s/o New Recs on Yearly Paps and Annual Physicals

[dogmom]

Originally Posted by brittone2

Just back to say that in my inbox this morning, medpage today had a link to this BMJ piece titled, Preventing Overdiagnosis: how to stop harming the healthy.

http://www.bmj.com/content/344/bmj.e...9I&keytype=ref

One snippet from the above:
Diagnostic scanning of the abdomen, pelvis, chest, head, and neck can reveal “incidental findings” in up to 40% of individuals being tested for other reasons.15 Some of these are tumours, and most of these “incidentalomas” are benign.

Not just that. I work in trauma, the trauma surgeons are backing away from those pan body CT scans to detect hidden trauma. The chance of these scans causing cancer in younger trauma patients are significantly higher than detected some hidden bleed or something that would not get detected in time by the health care professionals and lead to death. The risk/benefit ratio is not in the patient's favor. But you have the patient right there in front of you, sometimes demanding a scan, while they will get cancer decades later and not even come see you.

[fivi2]

I haven't been to a regular doctor in more years than I can remember (8? maybe longer). I intend to go to my ob/gyn yearly, but more often it is longer. (I know I had about a 4 year gap after my girls were born). My gyn doesn't function as a pcp, just an ob/gyn.

I always intend to go more frequently, I just never make time for it. Now that my migraines are getting more frequent, I will probably find a dr. soon. I am allergic to most antibiotics, so I haven't bothered to find a pcp for when I get minor illnesses. (knock on wood...) I am 38 yo, if it matters...

[Katigre]

Originally Posted by dogmom

Not just that. I work in trauma, the trauma surgeons are backing away from those pan body CT scans to detect hidden trauma. The chance of these scans causing cancer in younger trauma patients are significantly higher than detected some hidden bleed or something that would not get detected in time by the health care professionals and lead to death. The risk/benefit ratio is not in the patient's favor. But you have the patient right there in front of you, sometimes demanding a scan, while they will get cancer decades later and not even come see you.

This is great news b/c a few years ago the vast majority of ER dr's were saying that CT scans weren't much radiation and worrying about them wasn't a big deal. This is one reason I am somewhat scared to take my kids to the ER b/c of how heavily CT scans are pushed as if they're 'no big deal' when in fact they ARE a big deal that need to have the cost/benefit ratio taken into account. I always shudder when I hear about the multiple CT scans people have performed without a second thought. It seems like they're sometimes used as CYA for the hospital (or maybe b/c they're fast and also $$$) instead of being diagnostically important.

Ex. If my child is having abdominal pain and I suspect appendicitis, they clearly need to go to the ER. The ER is most likely going to recommend a CT scan to verify appendicitis or not - even though abdominal CT scans are high in radiation with a great er lifetime risk of cancer as a result of getting JUST ONE. Yet studies have found that using an ultrasound has just as high of an effectiveness rate as a CT for finding appendicitis in children (and there is no corresponding radiation exposure). I've talked with DH and our babysitters about how I do not want a CT scan used on my kids as a first-line-exam unless specifically warranted, would prefer 'watchful waiting' if possible (i.e., with a possible head trauma not jumping automatically to CT but assessing for other symptoms first), requesting ultrasound vs. CT for abdominal pain, etc...

[brittone2]

Originally Posted by Katigre

This is great news b/c a few years ago the vast majority of ER dr's were saying that CT scans weren't much radiation and worrying about them wasn't a big deal. This is one reason I am somewhat scared to take my kids to the ER b/c of how heavily CT scans are pushed as if they're 'no big deal' when in fact they ARE a big deal that need to have the cost/benefit ratio taken into account. I always shudder when I hear about the multiple CT scans people have performed without a second thought. It seems like they're sometimes used as CYA for the hospital (or maybe b/c they're fast and also $$$) instead of being diagnostically important.

Ex. If my child is having abdominal pain and I suspect appendicitis, they clearly need to go to the ER. The ER is most likely going to recommend a CT scan to verify appendicitis or not - even though abdominal CT scans are high in radiation with a great er lifetime risk of cancer as a result of getting JUST ONE. Yet studies have found that using an ultrasound has just as high of an effectiveness rate as a CT for finding appendicitis in children (and there is no corresponding radiation exposure). I've talked with DH and our babysitters about how I do not want a CT scan used on my kids as a first-line-exam unless specifically warranted, would prefer 'watchful waiting' if possible (i.e., with a possible head trauma not jumping automatically to CT but assessing for other symptoms first), requesting ultrasound vs. CT for abdominal pain, etc...

My mom had a small lung nodule detected as an incidental finding on a CT. Now they track it using multiple CTs every 6 months to a year. Size is such that it is like less than 1% likelihood of being malignant, but now she has to have it tracked regularly. SHe had to ask about a lower dose CT; they agreed they could get adequate imaging (and there are some studies for cases like hers that indicate the lower dose provides an adequate image for that scenario). But she had to advocate for it. No one offered. She has expressed concern over the radiation levels, and her doc told her yes, there's a chance that she could end up with breast cancer down the road as a result of the multiple CT scans. I realize the physicians are in a tough spot with a situation like this-wanting to track size, make sure it is stable, etc. but now she's on the treadmill of followup scans for it. I think after one more they will let her go to even longer intervals, but still.

There are cases like that that lead to biopsy, with very serious risks involved with that as well.

eta: DH had one wonky liver enzyme test come back years ago, and they wanted to do a liver US. Liver US was fine but in the process they thought they saw a small spot on his kidney (if I'm remembering correctly-this was almost a decade ago. May have been a different organ?), so they pushed him for a CT. He did the CT, and all was clean. But that type of "chasing" can definitely do damage to patients. I wonder how many of the docs would have subjected themselves to that CT, vs. a CYA scenario with a patient. Again, I realize they are in a tight spot, but with imaging as sensitive as it is, you can just keep chasing and chasing things it seems, and that comes with risks.