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Comment by tommoor | Hacker News Reader

To everyone that reads this:

If you've not had a checkup in the last year go and get one! It'll be included on your health insurance and the blood draw will include things like if you have high cholesterol.

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In the US I presume?

Canadians have a harder time...

In Canada/Ontario, you have to convince your doctor to give you a cholesterol test, e.g. family history. It won't be done preventively [1].

Even if you manage to get tested, if you're under 40 the doctor won't care and there will be no followup.

[1] https://exechealth.ca/ontario-drops-annual-physicals/

A test in the US < $50 and is easy to schedule without having a doctor involved at LabCore or similar. Is that an option in CA?

There are private clinics one can become a member of, but this is extremely uncommon and most people don't know it's an option.

Costs upwards of $3,000 annually.

Only 3,000? chuckles in American

You can go to quest diagnostics or labscorb and order yourself a test for under 200$ (no insurance needed) that would do an entire panel on you. I did this and then called a teledoc for like 40$ (copay) and had them go over hte results with me. It's pretty sweet.

> called a teledoc for like 40$ (copay)

So, more like $7400 annually [0], plus a $40 copay, discounting whatever other health care you needed in the year.

[0] https://www.kff.org/report-section/ehbs-2020-section-6-worke...

If you make 100K a year in Canada you pay $29,986 in taxes of which about a third goes to healthcare, so $10000 annually and you still won't get tested preventatively.

The difference is that the US cost is true whether you're wealthy or poor (above a certain margin). In Canada, if you make the median household income of $35k, you presumably pay proportionally less (or even less than that; I can't be bothered to look up the progressive taxation margins) in taxes, so $3500 max.

In Quebec at least, a doctor's prescription is required for all blood tests even at private labs.

Crazy how different it is vs the States - check out for instance what you can get immediately at this pretty popular chain: https://www.anylabtestnow.com/general-health/

Hundreds of different ones. Granted you still need some level of medical expertise to be able to accurately interpret results on a lot of them but a smart enough layman could probably self diagnose some illnesses with enough homework.

We even need a prescription for repeat labs. So if my doctor is away for personal reasons for a month and I need to have my [thing that I get tested every month] checked, I can't without having to navigate the entire healthcare system to find a workaround.

I would be easy for me to interpret the results as my doctor is clear that [number] should not fall under [threshold]. It even comes back highlighted in red on the result sheet if it falls under that number. And I have clear instruction on what to do if that happens.

But nope.

That's interesting pricing. I just did some blood tests at Quest Labs w/o a Dr and it ran me $200

You got a cholesterol test and only a cholesterol test? That was what the parent comment is about. Tests vary a lot by test. LabCorp states their prices very clearly.

Walgreens also has cholesterol tests for ~30$ https://news.walgreens.com/press-center/news/walgreens-intro...

I read the comment wrong. I thought they meant a full test battery not just a cholesterol test.

Meh. Might be an American thing, if you watch TV or news the images of persons will be constantly telling you to ask your doctor about this, consult a medical professional before this other activity they advertise, and oh you gotta see a dentist every six months. Just demand creation, better just to get a blood-pressure test when you do see a doctor and a cholesterol test based on the result.

To be fair, all the ad revenue for pharma products on American television networks whose parents happen to own a news network also do a great job of building leverage against the pharma companies ever being investigated too deeply.

You can have perfectly normal blood pressure and high cholesterol FWIW

There is no real medical need for an ‘annual physical’ it is a creation of the American medical-industrial complex and creates more problems than it solves.

Having said that seeing a doctor occasionally for blood pressure etc is useful, but the interval for someone young and otherwise not experiencing any symptoms doesn’t need to be annually

Isn't there catch-it-early type diseases? Like breast cancer, testicular cancer, colon cancer, etc... that prove this wrong?

The funny thing is, the older you get, you are likely to have some sort of symptom. Such is life.

For blood pressure, I would expand and add general bloodwork for health conscious individuals or people with a family history for certain issues -- diabetes, liver, androgen, heart health markers.. Here in Canada you just need to mention you are interested for health reasons and a doctor refers you -- not sure how costly it is in USA -- but apparently private clinics are a choice to build custom panels.

I've heard many experts talk about issues with "catching disease early", one being that what doctors find might have never developed far enough to cause harm and so the treatment might actually be more harmful.

I don't want to risk trying to explain it from memory since I have zero medical knowledge, but there's a YouTube video by "MedlifeCrisis" about this that also has sources cited in the description. The title is something like "the problem with screening".

> one being that what doctors find might have never developed far enough to cause harm and so the treatment might actually be more harmful.

This is not a reason to not screen regularly. If treating very early is the problem then you should still aim to detect it early and then closely monitor it until you have enough information to decide whether to act or not. There are many people that will simply not go in for testing until there is a major problem if you advise against regular testing. A close family member of mine just passed away recently because he didn't go in for regular testing and they caught the cancer way too late.

For ‘catch it early’ you are talking screening. That’s why there’s cervical cancer screening (pap smear/the new cytology test), mammograms, faecal occult blood tests, in australia skin cancer screening, etc.

And that’s why people should have a regular doctor and that’s why as you get older you see your doctor more frequently. But for young(ish) otherwise healthy people, the whole concept of something ther occurs annually doesnt make sense.

In the other hand, since most screening and medical engagement is with females, you are left with lots of men who get into their 40s without ever having seen a doctor. So - if thats you - go and see one, build a relationship, and if everything is good ask when you need to come back for prostate screening, FOBT, cholesterol or anything else. All across the board is unnecessary.

With regards to your last point, I’m all for devolving autonomy and power to the patient, but frankly across the board wide ranging blood testing (especially regularly) just doesn’t make sense for a significant percentage of people, unless there is a high pre test probability or a significant family history. All blood results are managed at the 95% CI so if you go in and have 20+ blood tests then more than likely at least one is going to be out of order. All you need to do is visit the askdocs subreddit to see the immense anxiety and flow down effects that has on a population who have absolutely no way of understanding a slightly out of bounds result. Those private clinics trying to spin up and do ‘wellness checks’ are frankly in my opinion, and until the evidence proves otherwise, a parasite on the worried well

Shouldn't you at least do regular blood panels to check for prediabetes and the like?

If a person is otherwise healthy, no. Or at least, there is no medical indication to do so. But a person with pre diabetes is not generally otherwise healthy. T2DM is not a condition of a healthy person, it is a lifestyle disease caused by lack of exercise, poor diet and obesity. This person should see a doctor, but they’re not a healthy person. They should be aiming to exercise and reduce body mass.

Of course, but there are plenty of people that won't realize that without seeing a doctor.

> There is no real medical need for an ‘annual physical’ it is a creation of the American medical-industrial complex and creates more problems than it solves.

What problems does it create? Isn't preventive care a good thing? Also Japan does annual physicals much more rigorous that in the US. I wish what is done in the US was more rigorous because it would have caught the autoimmune disease that caused my kidney failure. Unfortunately by the time there are visible symptoms, the damage cannot be reversed.

Medicine can hurt as well as heal. A concrete example. Many doctors will advise you not to get a full body MRI scan. You can pretty easily buy such a service, and hire some radiologists to pour over every cubic millimetre of your body. But it's a really bad idea.

Because they will almost certainly find something ambiguous or troubling. And they're gonna biopsy. And then, well, maybe that's ambiguous. Another biopsy. You're terrified, the doctor's now worried about something they would never have known about otherwise, and maybe you have surgery to get it early. In the end the complications of all that quite potentially add up to a shorter life expectancy than simply not getting scanned in the first place. On average. Though of course, if you had a giant treatable tumour that shows up, well, you'd want the scan. But most people don't have one, and all those interventions can cause harm.

There are a couple of orders of magnitude difference between findings from a full-body MRI and a routine labwork run.

The correct takeaway is to use information responsibly, not to deny yourself information.

I agree in principle, but health literacy is so appallingly low - globally - that more often than not people are not equipped to deal with this information. As I said in an earlier post on this thread, look at the askdocs subreddit. 90% of the posts there are worried well asking for clarification of some unnecessary test they went and specifically asked a doctor for, the result of which they don’t understand and which is causing a cascade of health anxiety.

If every person understood enough to realise how many ‘abnormalities’ enough investigations would show up, and how in 99% of people they mean absolutely nothing, then it would be fine. But that’s not our current situation. And if you’re one of those people who are capable of parsing the dense health literature and understanding the implications (or not) of ‘normal abnormal’ findings, then go for it. But for the population as a whole? It’s not viable or helpful

People are too dumb to do that, even if they're actively trying to.

You can't do that unless you know the prior probability of everything you're looking for.

Preventative care is different from the concept of all round comprehensive annual physical as it has been propagated through the culture from the American experience (I practice in Australia, so am talking from what I see from time working there, and the trickle through effect culturally of Australians thinking this is something they ‘have’ to have).

Preventative care consists of positive health messages (smoking cessation, moderate alcohol consumption, healthy diet, exercise), early identification of at risk individuals through family history, obesity, and then population wide cancer screening. Preventative care does not mean take a dozen tubes of blood and a pot of urine on every person every year.

I’m really sorry to hear about your kidney failure

Annual checkups are just that. 1) Body weight measurements. 2) The doctor talking to you about whether you have any medical or life concerns. 3) The doctor sharing advice on diet improvements, smoking improvements, exercise plans, including providing resources for them. 4) Recommended screenings based on age. 5) 1-2 vials of blood to get basic health information such as glucose levels, vitamin levels, etc. 6) Urine samples are only required if you're sexually active with multiple partners to screen for STDs and is completely optional.

That's been my experience. Through the annual physical I've been able to handle several minor issues, which have materially improved my life, and identified a major diagnosis that goes undiagnosed in the majority of people throughout their lives, and leads to them living significantly worse lives than they would have otherwise. By identifying it early, I have a chance for a much better lifestyle, and reducing the odds of an early death greatly.

Let me be really clear, everyone should have a doctor. But the concept of an annual checkup, as though there is a process to it and if you haven’t been to the doctor in the last 12 months is something you have to go through, is not part of general medical care. For the average under 30, and even under 40 male, with no family history, you are literally just pissing money away ordering annual vitamin, hormone and at some level lipid levels (although occasional checks are definitely useful).

It's a legal requirement for employers in Japan and they seem to have come up with it on their own.

https://www.city-cost.com/blogs/City-Cost/MPyry-medical

Being Japan, it's pointlessly thorough and invasive.

The most invasive part is that they send the results to your employer. I initially balked at this, but you effectively don't have a choice if you want to work at a big company in Japan, although it's worth noting the legal requirement is on the employer to get the tests done, not on the employee to do it.

Annual checkups are not justified from an evidence-based medicine perspective for most healthy adults. They don't produce better outcomes.

https://sciencebasedmedicine.org/is-the-annual-physical-unne...

Annual checkups aren't necessarily fully covered by health insurance plans. However, other preventative care services are.

https://www.healthcare.gov/coverage/preventive-care-benefits...

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