[CatDevURandom]

My spouse -- an md -- cringed a bit when I read your post. And not because it's not well meaning, or important, but because without qualifying what "comprehensive health check" means, that check could very well do you more harm than good.

So, yes. Please find a good primary care physician you trust and visit on an annual basis. Make sure you update that phsyician with what's going on in your life. That includes any family history, pain, issues etc. When in doubt, see another physician. But please don't go out and get a full MRI of your body just because (which, you are not saying, but does happen). There are enough VOMITs[0] in the course of normal defensive medicine. Don't go looking for problems because -- although they'll definitely help you look -- you might not be better off for it.

[0]: http://messybeast.com/dragonqueen/medical-acronyms.htm

[salgernon]

I went to the urgent care when I had what I thought was hemmoroids - the urgen care doctor hadn't seen anything quick like what she saw and sent me for a colonoscopy. Normally "they" recommend starting periodic colonoscopies at 50.

When the procedure was finished, I was told they would analyze the result, but I had a cancerous tumor and they sent me for a CT scan which confirmed stage iv colon cancer with liver metastasis. I'm now 8 months into chemo and after having my sigmoid colon removed, seem to have "stable disease" in my liver. I was otherwise asymptomatic.

Another chap at my company wasn't so lucky. He got hit by a car and lost consciousness. They did an MRI to check out his brain - and found tumors. A CT scan showed the same don't diagnosis as me, but his was far more advanced, with mean mastastasasis to the liver, lungs and brain. He passed away about 5 months later and was otherwise asymptomatic.

In both our cases, A blood test given after the diagnosis (CEA) showed highly elevated numbers - perhaps two orders of magnitude from nominal.

So my question would be: given that this blood test was a marker for our disease, why can't it be given more regularly as part of a routine checkup? I realize there are other reasons for a false positive, but couldn't it be an indication that further testing should be done? Yes a CT scan can cost $1500, but my chemo costs $12,000 per month.

[acveilleux]

The issue is either False positive followed by heavyweight, risky and invasive checks or the non-committal of many radiology reports "further evaluation recommended..."

Basically, radiologists are more afraid of being sued for missing something then they are of being sued for being too cautious. Evasive language is a defence against the latter.

This is a uniquely American condition BTW. Most other places, the liability rules are different and doctors aren't as afraid of lawsuits / insurance premium hikes.

[Grazester]

Can I ask your age? I am in my early 30's and thinking of getting a colonoscopy, not necessarily without merit but potentially for the reason you did.

[salgernon]

I'm 44. They said the tumor may have been detectable 10 years ago. There is no history of colon cancer in my family, although my father had prostate cancer treated in his fifties. (He's 89 now and still drives have myself to his weekly poker game. Does pretty well at it too, from what I hear.)

Colon cancer can be effectively treated when Caught in it's early stages. During my (first) colonoscopy they found another tumor that got removed in the first of several surgeries, and it had clear margins and required to further treatment.

[adevine]

I would actually be more critical of "regular checkups" than your post. If we are looking at being "data driven" when it comes to our health, the jury is definitely still out on even having annual physicals for otherwise relatively young, symptom free individuals: http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-p...

A central problem is that you get loads of false positives when you are screening symptom-free individuals, and these false positives can cause real harm: beyond anxiety, they often bring on potentially painful, expensive and side-effect causing treatments. Just see the recent recommendations over the PSA test: http://en.wikipedia.org/wiki/Prostate_cancer_screening.

Definitely go to the doctor if you notice any symptoms or worrisome changes. For other types of screenings, be aware that the recommendations often change and that there is a real cost/benefit analysis (even in terms of your own body, not just financial cost) to be done.

[calinet6]

As a recent sufferer of health anxiety, I couldn't agree more. You can really go overboard with tests that are often harmful, and without a really deep understanding of statistics, it's difficult to understand exactly what they mean.

I am thankful every day that I had a great GP who both did enough to be prudent, and also helped me stay balanced and not go overboard, in just the right way. I could have been a lot worse off had I continued to pursue treatment.

That said, in a state where anxiety is controlled and my health is now stable, it's still important to be aware of changes and new symptoms, and to have an annual standard physical with a doctor you trust and stick with consistently so they know you and your body over time. Just don't go overboard.

[petercooper]

I learnt something related to this from a brain surgeon relating to actual positives.

Say that a random scan uncovers that you have a minor brain aneurysm. The aneurysm's size and location implies it has a chance of rupture of around 0.2% per year. The operation to resolve the aneurysm, however, may have a 5% risk of death.

Weighing up the decision to have an operation is incredibly difficult, since most would be rather distracted by the idea of a ticking timebomb going off in their head at any time, yet the risk of the operation is more immediately significant. If undetected, the aneurysm may never rupture, or it may grow to a size where it causes other symptoms and can then be operated on.

(Or, of course, as in the case of a young friend of mine in his then early 20s, pretty much anyone can keel over at any time due to an undetected aneurysm anyway.. it's totally pot luck.)

[derefr]

Short-term point sampling can do you more harm than good—this is as true in medicine as it is in investing.

There's nothing wrong with getting an MRI every year if you aren't actually looking at it on its own, but rather diffing it in a time-series, and extracting chartable statistics from it, to see if anything in your body is getting progressively [adjective]er each year.

This approach won't actually tell you if you've got six months to live, but it's not supposed to. It's to show you that your liver has been getting 10% more scarred over with each visit, so—with evidence!—you'd better lay off the booze already. Or to find something like arteriosclerosis before it presents clinically.

[jacquesm]

You are tying up an MRI machine that might be put to better use.

[dionidium]

You're implying that MRI machines are 100% utilized and that any usage prevents some other usage. Surely that's not actually the case.

[jacquesm]

You don't need them to be 100% utilized, it's not the machines that are the problem but the technicians operating them and the doctors interpreting the results and so on.

There is a whole team clustered around an MRI machine and tying up the machine is effectively tying up the team.

If everybody got an MRI every year on the off chance they might have something then the machines would not be available to those that actually need them (because they have symptoms that require an MRI to narrow in on a cause).

And that's besides the whole fall-out further down the chain in case something does show up that does not generate symptoms and even further down the chain where probably un-necessary operations will be performed on symptom-less patients.

Doing the right amount of screening is a really hard problem. Getting an MRI done every year just because you can afford it is probably not even near the right amount.

[derefr]

The idea, here, would be to make MRIs both cheaper, safer, and less trusted for their predictive power.

Imagine if you could get an MRI the way you currently get a blood pressure test or ultrasound or x-ray. Imagine a simplified MRI machine in every GP's office 40 years from now. Imagine the machine having a networked software layer integrated that doesn't even allow the raw static-image data out to the doctors, but instead just reports out weighted-average feature-change velocity heatmaps.

Presumably, the only people getting an MRI done every year now are the ridiculously rich, who could buy an MRI machine of their own, and a hospital wing to put it in. But the theory behind getting one isn't bad. It's just scarcity, and the effect scarcity has on the level of trust we put in the few samples we can beg, borrow or steal.

[jacquesm]

An MRI is not some magical device, it's more like an advanced way to do tomography and interpreting the results and preparing you for the scan is non-trivial and likely will remain so even if the cost of the MRI machine drops to '0'.

So you're going to need the crew of attendants and interpreters with associated costs regardless of the price of the machine.

What cheap MRI machines will do is marginally reduce the cost of a scan, which would be a good thing but over the life of the machine it is the people that make up the bigger chunk of the cost.

Mobile MRI machines are currently truck sized, something that could be moved around in a suitcase and set up on the spot would be a game changer in the third world (as would be cheaper MRI machines to begin with), but for the first world it wouldn't be so much of a change.

What did change things dramatically was the reduction in the cost of ultra-sound but the complexity of an ultra-sound scanner compared to an MRI machine is orders of magnitude less, interpreting the results is still not the job of the tech administering the scan (though in the case of say a look at an infant in utero even a lay person can make out what is what and that's already useful).

Healthcare costs are an interesting subject of study, you could easily make a career out of that.

[downandout]

So you're saying executive physicals like this [1] are bad? Personally, I'd like to know if I'm dying. Many cancers and other serious problems betray few if any symptoms before it's too late to treat them.

[1] https://health.ucsd.edu/specialties/ehw/services/Pages/gold....

[ams6110]

Depends on your situation, but yes... they can be bad. First of all, false positive tests are a thing. It happens. More importantly, let's say you are diagnosed with something untreatable and terminal. Do you really want to know before you have to? Or perhaps it's something technically treatable, but with a low chance of cure and at a high cost to quality of life?

The thing to think about when you test for something, is what are you prepared to do about it if the results are positive? Not everyone will answer this question the same way.

[wpietri]

Yeah, having looked at some of the potential outcomes of false positives, I have no interest in whole-body scans. One day they'll be a great idea, but for now, I'm skipping them.

As one example of many, consider prostate cancer screening: http://www.medscape.com/viewarticle/811846

[shabda]

We could argue about what comprehensive means, but if you see my post below, the test I recommended has blood work for internal organs health check, chest xray, abdomen ultrasound and (pap smear/mamogram etc depending on gender/age). This requires one single blood draw, and no significant levels of radiation.

Most tests do have some degree of false positives, but there a number of defensive diagnostic tests which are nearly error free and clinically significant

To name some: * BUN + Serum creatinine - Kidney health * LFT - Liver health * Sugar levels - Early detection of diabetes

I am not recommending a MRI, but everyone should get an annual health check, for some values of comprehensive.

[melling]

It would be great to have a Hackers Guide to Healthcare. What's important, what the numbers mean, etc. I understand that certain tests (e.g. PSA) have false positives, but if we ever want to crawl out of the Dark Ages, we need to make some forward progress. Wearables, "tricorders", and early detection blood tests should be able to offer us something better in our lifetimes.

http://www.bloomberg.com/bw/articles/2014-07-03/star-treks-t...

[Osmium]

Not disagreeing about your post at all, which sounds entirely reasonable to me (I'm not a doctor), but I think this is worth emphasising:

> Most tests do have some degree of false positives,

I think many people don't appreciate the danger of false positives.

The complications that can come from unnecessary treatments, the dangers that more invasive tests might cause, the aggregate effect of all the time and expense the extra testing causes (e.g. by putting a strain on hospitals who may need that MRI for someone else), the negative emotional consequences of the stress from the false diagnosis, the possible financial implications etc. Even a very small chance of a false positive can have huge consequences if the test is deployed widely enough.

[zo1]

>"I think many people don't appreciate the danger of false positives."

Yes, but to most people, we compare that danger with the danger of a positive test that never gets done. More information is never a bad thing. And I'm reasonably sure that for almost every test that can have a dangerous false-positive, there is also a corresponding test that can corroborate those results, if not detect the false-positive.

[walshemj]

Yep you don't want to hear "ooh " that looks a bit small when you have an ultrasound scan of you kidneys :-(