Newly lost faith in health care

OP, if you know enough about diet/exercise to be disappointed in the provider, then you know enough to do a tiny bit of research make some pretty obvious changes on your own without having your hand held.

Take responsibility for your own health.
 
Theringworm said:
We live in a society of instant gratification. Society is only interested in immediate results and simple solutions..... never mind the complexity of the problems.

How many on here, or your spouses, are on GLP-1s. Anyone complaining about that pill being pushed to ya instead of giving you a rundown of diet plans or fitness workouts etc.? Nope, cause it's a simple fix and requires no effort on your part. Why would anyone want to diet and exercise for the same results when I can sit on my but, still eat crap but lose weight (I am embellishing here so don't take me too seriously, but the idea is reality). It's one of the easiest patient comorbidities currently to treat, I would bet.
Click to expand...

The GLP-1 popularity explosion fascinates me. It seemed that all of a sudden, there's a ton of commercials peddling Ro, Ozempic, Wegovy or others. In the ads they take a shot, in the stomach, smile, and act like their problems magically go away. The "small print" which needs to be mentioned about diet and exercise goes right along with stop taking the drug if you have nausea, vomiting, diarrhea, constipation, abdominal pain, you die, blah blah blah.

Actually, it blows my mind how almost every single commercial on TV is for a big pharma drug. No wonder our society is all hopped up on mountain dew!

Though, I do believe there is a positive with GLP-1s and can help a certain % of the population. My sister-in-law has struggled with her weight for her entire life and had tried dieting, exercising, going vegetarian, etc... My wife (her sister) hardly exercises at all, drinks a couple days a week (socially), and diet is less than stellar. Yet, she has no problem keeping weight off. Same mother and father, very different metabolisms.

Back to the OPs post. Don't be a sheep led to slaughter. Make an informed decision from multiple reference points on if what your Dr. is prescribing is in YOUR best interest.
 
Knowing how the medical system helps to navigate it's complicated process. However, in your case, your doctor in NOT following proper medical practice. I'm going to take the long route in explaining, as I think it will be more beneficial. I utilize a test with all my doctors. I simply call them by their first name. If they insist on being called doctor, they fail the test. What I mean here is their ego gets in the way of appropriate proper treatment. Your doctors) is/are a part of YOUR treatment team. Doctors should NEVER dictate YOUR treatment plan unless you are incapacitated and an appropriate decision maker in not available ( availability is more critical in emergences). The Medical standard is informed consent, YOUR doctor violated informed consent taking YOUR decision away from you. Your doctor is there to inform you about your choices, not to determine your choice for you, (unless you are incapacitated). Frankly, I would NOT be seeing that doctor. From my perspective, I do NOT want a doctor that violates my informed consent decision rights. It's simply bad medicine. For example, I just had blood work done, and my cholesterol is also high, a bit. I have had this happen in the past for a few different reasons, but have always been able to bring it down into the normal range. This time around, it is high because I have been much to busy to maintain my normal exercise routine. However, I know that that my workload will be slowing, and provide time to get it under control and return to normal. Thus, medication would not be the best decision, as a simple lifestyle change can fix it. Thus, IMNSHO, demand informed consent, and never allow a doctor to take your informed consent away; their job is to present YOUR choices, and the reasoning for or against each.
 
i've been dealing with shoulder impingement last 3 years. left shoulder ached often through surfing and archery. orthopedist that I was initially referred to retired recently. got an MRI when first referred to him. I had a slight tear or fraying in the superspinatus I think it was. had been doing PT along with a cortisone injection every 9 or so months. cortisone helped but the archery would trigger impingement (when drawing bow biceps tendon would flare up in bow arm). After 3rd injection wore off and impingement came back I gave up on archery and sold all my gear bc I could still surf with it but the archery put the pain over the top. orthopedist retires so I think what the heck I'll get a second opinion, I didn't want more injectionss bc they are just bands aids but think maybe I need surgery bc they told me there was a tear in the MRI. I go in and see the PA. she reviews MRI and she says no surgery needed, tear is minor, just stretch your pecsA LOT. I've been on a bit of a fitness kick the last 6 months (down 25lbs) so lots of push ups combined with pec stretching and voila! pain is gone. I still have my 20lb shot trainer, (which gave me pain before when drawing) and no pain! I'm ecstatic. got another bow on the way and I'm back in the game.

Does it suck that it feels every aspect of our society is for making as much money as possible. yes. our food is filled with processed crap so its a cheap as possible to produce to maximize profits. oh your obese,forget diet and exercise, have some ozempic. kinda sad but with my recent experience with my shoulder I still have a little faith left in the system.
 
I went to my physical about a month ago...BP was 120/80...I though great..then the Dr. informed me healthly is BP is now 110/70..."Big Pharma need to up sales on BP medicine?" Was my response...

My LDL was a few points above the "range"...tried to right me script..I just laughed..Told him to keep his poison I will take my chances.

BTW is sick care...we don't have health care in this country.
 
MD here. I calculate a patient’s atherosclerotic cardiovascular disease risk before I ever prescribe a statin. That calculation takes into account age, weight, risk factors, blood pressure, and cholesterol numbers. It is extremely rare to have a statin be indicated in a young person after all of that is taken into account. A statin for a young person with a standalone LDL in the 150s with no other risk factors is outdated medicine by more than 10 years.

I try to see all my patients twice per year. At least once per year I see them for a wellness visit that focuses EXCLUSIVELY on prevention, diet, exercise and screenings. All government and commercial insurance pays for this visit. If your doctor doesn’t do it it’s because they don’t want to, the patient doesn’t want to, or they are behind the times.

I always offer alternatives to medications if they are available AND have evidence to back them up.

I established with a fellow MD in my system as my own doctor. My LDL is similarly high as OP. He did EXACTLY what I do (calculate risk and benefit) and the conclusion, after a discussion, was diet changes and exercise, and no medication. We are both main-stream, state-school trained physicians who did accredited residency in family medicine.

There are legions of undertrained diploma mill “providers” who don’t know what they are doing. There are legions of doctors who haven’t looked at new standards of care or new literature in 20 years. There are other doctors who don’t believe in counseling with their patients to arrive to a mutual decision. It’s a tall order- but avoid all of them. There are still many who practice good medicine, and if they are on your side, then you have the benefit of someone with thorough real world training and the advances of modern medicine on your side.

And if someone always tells you what you want to hear as long as you keep giving them money, they might be taking you for a ride. That applies to any medical professional, chiropractor, naturopath, trainer, “nutrition expert “. Etc.
 
And I’m still waiting for that sweet, sweet “Big Pharma” money to hit my bank account. I’ve been at this for 10 years, so it should be coming soon right? Or am I doing something wrong? When do I get the sit-down and welcome into that fraternity? My medical school debt is still there, and Lily and Novo haven’t offered anything to get rid of that.
 
BravoNovember said:
I just had my yearly physical and my results have me very frustrated. My lipid panel results showed LDL were “high”. No discussion was had about diet or exercise, nothing about my lifestyle or family history, just an immediate prescription for a statin.

-33yo, generally healthy (no major issues, some family history, some chronic pain etc)
-5’9” 185 lbs, <20%body fat
-moderately active throughout the winter and more into the summer and fall.

Not sure if this is a rant or asking opinions at this point. But I would like to find a doctor that is willing to talk through things, not just sign Rx and send me on my way
Click to expand...
I really happy with my doc and he is very blunt about how rare it is that anyone makes enough difference in diet and exercise to make a significant difference, and big changes require so much almost nobody does it. He said it’s like one guy in 50 do enough to stay off meds.

You will probably not go on statins, try as hard as you can with diet and end up on them anyway. Just because you start statins doesn’t mean you can’t change diet and at your next bloodwork the dose would just be adjusted down.

My brother in law won’t take his prescription, and it will probably kill him. His choice - it’s a free country, but statins are one of the most successful meds ever.
 
TaperPin said:
I really happy with my doc and he is very blunt about how rare it is that anyone makes enough difference in diet and exercise to make a significant difference, and big changes require so much almost nobody does it. He said it’s like one guy in 50 do enough to stay off meds.

You will probably not go on statins, try as hard as you can with diet and end up on them anyway. Just because you start statins doesn’t mean you can’t change diet and at your next bloodwork the dose would just be adjusted down.

My brother in law won’t take his prescription, and it will probably kill him. His choice - it’s a free country, but statins are one of the most successful meds ever.
Click to expand...
Luckily with the right tools, it’s much more attainable than that to be successful. Even 10-20% loss of body weight will make drastic changes in diabetes, high cholesterol, high blood pressure etc. Lots of people that choose to do it are successful.

It does take work and it is hard to remain consistent, but it’s also hard to wake up in your 40s\50s\60s with joint pain and back pain, poor sleep from sleep apnea and the inability to continue to chase elk up a mountain. People just have to choose their hard.
 
BravoNovember said:
I just had my yearly physical and my results have me very frustrated. My lipid panel results showed LDL were “high”. No discussion was had about diet or exercise, nothing about my lifestyle or family history, just an immediate prescription for a statin.

-33yo, generally healthy (no major issues, some family history, some chronic pain etc)
-5’9” 185 lbs, <20%body fat
-moderately active throughout the winter and more into the summer and fall.

Not sure if this is a rant or asking opinions at this point. But I would like to find a doctor that is willing to talk through things, not just sign Rx and send me on my way
Click to expand...
Well, this became long enough I doubt most will read it. Sorry, I even left a lot out.

Diet and exercise only change LDL 5-10% for most people (if they do it). You are already in decent shape based on those numbers, so little to no gain to be had from exercise. Preventative care is not about how you feel today, it is about how you feel 10-20 years from now.

Beyond that, giving meaningful advice on diet, or exercise takes significantly more time than an office visit, really most people need multiple visits with a dietitian and exercise coach, not cheap and not covered by insurance. For 95% of people, lifestyle modification is a euphemism for doing nothing. I see it repeated in follow ups, and their answer will still be the same empty promise. On the other hand, I have seen some people who take the meds, aggressively manage lifestyle, then in a year or two we are weaning off and stopping medications. More often then not, those are not the people who decline medication. (Edit: should say more often than not people who make lifestyle changes are not those who decline medication).

Particle size and Apolipoprotien have not been shown to alter outcomes, both are money wasting tests at this point. HDL is also pretty meaningless, medicine once though it mattered, but that simply hasn't held up under examination. The only things worth looking at are triglycerides, LDL, and lipoprotein a (LPa). LPa is complicated by a lack of good treatment options, but those are being worked on, and PCSK9 inhibitors do lower it. LPa is new enough, perhaps like particle size and HDL, it might matter less than we think, but it takes time to confirm such things. Triglycerides respond very well to lifestyle modification.

LDL of 151 is far from a scary level, but certainly puts you at elevated risk for stroke, MI, acute limb ischemia, and dementia as you age. Time under the curve (how long you live with it being high) appears to be important on risk. While clear data is not available, and US guidelines focus on 10 year risk, I strongly suspect there are significant advantages to lowering cholesterol early, but data is not available to confirm or refute that.

Historically, and as still reflected in the outdated US guidelines, we have been hesitant to treat LDL aggressively. It is really cool to see patients with near surgical disease who with aggressive LDL lowering go from 80-90% obstruction to 20%. Or the person with sever coronary artery disease that is not a candidate for intervention and has angina an max nitrates, ranolazine, beta blocker, and CCB who has angina resolve and can slowly be weaned off those medications over the course of a few years once lipids are aggressively managed. Cannot promise that in all cases, but I have personally seen it multiple times and it shows up in current evidence as well. But, I suspect holding an LDL at less than 100 and never having severe disease would give better long term outcomes than stacking a max tolerated dose of statin with a PCSK9 inhibitor years later once problems arrise.

My LDL is in the range where US Guidelines say lifestyle modification (127), I was too embarrassed to ask my PCP, but I want to start low dose rosuvastatin (5 mg daily), because frankly based on current evidence he US guidelines are out dated and my lifestyle is not going to improve further.

Most PCPs under manage lipid issues in my area, which is poor preventative care. Statins are old and cheap, anyone who thinks pharmaceutical companies are getting ritch on them lives in dream land. Now, the heart failure meds you might need if you have a heart attack, those make money (as does the initial hospital stay and procedures).

Despite the Internet loving to hate them, no scientifically credible argument against statins is available, but recycled arguments that were scientifically valid in the 80s and early 90s are hauled out like no one took the time to look onto them.

Functional Medicine is about separating you from your money. The crap I have to clean up on people who see Functional Medicine can be pretty bad, but healthy people do good going to them (because they would do good regardless).

I check my memory frequently, I could pretend to remember everything perfectly, but I would rather double check myself, than give bad advice, it is like a pilot and a preflight checklist, any pilot worth a damn can do it by memory, but never will because it matters too much. Or, should I consider a reloader incompetent for looking at a reloading manual?
 
I had a similar Dr. as the one you described. I only saw him once and then went to a new Dr. New physician is great and listens. On one med currently and I've talked with him about how to stop taking it. He thinks I should stay on fo4 now at current level but he wants to help me drop my dosage and eventually get off the med. It's a great feeling to have him on my side. As others have said, go see a different physician.
 
Mish-pop said:
I had a similar Dr. as the one you described. I only saw him once and then went to a new Dr. New physician is great and listens. On one med currently and I've talked with him about how to stop taking it. He thinks I should stay on fo4 now at current level but he wants to help me drop my dosage and eventually get off the med. It's a great feeling to have him on my side. As others have said, go see a different physician.
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I love to see this. De-prescribing is one of my favorite things to do as a physician.
 
It’s actually easier than ever to find good doctors. If they don’t know that there is no vaccinating against a cold, they aren’t going to do you any favors. That is something very elementary they should have learned in the very beginning.
 
The best thing I have done in a long time was starting to see a private doctor who does not accept insurance. Completely different experience. No assistants, nurses, transgender check-in people. Dr. meets you at the door and knows you by name. You get full access to the same Doctor every appointment, he doesn't watch the clock and thoroughly discusses treatment options with medications being a last resort. He hands out his cell phone number to his patients and is available 24/7. I text him for an appt. and am usually seen the same day. I recently needed a blood panel, he ran the cost with my insurance (double coverage) at $250 out of pocket or $45 dollars cash/ no insurance. Private healthcare is more affordable than people think.
 
This also happened to me at 37. Super healthy I just eat more animal fat products that the pyramid suggests. I have a pretty progressive PA and she said the medical advise was a statin but I could also do a calcium scoring on my heart. My buddy and I both did it around the same time. She said it may not be covered by insurance but she would write it. I got my heart scanned and have ZERO plaque. I’ve had High cholesterol for years. It’s does not correlate to plaque buildup for me. My buddy also has high cholesterol and he showed decent building doing the calcium test. He got on a statin.
 
No excuses for the HC system......BUT, we are in the day and age where all of this info is at our fingertips.....if we don't utilize it, it's our own fault.
 
Marbles said:
Well, this became long enough I doubt most will read it. Sorry, I even left a lot out.

Diet and exercise only change LDL 5-10% for most people (if they do it). You are already in decent shape based on those numbers, so little to no gain to be had from exercise. Preventative care is not about how you feel today, it is about how you feel 10-20 years from now.

Beyond that, giving meaningful advice on diet, or exercise takes significantly more time than an office visit, really most people need multiple visits with a dietitian and exercise coach, not cheap and not covered by insurance. For 95% of people, lifestyle modification is a euphemism for doing nothing. I see it repeated in follow ups, and their answer will still be the same empty promise. On the other hand, I have seen some people who take the meds, aggressively manage lifestyle, then in a year or two we are weaning off and stopping medications. More often then not, those are not the people who decline medication. (Edit: should say more often than not people who make lifestyle changes are not those who decline medication).

Particle size and Apolipoprotien have not been shown to alter outcomes, both are money wasting tests at this point. HDL is also pretty meaningless, medicine once though it mattered, but that simply hasn't held up under examination. The only things worth looking at are triglycerides, LDL, and lipoprotein a (LPa). LPa is complicated by a lack of good treatment options, but those are being worked on, and PCSK9 inhibitors do lower it. LPa is new enough, perhaps like particle size and HDL, it might matter less than we think, but it takes time to confirm such things. Triglycerides respond very well to lifestyle modification.

LDL of 151 is far from a scary level, but certainly puts you at elevated risk for stroke, MI, acute limb ischemia, and dementia as you age. Time under the curve (how long you live with it being high) appears to be important on risk. While clear data is not available, and US guidelines focus on 10 year risk, I strongly suspect there are significant advantages to lowering cholesterol early, but data is not available to confirm or refute that.

Historically, and as still reflected in the outdated US guidelines, we have been hesitant to treat LDL aggressively. It is really cool to see patients with near surgical disease who with aggressive LDL lowering go from 80-90% obstruction to 20%. Or the person with sever coronary artery disease that is not a candidate for intervention and has angina an max nitrates, ranolazine, beta blocker, and CCB who has angina resolve and can slowly be weaned off those medications over the course of a few years once lipids are aggressively managed. Cannot promise that in all cases, but I have personally seen it multiple times and it shows up in current evidence as well. But, I suspect holding an LDL at less than 100 and never having severe disease would give better long term outcomes than stacking a max tolerated dose of statin with a PCSK9 inhibitor years later once problems arrise.

My LDL is in the range where US Guidelines say lifestyle modification (127), I was too embarrassed to ask my PCP, but I want to start low dose rosuvastatin (5 mg daily), because frankly based on current evidence he US guidelines are out dated and my lifestyle is not going to improve further.

Most PCPs under manage lipid issues in my area, which is poor preventative care. Statins are old and cheap, anyone who thinks pharmaceutical companies are getting ritch on them lives in dream land. Now, the heart failure meds you might need if you have a heart attack, those make money (as does the initial hospital stay and procedures).

Despite the Internet loving to hate them, no scientifically credible argument against statins is available, but recycled arguments that were scientifically valid in the 80s and early 90s are hauled out like no one took the time to look onto them.

Functionally Medicine is about separating you from your money. The crap I have to clean up on people who see Functional Medicine can be pretty bad, but healthy people do good going to them (because they would do good regardless).

I check my memory frequently, I could pretend to remember everything perfectly, but I would rather double check myself, than give bad advice, it is like a pilot and a preflight checklist, any pilot worth a damn can do it by memory, but never will because it matters too much. Or, should I consider a reloader incompetent for looking at a reloading manual?
Click to expand...
I appreciate the thoughtful response! I’ll need to read it a couple times and take notes for how I move forward with a new provider
 
A lot of good info here. It has also reminded me I need to get my lab work done, it’s been a few years.
 
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