TV doctors say annual checkups save lives – real doctors call bullshit (2016)

On my latest attempt to make an appointment they said that I am no longer a patient because I didn't come in during COVID, and that I would have to wait to get back in.

I decided I'd just go without until something bad happens. So far so good.

How do you know if you’re at high risk for something? This assumes a medically literate and motivated person will seek care based on … what? Realizing that grandpa, great-grandpa and dad all didn’t live past their 60’s? High cholesterol and hypertension can be “silent killers” - how do you know to check for them?

https://en.wikipedia.org/wiki/Base_rate_fallacy

The blood test comparison of healthy me to sick me was invaluable, because the healthy tests established a baseline of my system at peak condition.

Your attitude is actively harmful, real people suffer with uncaught diseases because we don’t routinely test “”healthy”” people.

The way to make a checkup cost less is to pay doctors and nurses less. There are no pharmaceuticals, no surgeries, no complicated specialist medical equipment, and no expensive labwork involved in the price.

Society generally doesn't agree with the notion that doctors and nurses should be paid less. Therefore, checkups are more or less priced appropriately. Paying high skilled labor for their advice simply costs a lot of money. Ask any dev contractor here on HN.

For example a low price test with almost zero both false positive and negative rate whose associate treatment has low cost and risk and that can save life of patients seems to me a test that should be applied to anyone at risk.

Proactive care is good. Testing is good.

However the insurance / healthcare cartel behaviour that's fuelled as a result is devastatingly expensive.

What does this mean? Which issues? How many thousands of diseases are there?

I have a friend who has low level of energy, everyone was calling him lazy his entire life. He thought thats just how life is. He cannot compare how it feel to be him with how it feel to be someone else.

I convinced him to see a doctor about this at the age of 25. First doctor didnt take him seriously, didnt want to do any tests. The complains are very non-spesific. maybe you are lazy, maybe you are depressed.

After weeks of fighting the medical system he discovered that he had a digestive issue, which led to low level of iron and low level of enegy. His entire life he was suffering from an easily treatable problem.

Imagine he treated this at the age of 12, how many sports did he miss out on, how much academic achievement was missed, maybe his career and life trajectory would be different.

A friend of mine struggled with back pain for 3 years. He coupst find the cause. It got so bad, he thought he'd become disabled. He left UK and went back to Romania to have support of his family. Suffenly in Romania he started getting better. Turned out it was vitamin D defficiency.

I started taking Vitamin D agressively, 2,000 units daily, 5 times the recommended amount by the NHS. After taking it for 6 months I went private and did a first vitamin D test in my life - my level is 1/3 of normal.

So how doea one know what is normal, if most people gp their entire life without ever doing a full blood test

remove the insurance ability to negotiate prices.

Ensure American's right to Healthcare.

* you can't get paid by insurance unless you have payment authorization from the patient on an estimate that is within 30% of the actual price (exceptions for emergency care).

* a requirement that all provider participate in an digital marketplace where patents and providers can get immediate quotes for labs/procedures and you get a list of local options+prices.

* anti-trust break up of healthcare cartels

* some price cap like 200% of medicare negotiated rates as a backstop for these really crazy outlier bills.

Ultimately, even the nerd doctors will send you to a specialist if you need it.

I like my current doctor a lot. He runs his own independent practice and is just generally really cool.

Insurance however is selling to the customer and the government, it's easy to cover the fake bullshit.

Citation needed

I do worry about overuse of antibiotics but I know a lot of times it just doesn't "go away without", or the viral infection ends up evolving to a bacterial one

Though what the doctors should do is give the prescription but say just to take it if the situation doesn't improve. This way you save a return to the doctor if it doesn't get better.

Around here common illness kids can come back after 24 hours of symptom free (daycares dont ask how they became symptom free). Super contagious like pinkeye requires doctors note that it's not pink eye, or put on a treatment plan.

This is irresponsible, tackling AMR is a WHO priority and local guidance (e.g. NICE, I don't know about the states - is it ICER? the CDC?) should reflect this and steer away from "just in case" antibiotic prescriptions.

From a friend who was involved in health care analytics decades ago, they'd frequently find that specific norms of healthcare practice depended highly on senior medical personal (e.g., a head physician within a department), and that you'd find major differences in standards both at different-but-comparable groups and at the same group following a major personnel change (retirement, moving elsewhere).

Another friend doing roving-doctor work at a number of smaller clinics and facilities described wildly different standards amongst physicians specifically regarding antibiotic prescriptions (my friend resisted prescribing them without specific indication, other doctors offered them as a default).

As with many other aspects of the world, what we observe directly is very much through a drinking straw (if you can find one of those any more): it's a very narrow view. This doesn't mean your experience is invalid or even infrequent. It does mean that it's likely not especially generalisable.

That said, what seems to change overall behaviours most is standards and norms being applied through policy, whether institutional (think Kaiser in California) or at the governmental level (government-offered services, etc.). Thought comes to mind that much of the US is now experiencing the negative aspects of that last, as with many tools, it can cut both ways.

Healthcare in Europe is not free. You're taxed for it quite highly.

Calling this system "healthcare" is too generous. It only exists to keep people from complaining, and healthy enough so they can be productive enough to be taxed. There is no care.

Imagine you are an insurer and advise free annual checkups. Some of your patients don't bother. Those patients have a higher mortality. You conclude the annual checkup is good.

But you might be deceiving yourself - the kind of people to ignore health advice about getting an annual checkup might also be the kind of people to ignore the health advice on the back of a cigarette packet...

That or it's yet another example of selection bias. There have been so so many things like this where the epidemiological data shows a correlation with health, but there isn't actually a causal link. For example, annual checkups might correlate with better health because it's a more common behavior among people who can afford to do it, and wealthier people tend to be healthier.

In the case of annual checkups, I believe insurance companies are required to cover them 100% by the Affordable Care Act:

https://www.hhs.gov/healthcare/about-the-aca/preventive-care...

s/better/cheaper/

They tried to bill me for that in the past at practices I was a patient of. There's a fine line between preventative care and E/M. You can generally walk the "preventative care" line by presenting your concerns as an observed change to be documented rather than a problem to be solved.

If they do charge you, call the office to appeal the billing and they generally drop it as long as you can push the point that you weren't seeking a specific treatment but rather were just informing the doctor of a change in your health or conditions since the last visit.

how are insurance companies (in the US) supposed to achieve this, when it is generally acquired through an employer?

If you're otherwise healthy you're not visiting the doctor at all. So where are these checking and screenings happening for adults?

More relevant for the insurer (which might help explain why an insurer is urging checkups) living until 80 with diabetes and on dialysis is much more expensive than living healthily until 80.

The point is that knowing you have a disease allows you to treat the disease, which one would hope would reduce your chances of dying or becoming disabled.

This overstates the impact of the Nordic study. If you go to the original article[0] you can see why, this study had very low participation and event rates which limits how strong of a conclusion we can draw from this as treatment effects may not be accurately reflected (for example in some countries the colonoscopy arm only had 32% participation). We also have historical studies looking at gFOBT and flexible sigmoidoscopy showing mortality benefits which can be extrapolated to colonoscopies. For a full picture of the evidence behind colon cancer screening I would suggest referring to the USPSTF which provides a publicly accessible summary and rationale[1].

With respect to developing countries, colorectal cancer (and living long enough to suffer its sequela) is mostly a developed country problem although this is changing.

In recent years, we have been seeing a surprising rise in colorectal cancer rates occurring at younger ages presenting with advanced disease which has led to the USPTF lowering the recommendation for screening to 45 from 50. With this trend in mind and historical data, we would really need extremely strong evidence to make the claim that screening colonoscopies are ineffective which the Nordic study does not provide.

> Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial.

This is just boldly incorrect and a VERY dangerous statement to make. The article you link to is entirely irrelevant as it looks at acute hypertension which is a very different beast, this article is describing what we call permissive hypertension in medicine. We have known for several years now that we do not need to tightly control inpatient blood pressures (which are often temporarily increased due to stress/illness) and that doing so is harmful. This says nothing about the consequences of untreated chronic hypertension in the outpatient setting.

For treatment (beyond the scope of USPSTF which does provide a grade A recommendation for hypertension screening) we can turn to the ACC[2] which also helpfully provides an evidence synthesis specifically drawing your attention to:

"In a meta-analysis of 61 prospective studies, the risk of CVD increased in a log-linear fashion from SBP levels <115 mm Hg to >180 mm Hg and from DBP levels <75 mm Hg to >105 mm Hg. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease."

[0] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

[1] https://www.uspreventiveservicestaskforce.org/uspstf/documen...

[2] https://www.ahajournals.org/doi/full/10.1161/HYP.00000000000...

If I didn't go in for an annual physical, I'd never get tested or screened for a single thing. I'd never have blood work done. Because when else do I go to a doctor? How else would I know?

That's what baffles me here. Your annual physical is the launching point for everything preventative. It's the only time you ever see your doctor if you're otherwise healthy. Saying no to annual physicals means saying no to literally all screening, or am I missing something?

https://news.ycombinator.com/item?id=35516775

This relies on the assumption that the physical examination has useful sensitivity or specificity as a screening tool which is untrue.

As an aside, MRI screening is not supported by evidence with the exception of select patients for breast cancer and people with hereditary cancer syndromes.

- Abdominal aortic aneurysm

- Bowel cancer

- Breast cancer

- Cervical cancer

- Diabetic eye screening

Patients with early symptoms of e.g. skin cancer can get moles checked out free of charge, and the yearly dental & vision check will screen for conditions like oral cancer and glaucoma.

The harm of something like a yearly colonoscopy in the general asymptomatic population would far exceed the potential benefits.

Feel free to do salutation to the false god of large scale metastudies :).

Here you already know causation. Early diagnosis is proven of great benefit for many diseases. It's more effective to specially study different groups of people and see what does and doesn't work.

Btw here breast cancer is biannual indeed, annual if you had it. Might differ per country.

The shaman does their useless ritual once a year and people are satisfied they are protected from black magic until the next annual checkup.

"periodic health maintenance visit" or just "periodic health check-up" is more of the newer academic/formal medical term (for example on UpToDate which is a very strong authority in clinical practice) but in real practice (when I used to do this) we also used annual checkup or physical. This was both with patients and other health professionals, it's just easier and it doesn't make a practical difference to you or me but in the context this article they're mostly referring the actual old annual physical exam.

> It seems like "periodic health maintenance" is necessarily a part of an "annual physical/checkup", just the same as a quick physical inspection is part of your annual as well.

> But that Vox is ignoring the "periodic health maintenance" part?

Keep in mind this article was written in 2016. This is from the article (emphasis added):

>"Almost nothing in the complete annual physical examination is based on evidence"

I was in residency around then and it was in the early days of screening evidence and tests becoming available and cheap. This was before even all the fancy new colon cancer stool tests came out and it wasn't that long before this article came out. We were even routinely ordering unnecessary labs like screening liver function tests and checking urine (which still happens sadly) on 30 year olds once a year who are in completely good health.

I think when this was written the annual physical actually meant an annual physical with a laundry list of unnecessary labs, but it was transitioning to the period where we use those words to mean a visit primarily aimed at evidence-based primary/secondary prevention and during peak "Choosing Wisely" campaign to reduce unnecessary investigation. I think the authors agenda is positive but seems misleading in the context of 2023.

Honestly, in my opinion if you're palpating an aortic aneurysm these days you're practically a nutjob but people (and myself) were absolutely doing this circa 2016. This is what that looks like[0], so even if you have someone skinny enough that you can feel this through their abdomen (the aorta is in front of the spine) we're pretending this is anything more than voodoo when we have cheap ultrasound (if appropriate).

[0]https://i0.wp.com/medicine-opera.com/wp-content/uploads/2016...

Your annual physical is where those things happen, or get scheduled.

That's what baffles me about this article. My annual checkup is pretty much the only time I ever see my doctor at all.

You get tested every few years and adjust diet/supplements/exercise based on the findings.

You wake up in the morning and have a piss. Your piss is measured for various chemicals from simple ions to proteins. It detects you have too much sodium so it communicates to your food dispenser and your bacon ration is reduced. (Yes that's from The Island.) You then get dressed in front of a camera which counts your moles and freckles. It sees a new one so you get a notification that your Touch Grass(TM) session is shortened.

When you get to work your workstation monitors your alertness to ensure you sleep enough. It detects your attention drifting 5% more than tolerated so another notification comes in letting you know Lights Out(R) is now 15 minutes earlier.

You attend a social gathering after work but your purchase of an alcoholic beverage is denied because a blood test last week showed a liver enzyme was elevated 1% out of the baseline range.

Telling people information in a manner that leads people into take the wrong conclusion from it -- "they're useless stop going to them" is really dumb.

You can say damn near anything citing only true information along the way.

How, exactly? What's the risk of death at an annual checkup? Hitting your knee a little too hard with the reflex hammer?