recommendations to the contrary be damned. This is despite the fact that cervical cancer screenings have zero to do with safety of birth control.

Just to be clear, cervical cancer screenings are very good! Especially so when done at evidence based intervals. But birth control can be safely prescribed without it, yet many health care providers require a pap test before they prescribe birth control.

I think the recommendation from USPSTF is every 3 years. If a provider is forcing yearly examinations on you without a good reason (i.e. suspicious findings on the path report) then I would consider talking to your provider or finding a new one.

edit: Here is a link to the recommendation https://www.uspreventiveservicestaskforce.org/Page/Document/...

> But I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want.

Happens to women too for birth control.

Or to get a blood test to see what kind of blood type you are, it’s not even enough to go to a primary cRe doctor and then get a lab ordered. They will try to resist telling you! Supposedly there is “no need” for you to know that information, and you can’t simply take a blood test from a lab without a PCP ordering it. Try it!

Luckily there is a loophole when you donate blood.

Or you can do your own lab, but I wouldn’t recommend it.

There are labs online that will gladly take your money for that, where they'll have a healthcare professional order the test and make the results available online.

A quick Google search returns this, for example: https://questdirect.questdiagnostics.com/products/blood-type...

I did exactly this, went to Quest diagnostics from an online thing and in the end they don’t give you the blood type or Rh factor. It’s just a standard test for various STIs etc.

I asked my PCP what my blood type was when I was getting blood tests for other things and he told me the same thing.

It’s most likely he doesn’t know. Order that test would be very strange for a PCP. Typically you’re only getting typed and screened if you’re about to surgery/birth/donate. This is so they can act quick to transfuse you if needed or know who to give your donated blood to. You need to ask your doctor to order this test for you and tell them your ok paying for it because it won’t get approved without reason. From a PCP perspective, he’s monitoring your cholesterol, blood counts, etc. knowing your blood type has no medical significance to him.

Thats just what the other commenter said. They won't tell you-- IE: test for-- your blood type unless they have a reason to.

Exactly

And btw there is a good reason to know. Look up for example Rh sensitivity, for pregnancy reasons. A woman who had a miscarriage and was Rh negative may be sensitized and won’t be able to have children with someone that has Rh positive blood. At least - it isn’t advisable!

In Europe you can do it easily, no prescription needed. Costs below €10.

Where I'm from, it's done at birth, it's just a standard part of a medical registration package thing your parents get. My parents kept my bloodtype card right next to my childhood vaccination records.

It's not like your bloodtype changes over time...

It can actually change in some cases. Liver transplants and bone marrow donations can trigger a change. Apparently kids a few weeks old can flip on their own as well.

Any more information about how and where I'd go about this?

But it depends where exactly in Europe you live. For example if you live in Milan, you can check it here: https://www.deltamedica.net/en/laboratorio-analisi/tests-and... - this lab is on the expensive side as they ask for €14.

The "no need" is so patently false. Notwithstanding the obvious privacy implications (your data belongs to you), first thing asked for if you are in the ER bleeding? Bloodtype.

Doubtful. The risk of giving the wrong blood is so high that the hospital should only rely on a test done right then and there.

Standard procedure as far as I know in German ERs (at least a while back, my mother used to work in clinical laboratories). Even if you have your blood type tattooed on your forehead and a passport stating it they still do it. Because the test is easy and fast, relying on your own up-to-date tests is safer then anything else. If there really is not enough time they could still use 0 negative blood I think.

We never rely on patients telling us their blood tyoe, or even past lab results. A test must have been performed recently (in my hospital it’s within the last seven days) for the blood bank to dispense blood.

If there is a major haemorrhage the patient will receive the universal donor (O-) while the test for definitive blood type is performed.

I was told that it makes a difference what the patient or their records claim, because it can accelerate obtaining the correct result. Since, it was alleged to me, you don't do a test for "what's your blood type", but rather something more like "is your blood type A-?". Therefore, if they say "oh, I'm O+", you can just run the test "is this person O+?".

Is that not the case?

Nope. I've been to the ER with a head wound that would not stop bleeding, and was never asked for my blood type.

Had they asked, I would have given the wrong answer. My blood was typed when I was born. 25 years later when I started donating blood, I was typed again -- and told a different type.

My physicians and phlebotomists assure me blood type cannot change, and old blood tests were simply not very accurate. I don't know any lab or clinic that trusts what someone else claims about blood type.

Ask the lab for your results. They have no problem providing it

you can get a finger prick test on amazon for something like $10

My dentist pushes a periodic "comprehensive/full panel" xray. More than the usual, and claimed the justification was in case I have jaw cancer or something serious (non tooth/gum) related problem.

I asked what about all the rest of the bones in my body?

I skipped it.

Roll the story where the person has an abscess and dies from it weeks later

Seems unlikely, at least for people willing to seek medical care when they have a surprisingly pain in their jaw.

Large doses of xrays aren't without risk. Apparently the comprehensive xray uses 4-6x the exposure of a normal xray.

Source?

I was willing to seek medical care for the ongoing pain of TMJ and I didn't because what I can afford is one Dr visit & one RX for generic opioids (the only treatment that touches that pain).

But there was no point. The only Dr I could afford became terrified of prescribing opioids (thanks DEA. yes it was the DEA). No matter that I had, for years and years, taken opioids responsibly.

However it's no longer a problem. That only Dr - that countless thousands of us could afford to visit - just closed up shop.

Am I willing? Sure. Able, no. Not in any way.

Happened to my mother's second husband. Tho, as sibling comment points out, that came down to avoiding medical treatment for something quite painful for so long that it became life-threatening.

5-6% of cancer comes from excess medical imaging.

Source?

It was an obvious joke.

Source?

Not all that obvious. We actually do have statistics on how X-ray scans affect your cancer odds. Full-body scans and other intense X-rays can have a 1 in 1000 chance of killing you in a couple of decades; most doctors won't consider them unless the condition they're hoping to diagnose is more dangerous than that.

Unfortunately not. Folks have some odd beliefs about medicine and with this, it isn't unlikely that a certain percentage of folks get cancer from medical treatments. I imagine that number is less in the modern world than it was before I was born. We did use Xrays to check how shoes fit, after all.

So taking that xray every 3-5 years saves you from the death in a few weeks? Or should you take the xray weekly?

This is key here. As a general rule of thumb is some information has no influence on the course of action then it is useless, as interesting as it may be. In this case you have the odd chance of that 5 year exam catching the problem at just the right time, but the overwhelming probability is that it will even show nothing (in which case you do nothing) or that you are about to die (in which case you can do nothing).

Mine does as well, once every three or five years or so? It's (also) so that they can see whether a cavity is forming underneath an existing filling, for example.

Mind you it's covered by my dental insurance so it's fine.

My regular eye exam caught early stage glaucoma. I go to follow-up screenings yearly to track progress, but it's entirely correct to say that going to my optometrist to get my updated prescription probably saved my sight.

All that being said, I always ask for a copy of my prescription so that I have it in my wallet just in case. I've been abroad when my glasses broke and having that on-hand made getting an emergency pair of glasses very simple.

edit I get my glasses at Costco, probably $120 all-in.

I usually travel with an extra pair of glasses. My preferred frames, including lenses, are $30 from Zenni.

I’ve been using the same prescription for about 6 years, it may be about time to see an optometrist and get my eyes checked out...

It's funny how lens.com requires a scan of a valid prescription and will not fill it after it expires-- stating something about a law. They even send email recommending that you stock up before it does. So I bought 2+ years worth, got ~50% "back" as "rebates", and then emptied their spend-tracking "rebate card" into the phone bill for the number they already had.

This must be merely what "increased access to eye exams and eye doctors" means in the USA.

Zenni lets you punch in your own numbers and takes your money and gives you glasses. These are a bit strong (my eyes have to adjust) but they are satisfactory.

In Germany they usually just give you a little credit-card-sized card with your glasses that has all the information about the lenses (and thus your prescription) on it.

yes, tho the point of the article is that you need a fast expiring prescription in the US. Even if you have the information you cannot directly buy glasses.

Not from a brick and mortar store, but you can online from places like Zenni.

Wow, even worse:

> Thankfully, I knew that two laws, one passed in 1997 and the other in 2003—which had, incidentally, been loudly opposed by the AOA—gave me the right to demand a copy of my prescription.

They don't even tell you the numbers, unless you insist. On they used to not tell you the numbers at all even after insisting..

I think many people don't hear this enough. Eye exams can catch things and since a lot of the people I know get a good 4~6 years out of their glasses it makes since to get an exam when replacing them. Sure, exams might cost time/money but most people just don't hear the story of going to get a new pair of glasses and being saved from xyz eye condition story enough. I live outside the USA now and to get contacts you need a recent eye exam to purchase them. I think this works out good because the country I live in has a high number of contact users and I feel it ensures better health for the great amount of those who need vision correction.

Eye exams catch problems in the healthcare wealthy. They catch nothing in the dozens of millions of Americans who aren't (and haven't been).

Sounds like a great reason to subsidize yearly eye exams for those who can't afford them. Or even to cover the cost of an annual exam for every person, to avoid the usual problems with means testing.

"regular eye exams are important", while probably true, seems like a really weird reason to say "if you want to buy glasses, you need a prescription".

Exactly. The fact that some procedure may be a really good idea doesn’t mean it should be a prerequisite for some unrelated thing that is also important. You shouldn’t have to get a yearly physical to be able to register to vote.

Honestly, I don't know. Yes, it's a hack. But it's also an effective hack. Young people don't go to doctors unless there's something wrong with their bodies that reminds them to go.

Should we restrict toothbrushes to be only available with a prescription from a dentist to encourage regular cleaning and inspection?

The added burden may also dissuade people from getting either thing in the first place.

I don't want to be hacked, and I don't think it's right to manipulate people to get your desired behavior.

And in the past I did not go to the doctor because it was very often a piss poor experience, with piss poor results.

Someone who isn't me has forged eye prescriptions with Photoshop to get around this problem to buy contacts and glasses online. I don't know in how much legal trouble he could get, but I think many people can understand.

I have severe allergies that occasionally requires epinephrine... without an annual checkup doctors typically won’t give me a prescription. I’ve similarly been hospitalized for asthma, same deal with an inhaler.

I had to really hunt to find a doctor who would give me a prescription without an annual checkup.

Legally they can’t. If you have a steroidal inhaler, you’ll need to be evaluated every few months to ensure the steroids are hitting your lungs instead of blood stream.

> If you have a steroidal inhaler, you’ll need to be evaluated every few months... [emphasis added]

I am reasonably sure this is not true, at least for most people's definition of "few".

Came here to post this same experience. I have terrible asthma and allergies that are completely controlled by the typical prescription medications that any lay person would select after a few minutes of googling, but I can only receive access to them for up to one year without going back to a doctor.

The result is I often run out at inopportune times so I try to hoard / ration medication to avoid that situation.

Medical paternalism was the norm until surprisingly recently. See

https://en.m.wikipedia.org/wiki/Medical_paternalism

I can see the case for it, I mean, I don't go into a car dealership and approve or deny which parts are to be replaced or which procedures are necessary. I have no basis for knowing.

Yes, but if you insist, your mechanic will probably still do what you ask them, as long a you pay up.

I’m 50/50 on this. The dealerships can be mindless flow-chart followers:

It’ll say “When A occurs, try replacing X” and they’ll do that, even though my notes stated that I switched all the Xs around and the problem didn’t move with them.

Yes. And sometimes I even want a service provider that insists they know better. (Eg I frequent some coffee shops like that.)

The crucial thing is that there are alternative providers where I can get exactly what I say I want, and get it.

As a former mechanic, at least my shop would occasionally refuse to let a vehicle leave the shop- the one example that I remember most clearly was a SUV that came in for an oil change. The owner was planning on a 800 mile trip with their family and wanted an oil change before leaving. One of the wheels had a serious suspension problem, and would likely fall off shortly & cause a rollover.

We weren't going to let that truck leave our shop w/o getting fixed, none of us wanted dead kids on our conscience. We extended credit to the customer & cut our rate so the owner could afford it. Point being, in this case we definitely knew better than the customer, somehow they didn't realize a wheel falling off at highway speed is dangerous. P

However, that was a very rare situation. If a customer insisted they wanted work done that we didn't feel was necessary, we would tell them so but still do the work if they wanted it.

Sure. And you can take steps toward dealing with ignorance that are still compatible with informed consent. For example, we should ban the advertising of prescription drugs on television. Most other respectable countries do.

Most would see that as an argument in support of paternalism, and as do I, which is why I agree with your position. Advertising drugs to consumers is akin to advertising specialty testing equipment to individuals: at best neutral and at worst harmful. You have no business self-diagnosing with a risk of stroke and running in there to demand Plavix. There should be no world in which the doctor goes, "Huh, Plavix! I've never heard of it, and if you think you're at risk of stroke, well bud, here you go, one years supply."

I do that all the time.

If you have a digestive disease your Dr may refuse to fill your prescription if your last colonoscopy was more than ~2 years ago. Even if you have a less serious condition.

(I'm providing another example, but I agree they shouldnt withhold care.)

They should care and ask you to do it, but no need for them to insist (or for there to even be a law or regulation to force them to insist).

Something that I don't understand (and I haven't lived in the USA to know): when you get tested for something, you don't walk away with the results? They are kept in some system that only the MD who asked for them have access ??? You are unable to give the results to some other doctor, asking for a second opinion?

Yes, that is accurate.

In the US, lab results are nearly always sent to the doctor who prescribed the tests, not to the patient. (And most tests cannot be requested without a doctor's order.) Some doctors are good about sharing the detailed results with their patients while others are not.

You can ask your doctor to send the results to another doctor (more often you just tell the new doctor to request them from the original doc). By law you are entitled to a copy of your medical record yourself but with many doctors it is surprisingly difficult to get them to do this. I have heard of cases where it took many weeks and the threat of a lawsuit.

Ostensibly, the reason for this state of affairs is so a patient can have a professional help explain and interpret the results.

I can go online and get all of my test results including graphs that show change. X-ray reports. The only thing not online is surgical notes, but I easier got copies of them. This is from the UCLA healthcare system. Also Quest labs has online results to patients. This is in CA. My brother-in-law, could not get results from tests in Virginia to get a second opinion. Perhaps it varies by state.

I go to a VA medical center and every word they have written about me, all my labs and scans are available online.

I had the option of having all test results emailed to me. I had the results of my physical before my doctor did. This is a result of modern medical information systems.

> But I can't think of any other area in healthcare where your care is held hostage unless you pay them for some unrelated diagnostics you don't want.

Certain medications require regular testing (example I'm familiar with is Orkambi for Cystic Fibrosis, and regular liver screens are required due to potential side effects), and the prescribing doctor won't renew those prescriptions otherwise.

That's the opposite of unrelated. They're worried the medications are going to damage you.

True - I misread the quote

Healthcare has always been used by their practitioners as a tool to extract money from customers.

Often they will say "it's for your own good".

In reality, it's just a cartel, extremely protected by government regulation.

For some reason, people think that the rules of economics don't apply when it comes to healthcare.

That's less true now than it used to be, but it's worth remembering that the AMA killed universal healthcare in the US... in the 1950s! They were specifically worried about doctor's wages and fees going down.

Happens to transgender people to get HRT.

Informed consent is a thing in most of the US now.

Most of USA isn't all. I don't follow the USA anymore since moving to Canada but when I lived in USA it wasn't informed consent in my area. Nevertheless I was downvoted for giving another example to OP. I would also say the needing a prescription for the years I did.. ruined my life because all doctors for years would deny me on religious grounds.

Can't wearing "good enough" glasses and contacts cause vision quality to degrade faster?

I've been wearing my "good enough" glasses about twenty years now. I know what the perfect vision feels like (I can get 20/10 easily with "right glasses") but that is just too much for me. I just can't live with that, everything is way too sharp. Glasses that give me 20/20 but no more make me feel much better. I always order online nowadays, and never have been subjected to this American "you need prescription/license (= pay) for this" way of dumbing things down.

In general, degrading quality of vision is most likely a symptom of something. Needing reading glasses when you age is the only exception, that is just normal.

Ask your optometrist why that argument fails for people who don't need vision correction.

> ... prescriptions expire so quickly ...

If you mean 'come with a written expiration date,' then mine never have and I would find this practice abhorrent.

If you mean 'really is no good in six months,' then your eyes are actually changing.

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