[ganley]

About a decade ago, I got a physical after having not set foot in a doctor's office in about 12 years. The doctor asked what made me come to get a physical after so long, and when I said nothing in particular, he pretended to write on his clipboard "Wife made me come here."

He said middle-aged guys with no obvious health problems pretty much only come to the doctor for one (or both) of two reasons: Their wife made them, or they want Viagra.

[thaumaturgy]

It's not just a macho thing.

I pretty severely injured an ankle back in September, at MMA, and for the first time in my life (at 38) it doesn't seem to be healing up very well. I keep finding new little movements that cause it to feel pretty wrong ("popping", "pulling", cold sensation, mild short-term pain, weakness).

One of these happened in front of my girlfriend, who ordered me to see a doctor, so I did. I filled out new copies of all the paperwork I filled out a year ago when I was grievously ill, sat around for a bit, got into the doctor's office, his assistant appeared and asked me a couple of questions, then the doctor appeared after a bit and asked me the same questions again. He palpated my ankle for a few seconds, told me to get a brace, and then left the room without another word.

Unless you're wealthy enough to afford a dedicated physician, there's just really no point in seeing a doctor for anything less than "I might be about to die".

...which sucks, because I'm a huge proponent of preventative medical care. It's just not available for most people.

[barsonme]

> Unless you're wealthy enough to afford a dedicated physician

I think it depends on your doctor.

My GP is fantastic. He's always running late because the company he works for slots patients in 30 minute intervals, but he takes as long as is needed for his patients.

I'm not even close to wealthy ($50k/year) I can go to him for anything from the flu to broken bones to high cholesterol without thinking, "this is pointless".

[ganley]

No idea which of us is more typical, but my doctor is awesome. Preventative care is deductible-waived, so there's really no good reason other than laziness for me not to get a regular annual physical.

[walshemj]

But you don't know if that of pain is going to kill you or not

[eon1]

The whole "getting a physical" annually is purely an old school American thing anyway. I don't know anyone in my country who does this - although apparently nowadays US med associations recommended you go visit a doctor every 5 years or so if you're under 40.

Still, if I walked into a doctor and said "is anything wrong with me?" with no symptoms or obvious indication that this might be so, they would probably take blood pressure, do a breathing test, ask me if anything was actually wrong, and then wonder why I was wasting their time (or maybe ask if I was looking for a medical certificate cos I didn't feel like going to work, heh).

[derefr]

Personally, I kind of wish my GP was there to help me optimize my health, rather than just to diagnose illness.

Like, all those dietary restrictions they give to people who've had heart attacks? Why not give them to me before I have a heart attack, so I won't ever get one? Make my life more of a hassle, so that I live longer!

I want to have someone in my life who plays the same role that a dental hygienist plays a dentist visit, but for my general physical health.

[eon1]

Okay.. so that kind of sounds like you need a dietician, which is someone you can ask your GP for a referral for, or in many cases just book an appointment with. Your GP doesn't send you to the dentist unless there's something so wrong with your teeth it's impacting the rest of your health; why would it be any different for your diet?

[DaUR]

> I want to have someone in my life who plays the same role that a dental hygienist plays a dentist visit, but for my general physical health.

You better not expect doctors to be that. Most of them still believe cholesterol causes heart disease, for example, or that you need 50% carbs in your diet.

[DanBC]

> He said middle-aged guys with no obvious health problems

Why would anyone see a doctor unless they had a health problem? (Or wanted health advice?)

[fencepost]

> Why would anyone see a doctor unless they had a health problem? (Or wanted health advice?)

Because "sedentary middle-aged American eating a typical American diet" (possibly including "fat" as well) might as well be considered a preexisting condition all by itself, and a simple checkup may catch something that can be addressed before it becomes a hospital visit. Most notable as things to watch out for are high blood pressure, high/poorly balanced cholesterol and diabetes or early signs of it. Two of those you can do some checking for at home fairly inexpensively, but cholesterol not so much.

Despite having health insurance (Thanks Obama! while it lasts) I haven't actually had a checkup in probably 5+ years, but after this I'm going to see about getting in and at the least getting bloodwork, etc. which I've been thinking about anyway. Clearly Jason Scott can't be called all that sedentary given all the walking he did during his heart attack, which is why this is a bit of a wakeup call.

Edit:

I'll throw in a surgeon's commentary from when my wife had her gallbladder out: "Men are stupid."

Context: He was noting that most gallbladder problems are in women, that 90% of gallbladders are removed laparoscopically as outpatient procedures, and that of the other 10% where people end up hospitalized most are men because "Men are stupid." Men will try to tough it out and won't go see a doctor until they're in so much pain that they end up in the ER, and the ER isn't going to dink around with a laparoscope for investigation - if things are that bad, they may well slice you open so they can see what's going on and yank it right then and there leaving a nice scar, at least one overnight in the hospital, and some significant movement restrictions while you're healing.

[Frondo]

Interesting. I was one of those stupid men who was immobilized with pain from acute cholecystitis, I went to the ER, and they still did it laparoscopically.

I did spend two nights in the hospital (one before the surgery, one after), but I'm surprised that surgery would be considered outpatient under any circumstances. Do they really send people home immediately after putting them under and rooting around in their chest cavities?

[fencepost]

The only reason my wife's involved an overnight stay was dehydration since she'd been unable to keep much of anything down for a couple days. That said, her surgery was scheduled after a pretty short series of doctor, ultrasound, surgeon, weekend, surgery.

[DanBC]

Your last paragraph - about men not seeing a doctor when they are in pain - doesn't seem to fit the context of people seeing a doctor when they have no symptoms.

And how many of those women needed surgery?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679744/

[fencepost]

Based on my reading of that, a very significant majority.

From a quick read before I dash out the door, it looks like at most ~21% had surgery based on indefinite or vague symptoms. I'd say that there's a good chance that many or most of those cases should have received at the least other treatment before surgery and that some physicians started resorting to surgery too soon once that surgery became easier, cheaper and safer.

That still leaves the other 79%.

[nommm-nommm]

Annual physical exam (AKA annual wellness visit, annual preventive exam, periodic health exam, and routine checkup) - http://www.webmd.com/a-to-z-guides/annual-physical-examinati...

Last I knew though they weren't evidence based.

[PeterisP]

Regular preventive checkups are (or should be?) a thing.

Quite a few deadly things need to be caught before they become obvious problems. As a crude example, prostate cancer is one of diseases causing death for men; and has the "nice" property that if it's detected early in a screening then it's (usually) treatable with minor side effects, but by the time it causes symptoms serious enough to seek a fix for the symptoms, it generally has grown enough to be lethal.

[js2]

Should they?

In 2012, the Cochrane Collaboration, an international group of medical researchers who systematically review the world’s biomedical research, analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years that sought to evaluate the benefits of routine, general health checkups — that is, visits to the physician for general health and not prompted by any particular symptom or complaint.

The unequivocal conclusion: the appointments are unlikely to be beneficial.

From https://www.nytimes.com/2015/01/09/opinion/skip-your-annual-...

[nommm-nommm]

What you say about prostate cancer is wrong/misleading/outdated. The side effects of prostate cancer treatment can absolutely not be described as "minor." Routine screening of asymptomatic average risk men have caused more harm than good.

https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

>Prostate cancer is very common but isn’t always harmful. It is found in 80% of autopsies where the men died of something else. Many more men die with prostate cancer than because of it.

>The screening test for prostate cancer is a blood test for prostate-specific antigen (PSA). This is not a yes-or-no test. It must be interpreted in the context of the patient’s age and risk factors and the rate of rise, and any cut-off level is arbitrary and will miss some small percentage of cancers. If the PSA test is positive, the next step is biopsy. Typically, 12 needle biopsies are done, 6 on each side. They find cancer in 25% of patients. But if you go back and do more biopsies, you’ll find cancer in 25% more patients. Theoretically, if you could see every cell in the prostate, you might be able to find a cancer cell or two in almost everyone, most of which would never progress or kill the patient. So you have to decide how many biopsies are reasonable. If you find cancer on a biopsy, the next step is treatment, and treatments for prostate cancer are not benign.

>In a large European study, screening resulted in an absolute reduction in deaths from prostate cancer of 7 per 10,000 men screened. We can look at this in terms of number needed to screen (NNS) and number needed to treat (NNT). To prevent one death from prostate cancer, 1,068 men would have to be screened and 48 treated. But here’s the kicker: there was no reduction in all-cause mortality. The overall death rate was the same in the screened group as in the unscreened group.

>If a prostate cancer is localized and low grade, it is reasonable to observe the patient and not treat unless he develops signs of progression. A recent study compared surgery to watchful waiting and found no reduction in deaths. Within 30 days of surgery, 1/5 of the patients had complications including deaths. 2 years after surgery, these long term complications were present:

    17% were incontinent
    81% had erectile dysfunction
    12% had bowel dysfunction

>Popular advice has been “Get tested; it could save your life” but current expert advice is “Don’t get tested; it does more harm than good.” (Mainly from impotence and incontinence.) Emotional anecdotes abound. One doctor wrote an article titled “The New York Times Killed My Patient.” His patient refused PSA testing because he had read that it was not recommended; he developed invasive prostate cancer and died. Another doctor wrote about the opposite experience: his patient had insisted on testing. He was diagnosed with low-grade localized cancer, the kind that can be observed without treating. But he couldn’t face living with the knowledge that he was harboring an untreated cancer. He was afraid of surgery and opted for radiation treatment. He developed radiation proctitis and had rectal pain and bleeding for years. He became impotent and lost bladder control. He told his doctor he would rather be dead than live wearing adult diapers.

>The American Urological Association initially disagreed with the recommendation not to screen, but they have re-considered and issued these new recommendations:

    Don’t screen men under 40 or over 70
    Don’t screen men with a life expectancy of less than 10-15 years
    Don’t screen men age 40-50 who are at average risk
    Consider screening men age 55-69 who are at average risk
    Consider screening high risk men of any age
    Before any screening, doctor should discuss risks and benefits with patient

The U.S. Preventive Services Task Force concludes:

https://www.uspreventiveservicestaskforce.org/Page/Document/...

>Although the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain, existing studies adequately demonstrate that the reduction in prostate cancer mortality after 10 to 14 years is, at most, very small, even for men in what seems to be the optimal age range of 55 to 69 years. There is no apparent reduction in all-cause mortality. In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death. Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit. The inevitability of overdiagnosis and overtreatment of prostate cancer as a result of screening means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term. The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.

We are slowly learning to do much less asymptomatic screening, though charities and celebrities are fighting against it. Joe Torre still comes on my TV saying "get screened early and often." The generic advice about "always catching cancer early" being an unequivocal good thing is false. Over-diagnosis and over-treatment are huge problems. For another example, thyroid cancer screening in South Korea has resulted in a massive increase in thyroid cancer diagnosis and treatment but not any decrease in thyroid cancer mortality.

I can go on about this topic, but I won't. I suggest reading that blog I linked to, its fantastic.

[ganley]

A health problem that you are aware of. You're supposed to see a doctor periodically because they might catch health problems that haven't yet advanced to the point that you know they're happening.

[DanBC]

It's not surprising that the US has such a problem of overdiagnosis and overtreatment.

http://www.bmj.com/content/349/bmj.g5432

[jstalin]

Preventive maintenance.

[Tepix]

If you are middle-aged (or older): to get a checkup

[ergothus]

I can't deny the conclusion, and I agree that men are socialized to not show weakness ("macho"), but for me, I tend to avoid going to the doctor because, as a general rule, it rarely helps and it always costs money. (macho-ness may make more sensitive to that, hard to really know)

I was very sickly as a child. Every doctor's visit did nothing to change this (it wasn't even "Hmm, you have a trend", it was "oh, you have a cold/bonchitis/etc.) It wasn't until I was 30 that I learned I was allergic to pollen, molds, dustmites, cats, dogs, and rats - basically everything that won't kill you (no food allergies I've nailed down) - and that discovery was made when my symptoms suddenly got dramatically worse for months, and I pinned down the only three things that had changed in that time and went to an allergist myself.

Each winter for several years since then I would get bronchitis, and the coughing and shortness of breath would last for months. Every doctor told me to take some Delsym and wait 4-8 weeks. I eventually pieced together that this is my allergies (which, while treated, aren't gone) draining into lungs overnight and slowly being coughed up during the day. Some anti-inflammatory treatment that is now legal in Washington turns out to have stopped that for the last few winters.

I've had two rounds of kidney stones in the last 5 years (each involving at least two stones, because apparently the inflammation from a kidney stone tends to "shake more loose") - Doctors couldn't do much beyond painmeds and flowmax. (First time though, I had a $1000 CT scan (I think it was CT - I get CT and MRI mixed up) because the doc suggested it.)

I had pneumonia once - didn't realize it, it was just a bad cold/cough that got dramatically worse. Calling my doctor for an appt gave me something in 3 days. Day of, I wasn't sure I would be breathing by the time of the appt, so I was going to go to the ER. (which would have been ridiculously expensive). My wife took me to a local urgent care clinic (PatientFirst in VA) because she was worried about the wait time at the ER. They were awesome, saw me immediately as I walked in (they could hear me breathing), did in-house xray of my lungs and o2 sensor. Now that I'm in Seattle, the local clinics work differently - they REALLY want you to have a primary care physician. I recall a doctor there once saying that's because they want someone to coordinate your care, maintain a big picture view, and proactively look into potential issues. I told her I'd never had a PCP do any of those things)

I'm not knocking medical science - it's a near impossible job: "Debug this program to which you don't have the source code, can't control or even know all the environment and inputs, and if you crash it someone dies". It's amazing they can do what they can, and in certain circumstances they are responsible for saving and improving a lot of lives (see above having pneumonia).

But the reality is that if I went to the doctor every time some part of me hurt (and now that I'm 40, that's a lot of parts) based on my past experiences, I'd just spend a lot of time and money and be not much better off. So I'm all for being cautious on big things like chest pains. I'm all for knowing the warning signs of stroke, heart attack, and the like. But going to the doctor for every little thing? Seems a waste.