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Comment by rubicon33 | Hacker News Reader

How do you go about getting a full blood panel every 6 mo? Doesn’t that come from your primary care doctor? Mine would think I’m insane if I asked for a full blood panel every 6 months at my age with no health issues. But I see the utility in it (trends in the data, anomalies, etc.). So how to do it?

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Yeah, you're right. No way in hell I could get my doctor to get a full blood panel every 6 months. Even if I could get him to get me one, he won't order all the stuff I want to see. So I use a boutique, turnkey telemedicine practice (I'm not sure how else to describe it). I order the blood panel and then go over the results with one of their expert patient care coordinators and then speak with one or more of their doctors as needed (all over Zoom). The one I use is Marek Health, but there are others (https://marekhealth.com/)

I think my initial intake was $200-300 to get the full blood panel and have a follow-up with a patient care coordinator as well as an appointment with the doctor (who is incredible). At the time I ordered the blood panel, I wasn't even planning on having a long-term relationship with them, but after seeing some stuff on my blood panel that I wanted to work on and having them come up with a plan, speaking to the docs regularly, I've just gotten so much value out of it. The whole thing made me feel like "wow, this is what healthcare should feel like."

Sadly, it's all out of pocket, but it's the last thing on the list of things I would complain about having to spend money on.

For some people, full bloods every 6 months might be overkill, I guess it just depends on what you have going on (not that I had major issues, but definitely things to address and others to optimize). But without a full panel, you're just flying blind. Sometimes, I get the panel and nothing has moved at all and there's nothing to do. Other times there are things I can easily address and the more panels I have, the more of a personal health profile I have to work with.

What physician is saying no to preventative medicine paid for by the consumer? Why do doctors think we are visiting for their benefit? I would be very interested in the arguments against blood labs. For the doctor, they draw blood and review results, which is something they do every day. For the patient, you draw blood and review results and pay for it, which is something normal people are not greatly inconvenienced by. The money may be the thing, but why would your physician know your budget? If you want a zero risk preventative procedure, the doctor should tell you how much it is, not give financial advice.

What argument would a doctor have against order a wider range of tests? The blood is outside of your body, and the physician is not in the lab running the centrifuge or mixing chemical agents to react.

Every Primary Care doctor visit I've ever had in my life (note: USA) felt like a cross between an assembly line and the DMV. It's all about rushing you through the visit as quickly as possible, spending as little time with the actual expensive doctor as possible, and getting you out the door so that other cu$tomer$ can get crammed through after you. Blood labs? They aint got time for that!

And nowadays, to make matters worse, I have to book an appointment for this delightful experience 2 months in advance for my existing doctor, and five months in advance for a "new patient visit" at a new doctor. Everything around Family Doctors says "go away".

> Every Primary Care doctor visit I've ever had in my life (note: USA) felt like a cross between an assembly line and the DMV.

Note that 'the DMV' is itself a bizarre American experience that a lot of the world doesn't put up with/find a need for.

It took quite a lot of references like this going straight over my head to look into this thing 'everyone [in the USA]' has to do and is familiar with and understand. (If I need a replacement driving licence or to change my address or whatever, I spend two minutes on a web form and it comes in the post. There just isn't 'a DMV' or equivalent office for me to (have to) go to.)

The reasoning I heard from a GP is: the more values you get back, the higher the chance of a false positive. A GP who has blood tested will do so based on your symptoms. Get the lab to do all the possible tests, and chances are at least one of them will be off but since you had no symptoms you’re going to have to test again since it might be a false positive. All this takes a lot of time and creates feelings of insecurity with the patient. So where I’m from, there are no ‘check-ups’ within insured or government funded health care, you strictly react on symptoms. There are only checks for specific forms of cancer and you’re invited for this specifically. Don’t know whether this is the best way, but it’s an explanation for the approach.

> What physician is saying no to preventative medicine paid for by the consumer?

its more common than you think; and many professionals resent the idea that its anything resembling a 'free market' where a 'consumer' (patient) can 'order services' without their provider's approval.

as you might imagine there are reasonable-sounding prima facie arguments for both sides of this discussion.

I have to fight with the doctor every time I want something he doesn't deem necessary.

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