Saying "No" to my doctor? Overtesting concern.

[Melisande]

tl;dnr: I am feeling fine. I have no symptoms. I just heard from a nurse/receptionist that a thorough blood test I had done came back all normal. Yet, she said that my doctor still wanted me to make an appointment to see him (without saying why). Should I just blow it off? I'm truly starting to feel like he has a boat payment to make.

Longer version:

I have a love/hate relationship (no, not that kind of love) with my primary care doctor. He's respectful and friendly, always ready to give a referral or hand out the meds I need (or believe I need); his office is close to my house and it's really easy to get appointments.

On the other hand, I think he is either a vicarious hypochondriac or trying really, really hard to drum up business. Whenever I see him (recently it's been for blood test results), he seems to come up with some dread disease I might have. Last time, back at the end of August, he insisted that I see a dermatologist for a skin lesion which was pretty obviously a simple boil because he thought it was a melanoma. At the same appointment, he suggested that my somewhat abnormal lipase levels might be an indication on pancreatic cancer (no, seriously, that's what he said) and that I should see a specialist for a CT-scan. And, finally, he saw my slightly low iron levels as an indication that I might have internal bleeding and suggested I see a third specialist for that. So, the only symptom I had was a boil (otherwise I had no complaints and was feeling 100%) and  the only indication that there was anything wrong with me were two mildly to moderately abnormal results on my blood test and he wants to refer me to three different specialists.

Instead of driving myself all over town and spending $120 on the combined co-pays, I decided to take a wait & see approach. The boil went away on its own (as I thought it would) and I continued feeling 100% (except for the expected winter cold which fully resolved a month or so ago.) But last week I had to have the blood tests redone (needed for represcription of a medication I'm taking). While I was at the office, I told them I was feeling fine, so symptoms, no side effects. All my vitals were normal (BP 100/60; resting pulse 67). Ok, so what does my doctor say?

Primary: "Have you considered that might have latent tuberculosis?"
Me: "No."
Primary: "well, you could get tested for it?"
Me: "Do you really believe there is a significant chance that I have this?"
Primary: "No, but if you did have it, it could be really bad since you are taking an immunosuppressant. If it's in the blood stream and your immune system is too depressed, it could become active."

Ok, true I am taking an immunosuppressant, but at a very low dose (my rheumatologist says that it is a sub-clinical dose and was surprised that I am seeing any positive effects at all). Also, I have been getting these routine blood tests (why I was there in the first place) and all the 10 or so tests I've had all shown my lymphocytes and other immune function-related blood elements within a normal range.

So, really, this just felt like a fishing expedition to me.

Anyway, I had the blood test done. Today, I get a call from my primary's office. The nurse tells me that everything came back normal, but then added that the doctor wanted to see me anyway. Like a dutiful, little patient I made another appointment. For what, I don't know, since she wouldn't tell me over the phone.

I'm feeling like he's just trying to drum up business and am thinking of calling back and canceling.

Do you think this doctor's comments/behavior are odd? Would you call back and cancel?

[CheapskateWife]

I might start shopping around for another PCP...There is just too much going on here to really know for sure, but another physician might take a less interventional approach, and help you feel less freaked out all the damn time about cancer, TB, and anemia.

[Pigeon]

I would probably call back and ask for the doctor to give me a call and ask him directly what the reason for the appointment is.

I think it's hard to judge what his reasoning is, without being a doctor and seeing your test results.  I can understand why he might not wish to ignore abnormal test results.  It could be an indication of something more serious, and if you had lasting damage he could possibly be on the hook for malpractice.

A couple things strike me as odd, but it may just be a variation in local doctor supply.  Where I live (not a rural or remote area) getting in to see a dermatologist requires an act of god if you are a new patient.  My oncologist couldn't get me an appointment when I had a suspicious skin condition.  So the boil thing seems a little excessive.  Also, the fact that you can so easily get an appointment to see the PCP is not my reality.  A new patient appointment with my doctor takes a year to get.  Obviously, it's easier if you are an existing patient, but you still can't just waltz in.

[soccerluvof4]

Its one thing for your Doctor to have your best interest in mind BUT based on what your describing its seemingly over the top.  At some point maybe they will find something but geez...! Thats why they call it Medical practice but seems to be milking it. I hate to take that side with any Doctor as overall my experience has been pretty good. i did have a lump on my neck once and my doctor told me I had a perodid tumor sent me to a specialist, specialist  felt it on my neck (just below jawline) and said yep for sure, we got to get you in because its going to just keep growing and we need to cut through nerve in your face so cant guarantee you will get the feeling back but should. I was really bummed, scared etc.. and a friend of mine notice it and said get a second opinion so I go to another doctor and he felt it, brought out a white board and drew a diagrahm of the procedure after feeling it for maybe 10 seconds...same thing never in face etc...but has to go.  Again was bummed etc..and my friend said why a dont you go to the medical college and request to see a doctor he gave me the name to. The first words our of his mouth were " why dont we take a CT and see what it is before we go digging into your neck" brilliant..lol.  Long and short of it , it was the one side of my vertabre in my neck simply calcified or stuck out more on the side of my neck. I wonder to this day what the other two would of told me they took out of my body had they done the surgery. That made me change my doctor. I have had doctors though that have obviously been cautious and probably saved me. The bottom line imho is its surprising 1 they have all this time to see you and 2 they keep wanting to see you despite everything being ok. I personally based on you posting this feel your not comfortable with them if I am reading it right and would get a new Doctor.

[Spork]

I'm not a doctor and you can safely ignore me for any medical advice.

My dad was a surgeon.  He was very old school.  He would often say of the newer breed of docs that they did not seem to have the diagnostic skills that the older guys had.  He believed in newer diagnostic methods, tests, technologies, but thought they should augment -- not replace -- the older diagnostic skills.  He felt like the newer breed of docs relied too heavily on just doing tons of tests.

Growing up, he sort of created a catch phrase in our house.  "It will be fine."  You'd run up to him bleeding all over the place (or sick or ... whatever).  He'd look at it carefully, then say "it will be fine."  It was rare that he showed any concern... and when he did, I tended to believe him.  (As an aside to the OP, skin lesions that might be melanoma scared the willies out of him and if he saw one, he'd take you immediately to his office and cut it off.)

So... it might not be that he's trying to drum up business to make a Porsche payment.  It might just be he isn't overly skilled at diagnostics.  You might try another doc.  I generally like them older because of how my dad colored my opinions.  ... just not so old that they'll retire as soon as I get to like them.

[Aggie1999]

Some doctors will have you come in for a visit to share the blood test results just so they can charge you for a second office visit. As others have said I would call the office back up and have the doctor tell me what the purpose of the additional visit is for. If it's just to share the blood test work and to give general advice, cancel the visit. Have the doctor mail you a complete copy of the blood test results.

I do the yearly preventative blood work through my PCP. He calls me up to share the results as long as nothing looks odd (never has). I have his office mail me a copy of the results. While I don't understand most of it there is a normal range provided for each number which is what I review.

[Jacks flunky]

I generally like them older because of how my dad colored my opinions.  ... just not so old that they'll retire as soon as I get to like them.

For most areas of practice, i believe including primary care, this is the opposite of the general trend for good outcomes. That is, best outcomes for most specialties are seen among physicians nearer to med school. Incidentally, surgery is one of the exceptions.

Of course, this doesn't address over testing, but you should be aware of the trade-off you are making.

With respect to the OP, I believe TB testing is standard practice if you take an immunosuppressant, but I'm not a physician, so don't take my word on that.


Sent from my MotoG3 using Tapatalk

[ysette9]

Do you live someplace where Kaiser is an option? I can't recommend them too highly. They are all about results and only doing the visits and tests that are shown to give you the best bang for your buck. They emphasize preventative measures and efficient communication methods such as just secure emailing you test results instead of having you come back in.

I agree with others that this guy sounds off somehow.

[AZDude]

Overtesting is a common problem in the medical establishment. It is entirely possible this doctor was not like this prior to a misdiagnosis that resulted in serious injury/death followed by a lawsuit. So now he recommends everything just to cover himself psychologically and financially.

[Melisande]

Thanks for all the replies. I got the tests back (without the appointment) and I think I see where the problem lies. The results were all normal, except for lipase which was a little high again (but lower than last time) as it has been in every blood test I've had over these past many months. So, rather than normal, it would have been more accurate to say that the results are normal for me. He probably wanted to tell me (yet again) that I should see a specialist, which I am not going to do for this "issue," particularly since he wasn't supposed to be testing the lipase in the first place.

So, yes, maybe he is overly concerned with dotting every "i" and crossing every "t".

[Erinbynight]

1. It is not normal for lipase to be elevated.

2. He dutifully retested to see if it trended down (as it would if pancreatitis was suspect).

3. He is asking you to see a specialist because it is NOT NORMAL to have elevated lipase (an enzyme pruduced by the pancreas, which if elevated could indicate anything from a stomach ulcer to pancreatic cancer).

4. You should seek another practitioner because you do not tust this one.

I am an RN who cares for acutely ill patients. Pancreatitis is usually when amylase and lipase are significanly elevated. When it is just lipase, your doctor SHOULD be testing to see why.

[NoStacheOhio]

I'm a big fan of watch-and-wait, especially for things that are just a little bit outside of the typical range. Rerun the same test in a month or six, and go from there.

[BrickByBrick]

I've noticed over the past few years a growing trend of a "let's do this, just in case" attitude among doctors.  I've noticed it more among young/middle-age doctors.  I assume it's due to a lawsuit-happy public and onerous regulations.  They have to spend too much time these days covering their butts.

[Case]

If you don't trust your doctor than there is no way he/she will meet their purpose (other than getting you the gets you want, as you put it).

Therefore, get a new doctor.

tl;dnr: I am feeling fine. I have no symptoms. I just heard from a nurse/receptionist that a thorough blood test I had done came back all normal. Yet, she said that my doctor still wanted me to make an appointment to see him (without saying why). Should I just blow it off? I'm truly starting to feel like he has a boat payment to make.

Longer version:

I have a love/hate relationship (no, not that kind of love) with my primary care doctor. He's respectful and friendly, always ready to give a referral or hand out the meds I need (or believe I need); his office is close to my house and it's really easy to get appointments.

On the other hand, I think he is either a vicarious hypochondriac or trying really, really hard to drum up business. Whenever I see him (recently it's been for blood test results), he seems to come up with some dread disease I might have. Last time, back at the end of August, he insisted that I see a dermatologist for a skin lesion which was pretty obviously a simple boil because he thought it was a melanoma. At the same appointment, he suggested that my somewhat abnormal lipase levels might be an indication on pancreatic cancer (no, seriously, that's what he said) and that I should see a specialist for a CT-scan. And, finally, he saw my slightly low iron levels as an indication that I might have internal bleeding and suggested I see a third specialist for that. So, the only symptom I had was a boil (otherwise I had no complaints and was feeling 100%) and  the only indication that there was anything wrong with me were two mildly to moderately abnormal results on my blood test and he wants to refer me to three different specialists.

Instead of driving myself all over town and spending $120 on the combined co-pays, I decided to take a wait & see approach. The boil went away on its own (as I thought it would) and I continued feeling 100% (except for the expected winter cold which fully resolved a month or so ago.) But last week I had to have the blood tests redone (needed for represcription of a medication I'm taking). While I was at the office, I told them I was feeling fine, so symptoms, no side effects. All my vitals were normal (BP 100/60; resting pulse 67). Ok, so what does my doctor say?

Primary: "Have you considered that might have latent tuberculosis?"
Me: "No."
Primary: "well, you could get tested for it?"
Me: "Do you really believe there is a significant chance that I have this?"
Primary: "No, but if you did have it, it could be really bad since you are taking an immunosuppressant. If it's in the blood stream and your immune system is too depressed, it could become active."

Ok, true I am taking an immunosuppressant, but at a very low dose (my rheumatologist says that it is a sub-clinical dose and was surprised that I am seeing any positive effects at all). Also, I have been getting these routine blood tests (why I was there in the first place) and all the 10 or so tests I've had all shown my lymphocytes and other immune function-related blood elements within a normal range.

So, really, this just felt like a fishing expedition to me.

Anyway, I had the blood test done. Today, I get a call from my primary's office. The nurse tells me that everything came back normal, but then added that the doctor wanted to see me anyway. Like a dutiful, little patient I made another appointment. For what, I don't know, since she wouldn't tell me over the phone.

I'm feeling like he's just trying to drum up business and am thinking of calling back and canceling.

Do you think this doctor's comments/behavior are odd? Would you call back and cancel?

[startingsmall]

1. It is not normal for lipase to be elevated.

2. He dutifully retested to see if it trended down (as it would if pancreatitis was suspect).

3. He is asking you to see a specialist because it is NOT NORMAL to have elevated lipase (an enzyme pruduced by the pancreas, which if elevated could indicate anything from a stomach ulcer to pancreatic cancer).

4. You should seek another practitioner because you do not tust this one.

I am an RN who cares for acutely ill patients. Pancreatitis is usually when amylase and lipase are significanly elevated. When it is just lipase, your doctor SHOULD be testing to see why.

Yes. I'm not in human medicine, just a lowly veterinarian, but yes to all of this. Chronic elevations warrant investigation. True, it may be "normal for you," but you won't know without further testing. I commonly find labwork abnormalities on supposedly-healthy pets that, when appropriately worked up, allow for early diagnosis/treatment of a potentially-serious problem. Preventive medicine is important. 

As far as him referring you to specialists, that doesn't put money in his pocket so you have to assume that his motives are good. Maybe he's just paranoid after a bad experience, but it's highly unlikely that he's "trying to drum up business."

TB testing if you're on immunosuppressive drugs isn't overkill; it's good medicine.

[SEAKSR]

There is something else to consider. OP states that they feel fine, 100%. Yet, just be cause we feel fine doesn't mean that we are in fact fine. IE, I don't realize that I've been dealing with a low grade headache constantly until I go to the eye doctor and get an update prescription. Then my fine is reset to actually pretty good.

The truth is the easiest person to lie to is ourselves. I say take your results to another physician, or even two if you want and have a couple more opinions. Let them have the same information that your existing physician has. Nothing more. If you can, try to go to a physician outside of your local area (lets just say I had a bad experience with docs having preconceived notions as to my issues from talking to the original physician before even looking at me).

[esq]

Anyway, I had the blood test done. Today, I get a call from my primary's office. The nurse tells me that everything came back normal, but then added that the doctor wanted to see me anyway. Like a dutiful, little patient I made another appointment. For what, I don't know, since she wouldn't tell me over the phone.

Oh no.  This sounds like a game you don't want to play.  No doctor should request you come in without knowing why. If you like your doc, sounds like you need to set some rules.  Looks like he's letting you decide whether you want these tests, so if you otherwise like him, tell him you're not one to run and have them done at the drop of a hat.

Spork, I LOVE my doc and she sounds like your Dad.  At last year's annual, I pointed to a raised dark spot and expressed concern that I might need to see a derm.  She advised me to try putting some cortisone cream and if it worked, then it was nothing to be concerned about.  Worked like a charm, and the bump is flat and almost invisible.  I sometimes wonder what would have happened had it been another doc at this practice that looked at this.