Monday, October 17, 2011

PSA Testing and Prostrate Cancer

Patient, Heal Thyself!

An interesting article on NPR the other day had an interview with a Doctor who was of the opinion that PSA testing should not be as promoted as it is.  It is a startling premise, as most folks think more testing, not less, is better.

The problem with this particular type of blood test is that, while it can detect the presence of certain kinds of cancer, a positive test result does not mean you have cancer.  As a result, he claims, a lot of people are having unnecessary biopsies and surgery, and as a result, a certain percentage of people will have complications, which claims is unnecessary.

The problem with the PSA test is the problem with the medical industry - and notice I said "industry" and not profession.  People may fail to realize this, given all the hand-wringing about the medical field these days, but people make money in medicine.  Not only do Doctors make money, but the billing companies, the insurance companies, the folks (usually Doctors) who own treatment centers, hospitals (not all of them, of course), even the nurses and Physician's Assistants.

Yes, there are Hospitals going bust - usually in the inner cities.  And yes, a lot of Doctors, particularly those just starting out, and those who are honest in their practice, are not getting rich.  But a lot of folks are making a lot of money in medicine.  And in some cases, this may be due to what are unnecessary procedures.

You may remember I reported in my post on Dentists, about a Dentist - who was otherwise competent and indeed expert in their field - who recomended a host of optional treatments for my teeth - everything from whitening procedures, to caps for my ground-down front teeth, to having myu jaw broken and reset to "correct" my bite.  These treatments would have cost $10,000 or more.

When I balked at the cost, she replied, "Your insurance will pay for it!"

When I noted that I had no insurance, she then said, "Oh, well, you don't really need it..."

Huh?  Did I miss something?  The need for treatments is based on your ability to pay?

But indeed, that is the norm in many medical practices - and indeed legal ones as well.  And while no Doctor may admit to it - and many may not be doing this intentionally - many may recommend treatments that they know they will make money from, and that the client can afford to pay.

We all have mortgages to pay, and overhead to cover in our practices - so don't act shocked.

Having a $10,000 deductible, therefor, is a very useful thing to have.  Why?  Because it telegraphs to the Doctor that you are not prepared to pay for anything that is not really necessary to your health.

I have friends who have "cradle to grave" protection in their health insurance.  Not suprisingly, they have lots of conditions and medicines and medical procedures performed.  Does one lead to the other?  Perhaps there is a link.

I am fortunate to have had two Doctors who believe in "Patient, Heal Thyself!".  One of them, who is a Vegetarian (I like him anyway) recommends changes in diet and lifestyle habits before prescribing drugs.  And yet many people - and Doctors - prefer the opposite - writing scripts for blood-pressure medication, diabetes medication, and the like, without trying to alter tha patient's lifestyle or diet.

In some instances, there are situations, I believe, where Doctors are inclined more to patch things up with medicine, rather than asking the Patient to get more exercise, eat less junk, and drink less alcohol (or smoke less, use less drugs, etc.).  And I think an awful lot of medical conditions in this country are indeed related to behavior, not just random illness.

I think it is key, to maintain your health, to find a Doctor who is not pill- or knife-happy and believes that health is more than just pills and cutting, but rather a whole approach to living.  Second, I think it is important to embrace your own mortality and realize that death is inevitable, and the best a Doctor can do is postpone the inevitable, not prevent it.  And third, I think going to a high deductible is one way to signal your Doctor that you are not interested in being a pill or surgery junkie.

Now, spare me the flames.   Yes, if you are a burn victim or whatever, you need medical attention.  But, on the other hand, if you the 400-lb guy who has a handicap pass and a little electric scooter to ride around in - whose only "handicap" is obesity, well, perhaps there is another approach to health than pills and abdominal band surgery.