Comment by cesarbs | Hacker News Reader

Comment by cesarbs | Hacker News Reader

I was just talking to my wife about this. I've recently been to the doctor because of some headaches I was having. They did some blood work, and when it came back I got a call from the doctor saying we should check my liver function again in 3 months. I wasn't very concerned because ever since I was a kid I have heard that (I guess some normal values for me are outside the range considered normal for most people).

This week, I logged in to their patient portal because I wanted to look at some previous blood test results. I was absolutely startled when I saw that my AST and ALT counts were pretty high, about twice the upper limit for what is considered normal.

But then I realized that I had that blood work done around the time I had started strength training and increased the amount of protein in my diet. A quick online search revealed that a single strength training session increases AST and ALT levels for up to seven days. Considering I had been exercising multiple times a week, it was completely normal for my levels to be elevated.

Now, why didn't the doctor simply ask me if I had been strength training? Such a simple question would have explained the abnormal test results and saved me some distress.

The part that blows me away is that you have a patient portal and can see your test results online.

I thought that was a common thing. Where do you live?

I've been to doctors in New Jersey, Pennsylvania, and Florida, and never heard of any such online system for reviewing your results. There's no incentive to provide the results to the patient without an in-person consultation they can bill the insurance company for.

This year is the first for physician attestation for MUS2, give it some time. Chances are you will have to actively ask for login information if you are seeing a doctor in a small(er) private practice, as it's likely not a core priority of their EHR software (think 'it's there because it has to be, not because we actually expect anyone to use it'). Of my 6 doctors, 3 have EHRs with patient portals, but none of them are populated with encounter data or visit notes; two don't use an EHR and one is associated with UCSF and uses Epic, so I get MyChart.

Last month I was trying to get a copy of my MRI from UCSF, but their cd burner on the PACS was down. They are participants in RSNA image share so patients can opt to import scans into a portal but it took me 3 people in the radiology library before finding someone who knew anything about it.

Yes there is,.. the empowered patient,.. Nj Hitech has just has assisted 5,500 physicians to EHR's systems, the hospital's are required as well. Patient Portals (PHR's) will follow. We are a start up working with Personal Medical Records (PHR's), making it feasible for you to use set aside insurance funds for wellness products ad services. Keep the faith, maintaining your health and promoting wellness is getting easier !!

Meaningful Use - Stage 2. Completely amazing to me that more Americans have no idea what's going on in health IT.

Recently rolled out at my local hospital. The best part is I get e-mail reminders for all appointments. I also get an e-mail notification when a test result has been logged.

AST and ALT change all the time. Depending on circumstances, 2x normal isn't particularly notable. Also, strength training isn't necessarily the cause nor is it something a doctor automatically, nor even commonly, flags for concern. The doctor should have asked you about changes in your daily routines, but you have to give them the benefit of the doubt. It's only the doctors job to find relevant data regarding your chief complaint. If they thought 2x changes were something to care about they would have followed up with you about that.

Not to be impolite but only to make a point: if you read enough to be distressed, you could have read enough to de-distress yourself.

your doctor knew it was probably unimportant, could be caused by a myriad of things, and a repeat blood test in a few months would be normal and mean they could forget about it.

Because of the patient portal with its ability for patients to access info they don't understand the significance of, you were "absolutely startled" and "distressed". If you didnt have access to those results then you wouldn't have been concerned.

Regardless of all that, you should still have repeat LFT's because you don't know for sure that "strngth training" was the cause of the problem.

Honestly, Doctors find navigating the minefield of clinical decision making difficult enough, trying to make judgements on sensitivity/specificity of tests and investigations, positive predictive values, remove confounding, drug company propaganda, publication bias etc etc without patients trying to get into it all as well. Should I spend 1 hour explaining to every fucker with a headache why a CT head is more likely to cause brain cancer than it is to diagnose it?

The solution to the US healthcare woes is NOT more patient autonomy and decision making. The solution is moving towards a less money orientated system and trying to encourage altruism and alignment of patient's goals with doctor's actions.

Should I spend 1 hour explaining

Yes, absolutely. Medicine needs to descend from its status as a high priesthood and be a little more accessible.

The question is if that's the best possible use of his time to improve the lives of the most patients.

A stereotypical micro vs macro problem where the best possible micro solution is likely not the best possible macro solution.

To some extent its a systemic problem with levels of support. Every customer that calls into a call center claiming space aliens are controlling their minds should not be transferred to argue with the VP of software development for an hour.

Possible solutions: reduce the scarcity of doctors capable of explaining ionizing radiation, add more non-doctors who can do more than just draw blood and check vitals, etc. Part of the macro problem is that a lot of micro problems are caused by insufficient communication and a lack of patient knowledge.

They're called "nurse practitioners" and it's a massively growing field.

> Should I spend 1 hour explaining to every fucker with a headache why a CT head is more likely to cause brain cancer than it is to diagnose it?

Absolutely you should. Because the beauty and the curse of the American health system is that patients can and do find other doctors willing to perform meaningless tests (as the article points out: because these tests are lucrative). If CT scans are more likely to cause a brain cancer, shouldn't the patient be informed?

> The solution to the US healthcare woes is NOT more patient autonomy and decision making.

No, more patient autonomy and decision making is happening regardless of whether it is a solution or a problem for the health care system. Medical professionals need to accept that patients are more informed than ever, and work with that fact instead of against it.

Imagine if the software industry had the same attitude (saying this with tongue firmly implanted in cheek).

> Should I spend 1 hour explaining to every fucker with a headache

I have a fairly qualified job in IT, and I regularly spend hours explaining trivialities to my clients. That's part of the reason why they hire me.

(Also, that particular question should not take one hour to explain unless the problem lies elsewhere -- it should be an order of magnitude less if your time is expensive.)

That this question would even seem to make sense, let alone phrased in a condescending tone, tells me there is a self selecting culture with some room for improvement there.

It's interesting that your comment is an nearly exact replica of my PRIOR comment and is the top comment for the thread and mine is the bottom. It's even more interesting that the only thing you added was an utterly non-starter solution (see below). This fits with my growing realization that the HN community is much more nascent for "Hacker" discussion in any area besides software. Sure software development, but biology (my area of expertise), fuggedaboutit.

> The solution is moving towards a less money orientated system and trying to encourage altruism and alignment of patient's goals with doctor's actions.

Altruism essentially never saves any ships. That's just not how the world operates. It's always about money. The only alignment that will work is more money going towards doctors.

> Altruism essentially never saves any ships. That's just not > how the world operates. It's always about money. The only > alignment that will work is more money going towards > doctors.

In the (non-US) hospital I work we have a really exceptional bunch of general surgeons. 4/6 of them are work-a-holics, 3 work only in the public system (basically halving their salaries c/f if they did a day a week in private practice). They routinely work from 7am til 7pm, love operating, will come in on weekends when they are not on call to see and operate on their patients. The others do small amounts of private work but are still really focused on their public work.

These guys have some degree of martyr complex, some degree of being workaholics, enjoy the status in the community they get from being seen as hardworking altruistic surgeons. They get a truckload of work done and really provide a great service for their patients.

This is not universal but other departments in the hospital have similar personalities.

These kinds of people are the ones that keep a socialised health system going. I think they would really struggle in a for-profit health system because it is really difficult to remain altruistic and go beyond the call of duty consistently when you feel like others are not. When your colleagues are being lazy, when your hospital/insurers are trying to rip you off or tighten the screws, or forcing you to spend large amounts of time doing paperwork and claims. When you feel like you are having to bankrupt your patients by operating on them. All these things make you bitter and stop you caring and performing for your patients.

Truth is most doctors don't know the difference between the theory of relative risk and theory of general relativity.

This exact thing happened to me - at the Mayo Clinic, of all places.

I found the same info after the initial test, then refrained from lifting for a week before the follow up lab work. Tests were normal the second time but had they not been, I'd have been given a (presumably more expensive) ultrasound.

My only guess is that the lifting-bad-liver-panel effect isn't something that happens often, since so many people strength train these days.

>I logged in to their patient portal

Is this "Patient Portal" software some kind of off-the-shelf crapware? It is terrible.

Unlikely. It's probably the healthcare organization's version of Epic's MyChart which gives patients the ability to access some of their own medical records.

Epic seems to have completely taken over EMR... And watching doctors and nurses try to use it, just wow.

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