Newly lost faith in health care

[RyanT26]

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.

 

[yfarm]

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Historically, and as still reflected in the outdated US guidelines, we have been hesitant to treat LDL aggressively.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?

Excellent, money spent annually in the US on unproven supplements, feel good therapies is enormous.

 

[StuckInTheEast]

Most doctors hear your symptoms, excuse themselves and go to the Google, and come back with a prescription.

I've literally watched this exact scenario...only they didn't excuse themselves and did it right infront of me thinking I wasn't paying attention maybe???
I don't see that Dr. anymore after that.

To the OP...I can relate. I've had some pretty bad Healthcare experiences last 5 years or so.
Its like others have said, there's a bell curve as with about any profession. Small percentage are genuinely good at what they do and care about doing their best and their patients well being, small percentage just utterly terrible and shouldn't be licensed but somehow still are...and the vast majority fall in the middle ranging from reasonably good, moving down through well meaning but largely incompetent or lazy on down to kinda care but just there for a paycheck...
I've dealt with alot of the lazy/incompetent types and a few that I can't believe are still allowed to practice. The few good ones I've found always seem to not stick around long before the system chases them to greener pastures.
Hoping my joints hold out, as the good Ortho surgeon I've previously dealt with just flew the coop.
I've got a few good friends in the medical field that all tell me the big corporate politics are making it hard to keep good people in many areas. Personally I think the whole system needs a reset, but I don't really have any answers on how to do that.
I do know pricing is out of touch with reality...
I ended up with a fast developing abscess on my chin/neck few months ago that was bad enough fast enough to warrant an ER trip...I had a CT scan, couple hundred dollars in IV antibiotics and a 3 minute, non sedated lance/drain proceedure(that missed the mark by the way)...I was "admitted for observation" but only in a room 5hrs and observed twice in that time for a minute or two.
total bill to insurance was almost $24k...
Luckily only cost me $2400 to reach my max out of pocket for the year.
Healthcare/health insurance is a circus of epic proportions anymore.

 

[Marbles]

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.

A coronary calcium score doesn't measure plaque (very common misconception even amongst providers). It is one more tool to individualize risk assessment if someone is borderline.

Score above 100, target an LDL of less than 100 and take an 81 mg aspirin. Score below, skip those. But a low score doesn't obviate other risk factors (chronic kidney disease and diabetes are two easy examples of high risk). In short, it is incorrect to use a coronary calcium score to ignore other known risks factors.

Plaque is predominantly composed of soft, fatty build up, as plaques age the body stabilizes them by laying down calcium deposits (that is an abbreviated description that sacrifices some accuracy). Calcium is a sign of old stable plaque, most yong people will have low scores regardless of plaque burden. You need a CTA coronary (which requires gating and not all locations can do) to be able to say no plaque. CTA's involve contrast, you need to take beta blockers prior to slow the heart to get good images, and if there is any heavy calcification the image will likely not be diagnostic due to blooming artifact. CTA's are great in young people, poor choice in those over 65 due to calcification.

One of the benefits of statins is plaque stabilization, and people who take statins will have more calcification while having lower risk. Similarly, long course endurance athletes will have high calcium scores with low risk and low plaque burden.

Conversely, plenty of people have heart attacks with no coronary calcification, particularly young ones with genetically high cholesterol or LPa.

Edit: Deleted last two paragraphs, not really applicable.

 

[yfarm]

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.

Highly unlikely at 37 you have hard plaque on a Ca scoring CT. More likely you would have soft plaque which is not seen on a scoring exam, only on a coronary cta. At 55 after a lifetime of eating what I wanted had a coronary CTA which showed clean coronaries and a carotid U/S which was clean and I stopped thinking about it. At 69 had a stress echo went to a rate pressure product of 42,000 ( 210 heart rate, 200 systolic blood pressure) normal ekg, ejection fraction of 65%. Continue to not be concerned about vascular disease. At age 31 heard a lecture from a Washington University cardiologist whose research interest was longevity. Ranked 200 factors as contributing to longevity
#1 genetics #2 81 mgs of aspirin daily. The next day I started taking 81 mg of Aspirin.

 

[Sccritterkiller]

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.

No surprise. You sound like a Dr. That actually tries to help folks instead putting them on meds..You should have gotten into med devices or work for an insurance company if you wanted to make money..Good Dr's. are boxed in by the system just like us patients. Thanks and keep up the good work!

I have had a tendon issue in a joint since '17...Insurance will approve shots knowing that in about 6 yrs cortisone will cause tendon decay and the entire joint will need to be replaced, trust me they have done the research, their bottom line depends on it..A PRP injection, which my Dr. recommends,would be considered out of pocket.

Their is no money to be made with a cure and until that changes, Big Pharma and Sick care industry is gonna stick to us all. Full disclosure I own pharmaceutical stocks, they have good returns.

When the AHA is against removing soda and desserts from the Snap program...you can't tell me the system is rigged.

 

[DLSJR]

This is an interesting thread. I just got my blood work back from my doctor yesterday, after my annual physical. I’m 66, take no prescription meds though doc did just prescribe Allopurinol yesterday, with my agreement, for uric acid levels that have gotten a bit high, 8.8. I’ll most likely increase the homeopathic supplement (the kind many of you don’t believe works) I’ve been taking for about 10 years without a single gout flare up until recently. I used to have gout attacks a few times a year until starting a supplement touted to reduce uric acid levels and went about 10 years without one until recently.

Until about 4 years ago I was like many people in their early 60’s. Overweight, out of shape, lots of achy joints, didn’t feel all that good but not terrible. Then, I had a bit of an epiphany. I decided that I wanted wellness, not just an absence of illness.

I started eating better, exercising more regularly, integrating stuff like swimming & a lot of pool walking into my routine, quit drinking even though I was a light consumer of alcohol anyway, started drinking a lot more water and really focused on WELLNESS. I lost 50 pounds and have kept it off. My knees feel better than they have in years. Awareness of where you’re at and what you’re doing to maintain or improve your health matters greatly.

My numbers are pretty good for a 66 year old who isn’t on meds. BP I was 122/65 yesterday. Cholesterol is 197 total, 41 HDL, 130 LDL (doc would like to see that a bit lower), triglycerides of 143 (I’d like it a bit lower but I have been eating lots of healthy fats, so perhaps it’ll come down with a little less avocados and coconut oil), blood sugar is 94.

My exercise routine is lots of walking, I’ve averaged just over 9,000 steps/ 3.8 miles a day for the last year. I try to lift twice a week, sometimes 3x, when the weather is warm, pool work is 3-5x/week and I try to sit in a dry sauna at least 3 times a week for about 20 minutes per session.

While my doctor is an important piece of the puzzle, my wellness is dependent on ME and MY actions.

 

[Coveyleader]

Same here........ Complete bullshit. Everyone like to piss on the "rest of world" but to me, the US and its medical systems are 3rd world.

 

[Marbles]

This is an interesting thread. I just got my blood work back from my doctor yesterday, after my annual physical. I’m 66, take no prescription meds though doc did just prescribe Allopurinol yesterday, with my agreement, for uric acid levels that have gotten a bit high, 8.8. I’ll most likely increase the homeopathic supplement (the kind many of you don’t believe works) I’ve been taking for about 10 years without a single gout flare up until recently. I used to have gout attacks a few times a year until starting a supplement touted to reduce uric acid levels and went about 10 years without one until recently.

Until about 4 years ago I was like many people in their early 60’s. Overweight, out of shape, lots of achy joints, didn’t feel all that good but not terrible. Then, I had a bit of an epiphany. I decided that I wanted wellness, not just an absence of illness.

I started eating better, exercising more regularly, integrating stuff like swimming & a lot of pool walking into my routine, quit drinking even though I was a light consumer of alcohol anyway, started drinking a lot more water and really focused on WELLNESS. I lost 50 pounds and have kept it off. My knees feel better than they have in years. Awareness of where you’re at and what you’re doing to maintain or improve your health matters greatly.

My numbers are pretty good for a 66 year old who isn’t on meds. BP I was 122/65 yesterday. Cholesterol is 197 total, 41 HDL, 130 LDL (doc would like to see that a bit lower), triglycerides of 143 (I’d like it a bit lower but I have been eating lots of healthy fats, so perhaps it’ll come down with a little less avocados and coconut oil), blood sugar is 94.

My exercise routine is lots of walking, I’ve averaged just over 9,000 steps/ 3.8 miles a day for the last year. I try to lift twice a week, sometimes 3x, when the weather is warm, pool work is 3-5x/week and I try to sit in a dry sauna at least 3 times a week for about 20 minutes per session.

While my doctor is an important piece of the puzzle, my wellness is dependent on ME and MY actions.

Seriously awesome job, weight loss and fitness are very important for quality of life.

 

[Pharmseller]

False. I’ve made zero dollars from the thousands of prescriptions written and have never once spoken to a pharmaceutical representative. I know what to prescribe from exhaustive training few can complete. A computer doesn’t tell me what to prescribe.

You don’t know, literally, what you’re missing.

You might respond with “I’m not talking with a paid shill” and that’s your choice, but what if that paid shill had managed care information you didn’t know about that could save your patients a lot of money?

Or a new indication you didn’t know about?

New safety information?

It’s really difficult and time consuming to stay current on everything.

So difficult, in fact, that few can do it.

You might be among the few.

But keep in mind that a good drug rep can be an important source of applicable information.




P

 

[ztc92]

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.

As a family doctor in a rural area (meaning very few specialists available to my patients without a lot of extra effort), I have so many thoughts upon reading this thread.

First, to the OP, I have to say I’m sorry you had such a poor experience. I agree with others, find a better doctor. At a minimum you should have heard your options for treating high cholesterol and had some agency in the decision on how to proceed. Like the quote above, the decision to start medicine should be based on good evidence. Early on I used this same calculator (ASCVD risk calculator for those wondering) for every patient I saw with high cholesterol. Now, a few years into practice, I always reference that calculator in my discussion and offer to go through it with the patient if they'd like to see it or if I’m unsure what the results will be. Otherwise, if I feel confident enough in what the answer will be based on their numbers/risk factors, then I will just tell them my recommendation and why.

Being a primary care doctor in the U.S. is becoming a very tall order. I still love my job and care a great deal for my patients, but the systems that I work within make that harder to maintain every day. Many of the medical decisions I make are determined by what treatments will or won’t be covered by insurance. As others have said, very few patients will follow my advice no matter how much extra training I’ve sought out to become more effective in educating people on healthy lifestyle choices. There is constant pressure to see more patients for shorter visit times. The amount of paperwork and administrative tasks I do amount to 1-2 hours every day after I finish clinic, the majority of which are completed to ensure my patients will get the things they need paid for by insurance. If I choose not to do that paperwork in a timely manner, the patient pays the price.

I realize much of what I wrote above sounds like a complaint and to a degree, it is. However my complaints rarely revolve around the patients I see or the organization I work for. The most challenging part of working in primary care is all the systems that don’t allow us to practice medicine in a way that we or our patients enjoy. For perspective, this year (2025), over 800 training spots in family medicine went unfilled, which is the largest number in history (though this is possibly skewed as we also have increased training spots for FM over time). I think this really speaks to how little incentive there is to go into primary care right now.

To be honest, I agree with many who say that healthcare needs a reset. It feels as though we’re at a tipping point where health insurance has developed a monopoly on the entire US healthcare system and they get to call all the shots. Due to the insanely high costs, very few can afford to go outside the insurance system for major medical needs, procedures or surgeries, though that can be a nice option for primary care. Despite that, some insurances (looking at you United Healthcare) have denial rates that approach 90%, meaning less than 10% of requests are actually paid for by insurance. I have cared for many patients with this experience and their choices are to pay the bill or take it to court and likely spend even more in legal fees.

I want to again say that I love my job and it feels like a blessing every day that I get to do this work. Yet despite that passion, the system has become so challenging to work within, even I have days where I consider another career just to get out of it.

There are lots of great doctors out there and if you look hard enough, I’m sure you’ll find one. That said, I fear the current system is going to gradually make that a rarer occurrence with each passing year until we see some major reform.

One final thought for those advocating lifestyle changes vs medications - I 100% agree with you but the vast majority of my patients don’t see it that way. I legitimately had a visit last week where a patient was mad his insurance wouldn’t cover ozempic for weight loss and he asked me if I could help him understand what foods to eat so he could “temporarily develop diabetes” in order to get the ozempic covered. He actually got angry with me when I suggested he focus on a healthy lifestyle and be grateful he doesn’t have diabetes and therefore doesn’t need mediation like ozempic to treat it. I have not seen him back since then and I doubt that I will.

 

[Mangata]

Really glad that the folks that I treat with acute life threatening illness are more grateful than the hyperlipidemia crowd…

 

[Will_m]

Unfortunately, medical profession isn’t very good. Look at Dr Berg, Dr. Ekberg, Ken Berry MD, and Callie Means MD.

Dr. berg is a chiropractor. Not a medical doctor.

 

[ZAK13]

I lost faith in the system a few years ago, especially after the BS with the C-19. Anyways, met a very nice lady from Europe a few weeks back, found out she was a doctor, we had a great discussion on cholesterol and health in general and how in Europe they want your numbers to be higher when it comes to ones' cholesterol, LDL & HDL numbers, said there was a direct correlation of less trauma and better survivability when it comes to head injuries and having higher numbers. She also stated that generally speaking that we here in North America are too easily prescribed meds, instead of eating healthier.

 

[jimh406]

Dr. berg is a chiropractor. Not a medical doctor.

Of course, that’s why they don’t have MD after their name.

 

[Predator_SD]

A healthy 33yo going to the doctor for yearly checkups? I think your first step is to stop doing that. Get a checkup at 30,40,50, etc. Check your own BP regularly at home, stay fit and active. Go in between 10 yr checkups if you break something or have a reason.

Seeing a general practitioner once a year is a waste of time and you’ll absolutely get offered meds to micromanage things. You certainly won’t get lifestyle advice meds are easier.

 

[Predator_SD]

Uhhh where is this computer in my office? Nothing tells me what to prescribe. I give my patients options, then we make a decision together.

That’s good on you but most general practice guys just throw antihypertensives or statins at ya and send you on your way.

I mean if a guy has a BP of 140/88 but is 30 lbs overweight and his idea of exercise is walking from the house to the truck in the morning antihypertensives aren’t the answer.

People have more information at their fingertips than ever before and have become frustrated with a healthcare industry that increasingly pushes drugs, vaccines, and other profit makers instead of promoting actual health.

 

[Predator_SD]

Functional health doc/naturalpath- “Big Pharma is just shipping out cash to these physicians so you can’t trust them.”

Same visit- here take this smorgasbord of expensive supplements that you’re lucky enough I sell out of my very own office, you clearly just need more Magnesium and Vitamin C, also don’t eat bread, or dairy, or sugar, or red food coloring, or anything else that you could possibly enjoy.

Saying this in jest a bit- but every profession has turds. But with my medical education I tend to have a very western based viewpoint and don’t see that changing anytime soon. People don’t realize how hard it is to get people to change lifestyles. I’d be rich if I had a nickel for every low back pain patient that was 150 pounds overweight and not see a connection with their lifestyle and pain, and some get downright angry when you suggest it’s something other than a herniated disc.

This is very true. Many people nowadays want a simple fix, a pill. To actually suggest they eat better and get some exercise is offensive to them.

 

[Predator_SD]

You’re certainly not wrong with the first paragraph. Lots of people aren’t interested when I tell them that diet, exercise and even moderate weight loss has a good chance to put their type two diabetes into remission. No aggression, but some just don’t have the interest in anything but pharmaceuticals. I work in a speciality office and a large teaching hospital, so on the flip side a lot of these people have never heard that before either.

Some insurances will cover gym memberships, but it’s far less that don’t unfortunately, at least here in Michigan. Not sure about elsewhere. I try to meet people where they are and make recommendations based off of what they already enjoy or have access to. Some people can take advantage of that type of stuff (gym equipment, general fitness equipment, etc) through their HSA/FSA though if they dig into it a bit. This is a huge area that insurance/health care could certainly be better though.

Maybe insurance should cover gym memberships and a certain portion of healthy food choices every month instead of medications.

In addition the US should ban pharmaceutical commercials on tv with catchy jingles showing people smiling and happy doing everyday things they presumably would not be able to do without x med.

The US spends more than anyone on healthcare and has the worst outcomes. Well, that’s because medications don’t make you healthier. They only treat the symptoms of an unhealthy lifestyle as that person gets more and more unhealthy.

 

[Speaks]

Interesting thread. First off I do think most primary care doctors got into the profession for the right reasons, are clearly smart people and work hard to do a good job. While I dont think some of the incentive structures built around them are ideal I think most are at least trying to do the right thing.

The computer checklists many of you see are largely mandated by their medical systems and are not a replacement for their expertise but set up to ensure they are asking what they need to and being thorough, I am sure there is a significant liability portion to it as well given how many patients will sue over imperfect performance of an inexact science. I also am not the least bit bothered if my doctor googles something in front of me trying to help me vett an answer to a question that they may have never received before.

I recall a conversation with my PC (at a small hospital in a rural area though not terribly far from a larger metro) a few years ago when I was asking why they only tested for LDL and not ApoB and LPa and was also asking about optimizing several blood test values (mine were all in the green anyway). She said something along the lines of "nearly everyone I see today and likely tomorrow will be somewhere between very and mildly unhealthy, most will not follow the most basic advice and our conversation will revolve around why a big mac is not a balance meal and why just because their uncle smoked and lived until 90 does not mean its harmless, I usually beg my patients to get as much exercise in a week as you do per day. You do triathlons, eat super healthy, and other than LDL have the best bookwork I am likely to see this week. You are also more concerned about how to do better than any of the people that really need to be. Im not really equipped to help you optimize much further and neither are the other doctors here, its just not what our patients need and what we focus most of our time on. I am happy to listen to your questions, help you vet out what you think you want to do, do some research and get back to you, I can also refer you to someone like a sports medicine clinic in the cities either generally or for specific questions or concerns."

I actually do think she has been very helpful, this ranges from "hey I have been reading this and that about how to look at my broader lipid panel and considering my diet and exercise and balancing this against my metabolic health goals what do you think?" and while it may be a day or two she comes back with insightful thoughts and pointed out things I was not considering. She does not bat an eye at letting me order whatever blood panels I want, prescribe me CGMs to optimize glucose, etc. It helps that I have made it clear I dont really care what insurance covers and am open to paying cash for stuff (she generally has very little idea what these things cost anyway) but she does a good job of trying to get stuff covered for me. She did tell me she has to hand me the print out telling me to eat less meat and more grains due to LDL numbers due to policy but thats just hospital policy.

I think its likely very hard for doctors these days serve patients with a very wide range of health needs and interest in being healthy, combined with following policy largely based around avoiding litigation and the mess that our insurance system has become. Expecting every doctor to know everything about everything and every drug etc would be silly and the computers they use are at least generally designed to help with that. Most of our system is designed around average to below average health and information level patients and unless you seek out a specialist that likely makes you pay cash to avoid the insurance company hassle it at least influences the kind of care you are going to get. I might be better suited for someone more along the lines of a Peter Attia (and I dont mean him but that kind of specialized practice) but I am not ready to pay for that either.

Back to OPs question I dont worry about slightly elevated LDL in my case but yours is also quite a but higher than mine which is a little high. I also have high HLH where yours is low and much lower trigs.

I would also for an ApoB test (though I bet that will also be high), and an LPa test (you likely only need to do that once to give you an idea of genetic risk factors). I would guess your a1c is maybe still in an ok range but far from optimal given trigs. I have no idea what your diet and exercise programs look like but I might start with

1. Cut out sugar and processed food
2. Significantly increase fiber through largely vegetable sources and a modest amount of fruit / berries
3. Be cautious about saturated fat, and by this I dont mean avoid meat but eat lean cuts of grass fed beef rather than corn fed ribeye and bacon. While standard recommendations on those doctor print outs say avoid red meat and eggs the average american gets 80% of saturated fat from pre-packaged desert items. Keep the lean meat ditch the desert and processed meat. Butter can be particularly bad for apob so at least keep that in mind if you have already done the other stuff.
4. Up your HDL with more fatty fish like Salmon
5. I would really want to avoid statins but they are better than heart disease if you cant get apob into a good range, psck9 inhibitors are another options but likely far more expensive. Most statin side effects can be eliminated through dose and trying a few different ones.
6. At least 45 min of zone 2 cardio at least 4 times a week 60min x 5 would be better.