One of the most frustrating things I see in my practice is how insurance companies are routinely skimping on blood work thereby short changing the consumer of good preventive health care. This area of medicine becomes another example of how consumers must fend for themselves.
A recent example of this occurred when a patient of mine with a Leukemia diagnosis delivered her yearly labs following a physical, on my desk for review, and I was horrified to see only a CBC with differential. Her MD had only looked at her red and white blood cells. When we sat down together, I asked when the last time she had had her blood sugar checked, a lipid panel done or her liver enzymes checked, her response was, not for years and certainly not since she was diagnosed with Leukemia. This woman’s health care provider is looking at her through a key hole.
In years past when we have gone for our annual physical certain basic exams were performed as a screening process. If anything were out of order we would return for a deeper assessment of that issue, more blood work a differential diagnostic. Blood tests can be diagnostic in and of themselves for some disorders and for other health issues when correlated with symptoms and more advanced diagnostics they provide a great tracking devise as we return to health. The trend from year to year is fewer and fewer blood tests are performed and ultimately the warning signs of impending disease are being missed.
Why are we the consumer the patient having to fight to have this most basic and valuable assessment tool provided to us?
A yearly panel that allows a skilled eye to pick up changes in health should include:
- a fasting glucose
- a lipid panel
- a CBC and differential
- a basic metabolic panel
With this basic panel we have a good cross section of how our blood chemistry is fairing and how the systems of the body are working independently and together.
Do you have Thyroid dysfunction?
Another frequently told story in my office is the patient, usually female over 30 who has gone year after year and asked for a thyroid screening because she has low body temperature, fatigue, loss of libido, hair thinning, mood swings and can’t seem to lose weight. She believes she has a thyroid issue because she has done her research and she has many of the symptoms.
In this case the practitioner runs a lipid panel to check her cholesterol and a TSH. If the results of the TSH fell into the normal range even if it was borderline high or low she was dismissed with no thyroid issue and instruction to eat less and exercise more because the test was negative for thyroid. She may need to work on her health, but what happened to the older more artful method of practicing medicine and screening a patient with all of the symptoms of thyroid dysfunction with a little more thorough testing.
Practicing medicine as an art, not a business
In years past, our personal physicians treated us from birth to death, they knew our family history, our health history and they knew that a complete physical include looking at and correlating subjective symptoms with objective findings through a good case history and looking at the patient as a human being. A thorough exam included a good blood work up and a physical and any other diagnostics related to the individuals condition. I believe this is good preventive medicine. If our physicians could practice medicine more as an art and investigation instead of a business our health care costs would go down not up.
Unfortunately, I can give you example after example of the insurance driven lack of practicing medicine as an art. Everyone of those cases where the patient was a cost containment dollar, was a person you know, a mother, sister, brother or friend. The stories always lead me back to, Doctor Heal Thyself. As a consumer in the present medical climate you must become informed, and be your own advocate. Get copies of your lab work, keep a medical file on yourself; most labs provide your results along with the normal ranges and flag anything out of range. LOOK AT THE LABS, if something is not right, go back for more, if your practitioner is dismissive or disinterested, FIND SOMEONE ELSE.