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[biomancer]

(A) It is standard to run a "standard blood test panel" with any sample, at least in the US, but
(B) The lab tech screwed up - you do not need to fast for a hormone test, as estrogen/progesterone levels are not affected by when you eat, and
(C) I'd bet the lab forgot to test those hormones anyway, as that's not part of the standard test panel, and thus
(D) I'd get a new doctor - who uses a different lab.

(E) Furthermore, if you didn't fast, and especially if you ate a meat- or dairy-rich meal within 24 hours before the test, that will inflate your "cholesterol" count, so if it was "a little high" after you had, say, steak for dinner or a good dose of cheese for lunch, then ignore the test.  DO NOT let the doc put you on statins without having first run the "cholesterol" tests CORRECTLY - which is to say, you need at least two spaced over several weeks to come in high, and you need to avoid all animal fats for at least 24 hours before the test, and you need to fast. 

Biomancer, who would furthermore like to flog all doctors who misuse the term "cholesterol" when what they really mean are triglycerides and lipoproteins.

[treehugger1]

(B) The lab tech screwed up - you do not need to fast for a hormone test, as estrogen/progesterone levels are not affected by when you eat, ...

I don't think the tech screwed up. I think that the cholesterol test was indeed what my doctor ordered. I just didn't realize exactly which tests were checked off on the lab sheet. I just assumed (mistakenly of course) that they were the hormone tests I had requested.

(C) I'd bet the lab forgot to test those hormones anyway, as that's not part of the standard test panel, and thus

Well, ho ho ho ... I found out today, when I went to the gynecologist to get the blood test interpreted, that yes indeed, my primary health care Dr. (the one I've been complaining about) only ordered a progesterone level test and not the FSH and estrogen tests I needed to see if I'm menopausal. The gynecologist then said that the progesterone was "a little low," but was more interested in my slightly elevated cholesterol number (which of course, I don't care about).

Then, incredibly enough he tried to bully me into getting a screening mammogram. When I refused (for reasons which I explained to him) he got all righteous, called in the nurse and "publicly" said that I was irresponsible (!) and "playing Russian roulette with my heath". Oh give me a friggin' break.

(D) I'd get a new doctor - who uses a different lab.

Yes. A new doctor AND a new gynecologist!

[dellaroux]

I'm going to go back and re-read again, but it's sounding to me as if the wrong test was ordered, perhaps, and that's what is possibly being covered up.

If they won't tell you the results for the one you thought was being run, and are giving you levels that you didn't request, you might want to request a copy of the labwork order page to see what was actually checked off.

And I'd keep that when you go to see your next physician, which you should, I think, also, do.

Having worked for and with pharmas, and in hospitals and specialty offices as a staff assistant, it is truly necessary to follow up on things. Errors as well as complicit/self-interested orders can be placed, get mixed up, substituted, etc.

You have to be your own best advocate and care manager, because structures have changed so much that there is often no-one leading the team but the patient.

Good for starting on your assigned reading...

[unspoiled]

Then, incredibly enough he tried to bully me into getting a screening mammogram. When I refused (for reasons which I explained to him) he got all righteous, called in the nurse and "publicly" said that I was irresponsible (!) and "playing Russian roulette with my heath". Oh give me a friggin' break.

(D) I'd get a new doctor - who uses a different lab.

Yes. A new doctor AND a new gynecologist!

It really sounds like you don't trust any of your doctors at this point, which should be fine by us - you've interacted with them personally and we haven't.  Yet you trust an Amazon catalog book (bestseller?) written by a clinical instructor.  I'm a little confused.  Is it because it reads "anti-establishment" or because he's a clinical instructor and the book can be found in some university libraries?

As a fellow patient, I think it's our right to refuse any test or procedure, it's our body and our convictions which we're not required to defend nor here or there, since potential illness would result in hardship for us and our families alone, but this option has to be properly documented for everyone's protection, and this documentation process is just one part of taking responsibility for our decisions. 

I recently changed gynecologists for this very problem - insensitive bedside manner while debating options (never mind what the options were).  Now I am lucky enough to have found someone who is willing to work with me.  I'm also willing to work with him. 

I do independent reading as well, quite a lot of it, before I go to the doctor, because I like to ask informed questions, but generally a capable specialist with the authority of experience can silence all the theory I've read in books and articles in a less than a minute, while not necessarily contradicting it, but putting it in a different perspective I would have never thought about.  One advantage of medical school, in my view, is that it does teach doctors not how much they know, but how little they know, and where specifically to look for it. 

[treehugger1]

Then, incredibly enough he tried to bully me into getting a screening mammogram. When I refused (for reasons which I explained to him) he got all righteous, called in the nurse and "publicly" said that I was irresponsible (!) and "playing Russian roulette with my heath". Oh give me a friggin' break.

(D) I'd get a new doctor - who uses a different lab.

Yes. A new doctor AND a new gynecologist!

It really sounds like you don't trust any of your doctors at this point, which should be fine by us - you've interacted with them personally and we haven't.  Yet you trust an Amazon catalog book (bestseller?) written by a clinical instructor.  I'm a little confused.  Is it because it reads "anti-establishment" or because he's a clinical instructor and the book can be found in some university libraries?

I trust my GI guy, to a certain extent. So, no, I don't mistrust *all* of my doctors. Like you, I read a lot, connect the dots *and* I listen to what M.D.s have to say. Yes, I trust what I read on the Web ... if it rings true and explains the otherwise inexplicable.

Little personal story: I suffered for years (7, to be precise) with a debilitating pain disorder. I saw about 35 different medical practitioners, GPs, specialists, physical therapists, etc. Nothing worked, the disorder only degenerated to the point where I really could not function. So, finally, I decided to research the matter on my own full time until I found a solution . I did so after about a month, largely through the internet -- discussion groups and readings which eventually lead me to a practitioner (4 states away). This practitioner was one of the few in the country who got consistent results with this kind of problem. She was not an "alternative" therapist offering some strange New Age treatment. She was a fully licenced physical therapist (in fact, she was on the board of the American Physical Therapists association), offering a very non-standard, yet entirely evidenced-based approach. Long story short. After 5 months working with her -- I finally recovered almost completely, something all the other M.D.s said was impossible.

I do independent reading as well, quite a lot of it, before I go to the doctor, because I like to ask informed questions, but generally a capable specialist with the authority of experience can silence all the theory I've read in books and articles in a less than a minute, while not necessarily contradicting it, but putting it in a different perspective I would have never thought about.  One advantage of medical school, in my view, is that it does teach doctors not how much they know, but how little they know, and where specifically to look for it. 

I'm glad you have such faith in M.D.s. I'm glad you've had such a good experience. I believe that Med School teaches future doctors to approach problems in a certain, standard fashion. But *sometimes* standard practice is faulty and they are most certainly not trained to question that.

This is also why I personally find the internet (from this forum to various medical journals) so helpful when it comes to medical questions. If one is careful and uses common sense in evaluating different sources of information, one can sort the good from the bad in standard care and empower oneself to make one's own (informed) choices.

[unspoiled]

I'm glad you have such faith in M.D.s. I'm glad you've had such a good experience.

Little personal story: I suffered for years (7, to be precise) with a debilitating pain disorder. I saw about 35 different medical practitioners, GPs, specialists, physical therapists, etc. Nothing worked, the disorder only degenerated to the point where I really could not function. So, finally, I decided to research the matter on my own full time until I found a solution . I did so after about a month, largely through the internet -- discussion groups and readings which eventually lead me to a practitioner (4 states away). This practitioner was one of the few in the country who got consistent results with this kind of problem. She was not an "alternative" therapist offering some strange New Age treatment. She was a fully licenced physical therapist (in fact, she was on the board of the American Physical Therapists association), offering a very non-standard, yet entirely evidenced-based approach. Long story short. After 5 months working with her -- I finally recovered almost completely, something all the other M.D.s said was impossible.

I've had some good, bad, terrible, and indifferent experiences with MDs when it came to myself and my family, especially the latter since I wasn't in control of their prior health choices.  But "faith" is the right word.  I do start with faith in MDs I preselect based on certain criteria, and while it is possible for me to lose faith as I go, I take some responsibility in retrospect for the selection process, and maybe for the faulty chemistry/disconnect as well. This doesn't mean I keep seeing a certain physician if I don't respect both their judgment and bedside manner, and I don't blame myself excessively not being to click with a certain physician. I think it should come naturally, and there's plenty of them doctors out there.  I also like to have a PPO etc. I've never had a HMO and I don't think I could deal with something like that.  

I too am seeing a licensed physical therapist team.  I've just started and the results are already noticeable.  I found them on the Internet (came with excellent credentials including a published book, testimonies from patients etc.) and my specialist approves of the progress I've made although he didn't go through the trouble of researching them for me.  

If the physician is savvy, this shouldn't be a "us vs. them" thing.  Physical therapists should fulfill, and perceived as fulfilling, a complimentary not antagonist role.

[treehugger1]

I'm glad you have such faith in M.D.s. I'm glad you've had such a good experience.

Little personal story: I suffered for years (7, to be precise) with a debilitating pain disorder. I saw about 35 different medical practitioners, GPs, specialists, physical therapists, etc. Nothing worked, the disorder only degenerated to the point where I really could not function. So, finally, I decided to research the matter on my own full time until I found a solution . I did so after about a month, largely through the internet -- discussion groups and readings which eventually lead me to a practitioner (4 states away). This practitioner was one of the few in the country who got consistent results with this kind of problem. She was not an "alternative" therapist offering some strange New Age treatment. She was a fully licenced physical therapist (in fact, she was on the board of the American Physical Therapists association), offering a very non-standard, yet entirely evidenced-based approach. Long story short. After 5 months working with her -- I finally recovered almost completely, something all the other M.D.s said was impossible.

I've had some good, bad, terrible, and indifferent experiences with MDs when it came to myself and my family, especially the latter since I wasn't in control of their prior health choices.  But "faith" is the right word.  I do start with faith in MDs I preselect based on certain criteria, and while it is possible for me to lose faith as I go, I take some responsibility in retrospect for the selection process, and maybe for the faulty chemistry/disconnect as well. This doesn't mean I keep seeing a certain physician if I don't respect both their judgment and bedside manner, and I don't blame myself excessively not being to click with a certain physician. I think it should come naturally, and there's plenty of them doctors out there.  I also like to have a PPO etc. I've never had a HMO and I don't think I could deal with something like that. 

I too am seeing a licensed physical therapist team.  I've just started and the results are already noticeable.  I found them on the Internet (came with excellent credentials including a published book, testimonies from patients etc.) and my specialist approves of the progress I've made although he didn't go through the trouble of researching them for me. 

If the physician is savvy, this shouldn't be a "us vs. them" thing.  Physical therapists should fulfill, and perceived as fulfilling, a complimentary not antagonist role.

I agree with what you are saying and particularly this last point. The therapist I wound up working with did have a good, supportive relationship with (certain) M.D.s in her area. It's just that I personally did not happen to find her through an M.D.

You mention PPOs. Yeah, I've always insisted on that too. That's one of the reasons why I could actually use this therapist. (My therapist also found a way of working with my insurance company to extend my benefits from the supposed maximum of 3 months to 5 months. So, she was more than just technically proficience, she was also nicely bull-headed and savvy as well.)

Congrats on the physical therapy progress. Here's hoping you'll be painfree and fully functional soon!

[collegekidsmom]

I think MDs are great, when you are actually sick. I think there is also some concern these days about all of the testing that goes on. If I had symptoms, was in pain or had other reason to feel I needed a doctor, I think the motivation for going to a doctor is quite different. What happens now is that even when you do not have any health concern, there are all of these tests offered to find out just what MIGHT be wrong with you. So, do you have a colonoscopy, with its possible risks, just to find out that you don't have colon cancer, or mammograms with radiation exposure to find out that you don't have cancer? Do you have an escalating number of immunizations foisted on your kids? It doesn't make sense that everyone needs to have their breasts, prostates, and colons checked,while the rest of their bodies may be the ones growing some kind of cancer. After experiencing my family member coughing all the time and getting the runaround about bronchitis medications (when he actually had somewhat advanced lung cancer), I wondered why lung cancer screening wasn't more common. Why did he have to wait so long before diagnosis?
 
I also try to stay out of any doctors offices during the flu season as that is where the flu is likely to be. I never took my kids to the doctor if at all possible-and made physical appointments in the summer or other time when less sick kids were likely to be there.

I have always watched the "mystery diagnosis" kinds of medical shows on TV. They feature a person who has some strange variety of symptoms that it seems nobody has ever seen before.  I used to help people in a medical library with all of the medical literature in similar situations. I am amazed at how many patients now, after searching the internet by all kinds of symptoms and terms, are able to find out what's wrong with them after visiting many physicians. It's fantastic.

[inthelab]

They gave out medical results over the phone?  That sounds dodgy of itself.

No, it's common practice.

[inthelab]

Biomancer hit the main points I was going to type.
Find a new doc.

[bookishone]

What happens now is that even when you do not have any health concern, there are all of these tests offered to find out just what MIGHT be wrong with you. So, do you have a colonoscopy, with its possible risks, just to find out that you don't have colon cancer, or mammograms with radiation exposure to find out that you don't have cancer? Do you have an escalating number of immunizations foisted on your kids? It doesn't make sense that everyone needs to have their breasts, prostates, and colons checked,while the rest of their bodies may be the ones growing some kind of cancer.

Although I'm apparently in the minority on this thread, I have to comment here, probably a bad idea. It's not  excessive for a physician to urge any patient to have an appropriate screening test. The millions of standard cholesterol tests, mammograms, and colonoscopies ordered and performed in this country save lives as well as health care dollars. If you're a female over 40, or under 40 with a family history of breast cancer, it's your gynecologist is certainly not out of line in urging you to get a mammogram, even just a baseline mammogram. It's up to you whether or not to get one, of course.

I have to wonder if some of your issues with your doctors derives from what seems to be an assumption that you and they are naturally in opposition. Yes, your doctors are covering themselves by ordering the standard diagnostic tests for someone of your age and family history (whatever those are); but they're also trying to help you out by identifying small health problems while they're still fixable before they become big and expensive. Insurance companies only pay for screening tests that identify common and fixable problems in a large population. They won't pay (I imagine) for a cholesterol test for a 9-year-old unless there's a history of familial hypercholesterolemia, but if you're an American adult who hasn't had your cholesterol checked in a few years, yes, that's a reasonable test to run, both from your point of view (catch it early) and from your insurance company's point of view (catch it while it's cheap to fix). I do agree that your doctor should have told you he was running that test as well, but it's likely just one of the things that gets included in the "standard blood test" set for all of the reasons above. And I don't blame you for not wanting to go on a statin, but the reasoning behind the standard cholesterol test is at least partly because it's useful to know about cholesterol increase while it's still at a stage where you can decrease it through food and lifestyle changes.

If more people had access to these basic screening tests and the preventive care they enable, our health care system would save both lives and money.

[kaysixteen]

Thread is interesting-- let me ask a question along a similar line: I like my primary care MD (who does double as a cardio, though I do not (thankfully) need these services yet).  I do have ongoing issues for which I take meds, and I get bloodwork prior to my appts. with him.  We have several decisions pending as to the long-term direction of my treatment.  I last saw him in March, and he wanted me back in June, but the day of our appt., he cancelled, secretary saying there was an emergency he needed to attend to in hospital.  He told her to just schedule me another appt. in the queue, that he did not need to see me asap unless I felt sick (I didn't), so we scheduled next available appt., which was mid-August.  The day of this appt. his sec cancelled again for same reason, again only making next available appt. for mid-Oct.  I feel now that I really do need to have him keep this appt., or, if he ends up unable to do so, that he should get me in asap thereafter, rather than wait for the two+ month queue to free up space again ( I am thinking, based on my visits to his office, etc., that a big part o fthe problem is that he likely has too many patients), but, should he have to cancel again and the secretary does try to reschedule according to the queue, potentially weeks later, what, if anything, should I say?  Also, when, if ever, might I decide that:

1) he really maybe does not want to be my doctor anymore
or 2) I should look for another primary myself

[unspoiled]

I think MDs are great, when you are actually sick. I think there is also some concern these days about all of the testing that goes on. If I had symptoms, was in pain or had other reason to feel I needed a doctor, I think the motivation for going to a doctor is quite different. What happens now is that even when you do not have any health concern, there are all of these tests offered to find out just what MIGHT be wrong with you.

As they say, "it's easier to prevent than to cure."  One of the social ills in the part of the world where I come from is that there's not enough emphasis on preventive medicine.  Again as a patient, I have one chronic condition which could have been easily prevented provided some action were taken to figure out what MIGHT be wrong with me when I was a happy, well-adjusted, well-read child.  When I became old enough to internalize and verbalize my symptoms and limitations, it was too late for treatment and the respective function was compromised (too late even for physical therapy, I do that for a different condition that surfaced later in life and which holds brighter prospects).  I don't hold a grudge, those were the times, but I'm not going to let that happen again to anyone in my family as long as I can help it.  

So, do you have a colonoscopy, with its possible risks, just to find out that you don't have colon cancer, or mammograms with radiation exposure to find out that you don't have cancer? Do you have an escalating number of immunizations foisted on your kids? ... I wondered why lung cancer screening wasn't more common.

What Bookishone said here (appropriate screening test - in the general population and also based on individual risk factors) is the key.  If you work(ed) in a medical library, pick up a textbook/review book of Family Medicine and the logic behind the screenings will not seem that bizarre. As for immunizations, I'm from Eastern Europe so I've had a bunch of childhood infectious diseases they vaccinate here for and I was "fine,"  together with all my classmates.  My father however became afflicted in adulthood while nursing my brother from one of those (my father had so many siblings they had forgotten who had had which disease, and just assumed he had had it at some point as well) and my father had severe complications.  Again as they say, "there are no diseases, there are patients."  

I have always watched the "mystery diagnosis" kinds of medical shows on TV. They feature a person who has some strange variety of symptoms that it seems nobody has ever seen before.

I used to like those TV scenarios as well but I find the more exotic they get, the more formulaic they get as well - an admirable collection of zebras (this is inspired by a saying in clinical medicine: "When you hear the noise of hoofs, think about horses, not zebras").  Rare diseases are, well, rare in the general population.  They're not that rare if one already has known certain genetic or environmental risk factors that make one a suspect.  

I am amazed at how many patients now, after searching the internet by all kinds of symptoms and terms, are able to find out what's wrong with them after visiting many physicians. It's fantastic.

You mean they self-diagnose?  

[biomancer]

Thread is interesting-- let me ask a question along a similar line: I like my primary care MD (who does double as a cardio, though I do not (thankfully) need these services yet).  I do have ongoing issues for which I take meds, and I get bloodwork prior to my appts. with him.  We have several decisions pending as to the long-term direction of my treatment.  I last saw him in March, and he wanted me back in June, but the day of our appt., he cancelled, secretary saying there was an emergency he needed to attend to in hospital.  He told her to just schedule me another appt. in the queue, that he did not need to see me asap unless I felt sick (I didn't), so we scheduled next available appt., which was mid-August.  The day of this appt. his sec cancelled again for same reason, again only making next available appt. for mid-Oct.  I feel now that I really do need to have him keep this appt., or, if he ends up unable to do so, that he should get me in asap thereafter, rather than wait for the two+ month queue to free up space again ( I am thinking, based on my visits to his office, etc., that a big part o fthe problem is that he likely has too many patients), but, should he have to cancel again and the secretary does try to reschedule according to the queue, potentially weeks later, what, if anything, should I say?  Also, when, if ever, might I decide that:

1) he really maybe does not want to be my doctor anymore
or 2) I should look for another primary myself

Kay, I think the big question I'd be asking in your situation is:  what is the time frame for an appointment when it's you that has the emergency?  For example, if you came down with flu (normal, swine, bird, whichever) tomorrow, could your doctor fit you in fast enough to get you on the appropriate medication (tamiflu, relenza) within the 72 hour window that the drug actually works?  If the answer to that is "no" then it's definitely time for a different doctor.  Part of why I liked my doc in SLACville so much is that she could always get me in within 24 hours, and often the same day.

[treehugger1]

Although I'm apparently in the minority on this thread, I have to comment here, probably a bad idea. It's not  excessive for a physician to urge any patient to have an appropriate screening test. The millions of standard cholesterol tests, mammograms, and colonoscopies ordered and performed in this country save lives as well as health care dollars. If you're a female over 40, or under 40 with a family history of breast cancer, it's your gynecologist is certainly not out of line in urging you to get a mammogram, even just a baseline mammogram. It's up to you whether or not to get one, of course.

But this brings us back to the issue that standard practice is sometimes wrong. No one would question a doctor's urging someone to have an appropriate exam (although attempts at belittlement and shaming should, I would think, never be acceptable). However, what is "appropriate"? The standard now, as you mention, is that women over 40 should have regular mammograms. (I believe this is the AMA standard.) However, there has been some very credible research that shows that this standard should be questioned -- that women in their 40s, particularly premenopausal women should not get regular mammograms, for a whole host of reasons: 1) Their breast tissue is denser, leading to higher false positives and negatives 2) there is more life-long exposure to radiation 3) the smaller cancers that are found and treated might never have become dangerous, etc.

This report on the Cochrane meta analysis discusses some of the complexities of screening recommendations -- and does a fine job unpacking the statistics. Example: "This means that for every 2,000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if not screened, will be diagnosed with breast cancer and will be treated unnecessarily." (Notice the false positive risk?)

Unfortunately, I am quite sure that the average family doctor or gynecologist does not spend 15+ minutes discussing the pros and cons of screening mammograns in honest detail -- they merely "urge" women to get them.

In my case, my gynecologist kept insisting that I had a 1 in 8 chance of dying from breast cancer (if, it was implied, I didn't get the mammogram regularly.) I did a little research. First, according to statistical calculators on line, I have not a 1 in 8, but between a 7.5 and 9% chance of breast cancer given my particular set of predisposing and protective factors. Second, my gynecologist made it sound like I had a 1 in 8 chance of getting breast cancer really soon -- like this month or next -- not over the course of my entire life. (These statistics assume that the woman will live to 90, BTW.) The on-line calculators, however, broke up the breast cancer risk into decades. I have something like a .2% chance of getting BC in the next five years.

Next, we have the question of relative vs. absolute risk. According to the Cochrane report, mammograms reduce risk in a certain set of patients (over-50, I believe) by 15%. But the absolute risk is much smaller. In my case, if mammograms were to reduce my chances by 15% (relative risk), I'd have a little less than 1.5% lifetime reduction in risk. That's kinda tiny, actually when you think about it. And that doesn't even factor in the risk of false positives, the call-backs for repeated tests, the worrying, the money spent on exams, the time taken off work, etc.

In any case, like I said, it is the rare doctor that actually spells out risks and benefits of this (or other kinds of screening) for their patients.