> 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.
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?
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.
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.
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.
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.
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.
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.
>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:
>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.
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.
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.