“If you haven’t got your health, you haven’t got anything” – Count Rugen
Eat well. Exercise. Brush your teeth. Cultivate a positive outlook. Get plenty of rest. Everything in moderation (including moderation.)
Along with a regular medical exam, these preventative practices are the foundation of a strategy to live a long, healthful life.
We do a respectable job of taking care of ourselves. Vegetables are eaten in abundance. With no car, walking and biking helps us build both health and wealth. (Recently I’ve increased the intensity by strapping an 8 kg little boy to my chest.) We have no employer imposed requirements or deadlines, so distress is low and eustress is moderate.
We also practice awareness, paying attention to our bodies. I’m fairly certain that when I can easily bike 900 km up and down mountains that I’m unlikely to have cardiac problems.
But of course, sometimes things happen, which is where the regular medical exam comes in.
It has been 3 years since I’ve put my body completely under the microscope. I had a limited exam 1.5 years ago when I made my genetic contribution to GCCjr, and the Doctor said I was in the 99th percentile for risk free anesthesia. I also had a quick exam 5 months ago as part of applying for residency in Taiwan, which I also passed with full marks (No HIV or Syphilis, nice to know.) Not bad for a body with 4 decades of use. But 3 years is too long.
At a Taipei private medical clinic, we both scheduled full health exams. It would have been cheaper at one of the public hospitals, but for a couple hundred dollars extra we were able to get prodded and probed in a spa-like setting.
The full health exam took a full day for each of us, beginning at 7 am (schedule.) During Day 1 for Winnie’s exam, GCCjr and I were given a private VIP room where we eschewed the reclining lounge chairs and television in favor of playing and taking naps on the floor. Mom was able to stop in a few times for feedings.
I returned on Day 2 where I underwent the the most detailed exam I’ve ever experienced, including when I was applying for the US Air Force Academy at age 17. A bilingual guide made sure I was always aware of the purpose of each exam, and how long I might wait in the lounge.
One of my favorite tests was the full review of internal organs, where the Doctor showed me my kidneys, gall bladder, liver, etc… and verified that there were no stones and no abnormal growth.
Abdominal Sonography (photo from Lian An Health Clinic)
I also enjoyed the Gastroscopy, where a camera was inserted down my throat to view my stomach and intestines. I would have enjoyed it less if I was awake, which is a reduced cost option.
Gastroscopy (photo from Lian An Health Clinic)
I was less of a fan of the nasal endoscopic exam, where they shoved gently guided a camera up my nose. The prostate exam was equally enjoyable.
At the end of the day, a Doctor sat down with me for an hour and we reviewed all of the test results. (Full list of tests here.) I don’t remember ever spending a full hour with a Doctor, let alone where I was awake and could ask all the questions I wanted.
From the bone density exam, he suggested I get more sun to improve calcium absorption. From the review of my autonomic nervous system (similar to an EKG test) he suggested I try to get less stress. Otherwise, I’m free of any major health problems
Winnie also received a clean bill of health.
And with that, we are now free to roam about the globe for another year (or three.)
Total costs (no insurance):
Jeremy’s exam package: 29,400 TWD (~$905)
– added Thyroid sonography
Winnie’s exam package: 22,000 TWD (~$675)
– no gastroscopy and some tests skipped due to breastfeeding
Great value for piece of mind and body. Don’t think I’ve spent an hour with a Dr in my entire life. This is definitely something I’d be keen on doing, but UK prices, I see this as a 5-6k day out.
Do you get to keep the robes?
More like a track suit than a robe, but yeah we got to keep them.
No HIV or Syphilis = WIN!
Indeed
Thank you for writing this post. Mr. Budgets biggest fear about early retirement is not having health insurance. I remind him that our current health plan isn’t very good and that by retiring early and being location independent we will have access to much better healthcare from around the world.
Plus the ACA is pretty good
Wow, the low cost of those tests is mind-blowing! There’s no way I could have gotten half of those tests here for that price. It just exaggerates how overpriced and for profit everything is here. That’s my biggest concern in “non-work” life is healthcare and getting “good” health care without breaking the bank for it. It’s just part of dealing with non-work covered insurance lifestyle I guess.
The private health clinic we used is also for profit. But because pricing is transparent, normal competitive pressures keep prices in check.
Take a look at the pricing of some plans on the ACA Health Exchange. It is fairly reasonable and is an expense like any other.
Stress and you’re FI??? What’s up with that Mr. GCC? I’m just curious how much added benefit there is to those “enhanced” services from a normal routine annual check-up? Is there a 40% greater chance to catch cancer earlier? Just wondering if you looked at any of the stats (if any)? Thanks.
My guess is the objective benefit is low, else insurance companies in the US would drive more preventative care. Or cynically, maybe the cost/positive is too high and they would rather pay for the cancer drugs on a smaller percentage later
We were happy with the subjective benefits so I didn’t do in depth research
Re: stress – I blame GCCjr ;)
Taiwan is the best place to have thorough health exams. We did that last time me and my husband went back to Taiwan. We loved it. It’s great to know what’s going on in your body without breaking the bank and waiting for several months to complete the exams from different departments. I found out your blog few months ago and was amazed. I met my husband in CA and he moved to Taiwan to live with me for 7 years. A little culture shock but he loves it and figure out how Taiwanese think. We moved to CA 5 years ago. I would love to meet you in person when we go back to Taipei. We stay in Tien-Mu, where my parents live. Anyways, keep up the good work.
The Taiwan health system is really very well run. A single payer system is definitely efficient and cost effective
Give us a shout when you are in town
Just mind blowing. We can be billed $600-700 for a routine office visit for us or one of the kids if we get a shot or two, a vial of blood drawn, and maybe a 2-5 minute chat with the doc. And there you get luxury spa treatment and tons of procedures and exams and tests for the same price.
On a funny but-not-funny note, I’m currently helping my father in law sort through his med bills from a recent hospital stay. It was a routine surgery followed by complications where he ended up in the hospital for about 45 days. Just saw the bill yesterday (4 months later of course). Almost a half million just for the hospital charges, not including all the docs, pharmacy stuff, initial ER visit, rehab, the surgeon’s services, nor the anesthesiologist. Crazy stuff man. That’s why I say in the US for those with some assets, health insurance isn’t to ensure your good health but instead it’s to protect your assets from being completely wiped out if you’re unlucky enough to get sick. Fortunately my FIL is of medicare age so he’ll owe only a few thousand probably.
The US system is all kinds of special and really f#@ked up. I think of that every time I vote
Yes, same here. Fortunately I think most of the presidential candidates on both sides of the aisle agree the system is fcuked, just a matter of how to fix it the best way. Odds are neither party can make it perfect any time soon.
And hey, guess what, I got to spend over an hour this morning filling out an insurance appeal for something that clearly should have been paid for but wasn’t. I bet between all the different parties involved we’ve spent 6+ hours bickering over a $60 charge (most of that not my time fortunately). Gee why is US based healthcare so expensive? ;) We are lucky to rarely need medical services beyond preventative stuff and that’s usually free (this current $60 charge notwithstanding unless I wind the appeal)
I like what has been happening in Massachusetts (Individual Mandate, Up front pricing transparency laws, etc…)
Hopefully more of that makes it to the National level
Wow, an hour to talk to the doctor! Here, you mainly deal with nurse practicioners or physician assistants or even lesser qualified medical office staff as they herd you around to different exams and then the doctor talks to you briefly as they’re in a rush to see as many patients as possible. Speaking of which…I haven’t had a check up since my son was born 2 years ago…been busy…need to make an appointment!
If delivering health care is the goal, the US really has a broken system.
This is absolutely fascinating. I had no idea such places exist!
Medical tourism is awesome. Get quality care at a reasonable price
There are wellness centers like this popping up all over the place. Spend the day at the spa and recover on the beach
Very interesting stuff, definitely see why you want to do such test to get an idea about your body. Taiwan is so advanced and great when it comes to this kind of medical care.
A first world country with first world health care
Moderation in moderation! A man after my own heart! Sometimes you just need to cut loose.
It’s shocking the disparity in price between what you received in Taiwan and what a similar package would cost in the US. Actually, I don’t even know where I could go to get that treatment at all.
Congrats on the clean bill of health!
Moderation in excess must be a major cause of illness and/or depression. I’m sure there is a study
Amazing. I’ve had a lot of physicals in my day but never anything like that.
More and more I’m beginning to realize I don’t want to grow old in the US health care system….
I’m with you on that
For about $1,000/month in Taiwan, many Seniors have live-in help. How is that for LTC?
Wow, that’s so cool. I wish health care in the US was as focused on preventative care as it is in Taiwan!
Glad you are both healthy! But most of those tests are medically unnecessary. The for profit clinic is making a profit by doing all sorts of probably unnecessary tests! While I am of course unaware of your medical history and symptoms, an endoscopy and abdominal ultrasound are not part of general preventive care in the US, Australia, or Europe, and my guess is Taiwan’s public health system would not pay for such an evaluation.
Just remember any test can have a false positive, and this is more of a concern if the pre-test probability is low, and you might end up having more (potentially dangerous) tests to follow up a false positive. And remember that while complications are low, invasive procedures (especially with sedation) have rare but serious side effects (including death.)
I am sure you researched this all ahead of time, and if you are comfortable with these risks have at it, but your readers might want to know that much of this is not based in evidence and can potentially be harmful.
Hi snowcanyon, a favor if I may:
Can you put this risk in context? I get what you are saying, but I don’t know how to distinguish this risk from potential shark attack, struck by lightning, etc… Without context we just spread fear rather than knowledge
What is the probability of harm/death when compared to other common activities:
– sky diving
– bungee jumping
– scuba diving
– driving a car in rush hour traffic 10,000 miles/year
– smoking, drinking, and leading a sedentary lifestyle
What snowcan you said.
I’m a physician. And as a physician, you don’t order a test unless you suspect something. You’re clinical suspucion should be high, and only then should a physician confirm that suspucion with a lab test, imaging, or procedure.
Because if there is a low pre test probably of a disease, the chance of a false positive is higher. Every test has side effects. Performing a gastroscopy for no reason on a health patient is disgusting because it can have serious side effects such as airway compromise, perforation, aspiration, infection among others. I find this absolutely unethical. The ultrasound exam was all show. Many people have regular gallstones es and kidney stones. Even if one was found, you would not remove it in an asymptomic patient.
More testing is not preventative care. Focused testing is. Most of these tests are unnecessary. The gastroscopy on a symptom less patient is dangerous and unethical. The fact that most of these comments are applauding this exam shows just how much the US system is a failure. It also explains it’s high costs. Most Americans demand more laboratory tests, more imaging, and more procedures in order to get a “clean bill of health.” In fact, they are putting themselves in danger of a false positive or an incidental yet benign finding.
You were given the equivalent of a loaded mutual fund with a high expense ratio. The more active ones trades does not make one a better investor. Similarly, the more tests a doctor orders, does not make one a better doctor. In this case, the opposite is true.
Hi supreet,
How much would you charge for me to undergo an annual exam at your office, including an eye exam and a 1-hour consult ? Feel free to choose the minimum amount of testing required to provide a clean bill of health. If I had complaints about occasional stomach pain and acid reflux, would additional testing be required? If so, how much would that cost? Would I get results and bill the same day? If not, when could I expect to receive them?
For the potential risk of negative effects of the gastroscopy, can you provide context? Crossing the street can result in death; it is the probability of such an event and value of the outcome that is important, not that a bad outcome might occur.
I think we also may have a different definition of “disgusting” and “unethical.” I think providing a clear price for a defined service that I want to receive, and then providing it with high quality is very ethical. In comparison, lack of pricing transparency and excessive fees that force middle class patients into bankruptcy (see Justin’s comment above) would be a whole different level of disgusting.
Thanks
Jeremy
I’m not a doctor nor a actuary of any kind, so I can’t say for sure what your risks were in undergoing the exams that you had, but for more context on why said exams can produce negative, unintended consequences I recommend reading Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care
by H. Gilbert Welch. I don’t think supreet was saying that the transparency in pricing you received was ‘disgusting’ merely that it can be extremely hard for patients to properly weight the risks of preventative testing, and thus for a doctor to conduct these tests on someone at low risk without enumerating the potential mal-effects is unethical.
I have the same understanding of supreet’s comment.
I put the book on my list, thanks for the recommendation
Wow, that’s a pretty extensive checkup, glad all was good.
Wikipedia has a good overview with multiple sections regarding the dangers of false positives & over-screening: https://en.wikipedia.org/wiki/Overscreening#Overscreening_examples
In brief, the problem with running tests that aren’t indicated medically is that if you do have a false positive, you obviously need to investigate it further. Depending on what is required for a definitive diagnosis, it is generally invasive, meaning it comes with more risks with the procedure (what are these risks? depends on the type of procedure and the experience of the person doing the procedure itself). Plus you expose the patient to a much higher level of unnecessary anxiety while waiting to have the procedure done & waiting for the results which affects quality of life, not to mention perhaps making decisions that they wouldn’t have made before.
A good example of risks of an unnecessary procedure that might help you see this is something like an amniocentesis or chorionic villus sampling. This is a diagnostic test in which an OB places a needle into a pregnant woman’s uterus in order to get a sample of amniotic fluid or placental tissue to determine if the fetus has chromosomal abnormalities like Trisomy 21 (Down’s) or other types of issues. Sounds great, but the biggest risk to the procedure is miscarriage at around 1%. This is why we don’t subject all pregnant mothers to this test. There are approximately 4 million babies born each year in the United States: if we did this test to every single pregnant woman, we would potentially cause the miscarriage of 40,000 infants who are nearly all normal & healthy.
From the business side, false positives cost more money to the system, increasing costs to health care over all. Generally, health care screenings are considered cost-effective if the amount of money spent on screenings to gain one life year of an affected person is <$100,000. It's a little complicated, but here's a made up example:
You have this screening for stomach cancer. It costs $1,000 per person. If you did it on 99 patients and spent $99,000 and found 1 person to have the stomach cancer and by doing this screen earlier, you got that person to have 1 extra year of life (through treatment since you caught it early), then that screen is considered cost effective.
Hope this helps.
We did amniocentesis as well. Worked like a champ
I second the recommendation that folks read the excellent Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care
by H. Gilbert Welch. A very good book that does a good job of puncturing the preventative care myth. His chapters on back surgery and knee/hip replacements are priceless.
That myth plays a big role in the selling of ACA – sadly this post and most the media have abandoned the scientific method for feel good medicine.
It all comes down to Bastiat’s ‘that which is not seen’.
I put the book on my list
I’m a big fan of the scientific method, which is why I eat solely for nutritional purposes and never for pleasure
Good luck with that. Healthy food and nutrition are the only subject of more fuzzy internet posts and lazy science/math than healthcare.
There’s a lot of value in knowing you don’t know. Me I’ll stick to an all cheese and cilantro diet.
I’m a long-time GCC fan/reader and also a physician.
I can confirm what the other two doctors have said – it looks like you got a little hoodwinked, but admittedly at a good price and apparently no worse for the wear.
The FP (false positive) concern is the biggest with unnecessary preventative care and has already been explained pretty well. But it’s also worth thinking about the supposed upside. Patients usually want these tests to assure themselves they’re completely healthy. But of course there’s really no such thing and, even if there was, the tests aren’t able to completely rule out disease. This corresponds with false negatives, which are another hazard with any test. What if you had a low-grade gastric carcinoma missed on endoscopy (which obviously rely on the skill of the physician performing the test)? What if your prostate was “normal” on exam but actually cancerous? And so on.
Unlike the examples you gave about sky-diving, crossing the street, etc., the benefit of medical testing is much less clear. If I sky-dive, maybe I have a 1% chance of dying, but presumably I also have a 100% chance of enjoying myself.
Preventative care is the subject of a lot of debate amongst physicians – for example, many challenge the utility of mammography for breast cancer screening in some (or all) age groups. Preventative PSA testing used to be routine but has since been shown, on balance, to hurt patients more than it helps.
Hopefully this helps. And thanks for creating/maintaining such a great blog.
Hi Nicander
Thanks for presenting a very reasonable and logical assessment. I’m in complete agreement on everything (except the hoodwinked part)
The title of this post isn’t, “How I Received the World’s Best Medical Exam” it is “Spa Day at the Health Clinic.” Recreation was a factor. I had a good time, learned a great deal in my 1 hour conversation with a (US trained) Doctor, and had all of the routine exams that I used to get annually in the US (blood work, etc…) plus some sky diving and swimming with sharks thrown in. There were other tests I wanted to do but did a value assessment and decided against it (A full body MRI would have been cool)
On the other side, I like to get the best value for my money (most of the time.) What would you advise for future routine screening? Never see a Doctor unless I’m symptomatic? What is the minimum?
Thanks much
Jeremy
I think it’s worth asking where the feeling of recreation comes from. Presumably it’s from the sense of reassurance once you get all of your normal tests back. But maybe it’s more complicated than that. Maybe we are in the process of diagnosing you both with Munchhausen syndrome…
The ethics mentioned earlier can get a little interesting. Is explaining the risks/benefits of an unnecessary test to a patient enough, assuming they are of sound mind? I (and I think many other doctors) would say no, because the difficulty with the tests is managing the false positives, which is usually not straightforward. Normal tests are a relief.
Routine care and value for your money – the AHRQ maintains a screening calculator (http://epss.ahrq.gov/ePSS/search.jsp) you can use to see what the USPSTF recommends for screening based on your age group, smoking status, etc. Note the lack of “routine blood work” (this also get asked for all the time).
The AHRQ items would be standard of care in any US-based primary care office. But keep in mind the tests are only as good as their operating characteristics. So having normal tests is only as reassuring as the test characteristics allow it to be. And furthermore, many of the USPSTF recommendations are hotly debated, despite being a relatively conservative body.
Minimum for you – the short answer is nobody really knows, but based on the screening schedules, contact with a health care provider (not necessarily a doctor) somewhere between every 1-5 years is reasonable (assuming you have no complaints).
Is there a test for Munchausen syndrome? I’ll add that to the list for next time ;)
The recreation factor comes from the novelty of having this wide array of testing that could be done on the cheap. Kid in the candy store
Thanks for the link, I’ll check it out
It is interesting to see how the medical systems in different countries function. As @snowcanyon and @supreet had commented, many of these tests are sensitive but not specific and will lead to unnecessary invasive tests.
If I offered this sort of medical facility in the U.S., I would surely be shunned by the medical community and probably even have my medical license revoked for practicing questionably ethical medicine. Discussion of all of this could possibly fill an entire encyclopedic set (size 8 font!).
Thanks for posting your experiences! Always great material!
I find it fascinating. Millions of people per year in Taiwan undergo testing similar to what I describe in this post. Everyone in the country is provided all healthcare they need under a single payer system. Pricing is transparent and reasonable.
By contrast, in the US a Dr can charge $14k for $14 worth of snake antivenom or be too busy to wash his hands and kill 100k patients a year.
This is only part of the whole picture, of course, but it seems odd for US based Doctors to boast of their ethical superiority. It reminds me a bit of the parable, he who lives in a glass house shouldn’t throw stones.
Thanks for sharing your perspective on potential shunning and license revocation. Fascinating indeed
I’ve really enjoyed your blog, but I think you’ve missed the mark a bit here. You seem to want to get into an argument about the the price of healthcare in the US and, like a typical American, place the blame for the high prices on the doctors as if the doctor sets the prices for procedures and consultations. Far from it! The reasons for high cost of care in the US are multifactorial with contributing factors including malpractice, American entitlement, lack of a unified electronic medical record, and of course, doctors doing unnecessary tests or procedures. There’s certainly blame to go around, and doctors own a good portion of it. But it is NOT because a doctor somewhere decided the price for a colonoscopy should be $10,000. Those decisions are made by insurance companies, in terms of what they will reimburse, which is ultimately related to Medicare – re: the government.
That argument isn’t actually the one I want to have, so I’ll just leave that be. There are many health policy experts much more versed than me on what’s wrong with our broken system – American healthcare.
You mention that the amnio you did turned out just fine, as if that proves that all amnio’s turn out just fine and the benefit therefore outweighs the risk. I don’t have a problem with someone choosing an amnio. I just think it is a personal decision and that it is the MD responsibility to properly counsel on the pros and cons.
I thought I’d give you a few anecdotes of harm done by unnecessary tests from my own practice.
I am a Radiation Oncologist. In order to plan our radiation for cancer patients, I have to get a 3-D rendering of the patient’s body in order to choose the appropriate angle and energies of radiation to use. That 3D rendering we get is in the form of a CT scan. I treat a great number of breast cancer patients on home we end up getting a CT of the chest. Not because she had a cough or difficulty breathing, but just to plan the radiation. My hospital has a policy that each of the CT scans will be “read” by a radiologist. This not infrequently results in some finding that I then have to follow-up on with additional tests.
For instance, one scan showed a mass on the kidney that required an MRI to determine it was completely benign. (Pro: None. Con: Cost and anxiety and time)
About once every few months, there will be lung nodules under a centimeter in size identified. These could represent incurable metastatic breast cancer, a new lung cancer, or just some scarring from a life of breathing in impurities in the surrounding air. We just don’t know. And we can’t biopsy it until it’s over 1 cm, because it’s just too hard to find with a needle or even surgically when there are so small. So I sit the woman down, who is completely asymptomatic and tell her, “We found these things in your lungs, it’s probably nothing, but it could be metastatic breast cancer. We won’t know until we repeat the CT scan in 2-3 months.” So then she worries for 3 months, and has trouble sleeping, and meets with a counselor, and asks me for a benzodiazepine, and can’t have sex with her husband because so preoccupied, etc.
Not long ago one of my patients (about your age) had a 0.5cm lesion, same song and dance, repeat CT in 2 months. At 2 months there was a new nodule, 1.5cm in size. Yikes. So we go for the CT-guided needle biopsy. She starts coughing up blood during the procedure (normal side effect) and we have to abort. No answer. So she waits a few more weeks. And then we try again. This time the biopsy is definitive and shows its benign. Not cancer. And on the repeat CT for the CT-guided biopsy the characteristics of the nodule have changed. No longer looks so “cancer” like. Probably a resolving infection. If we hadn’t “read” the first CT, then she never would have gone through all this.
I could go on. These are just some experiences of mine in the last few months.
Some screening tests have clearly been shown to save lives when applied to the correct population. Pap smears are a great example of a very inexpensive, low risk procedure that can detect pre-cancer and allow for eradication BEFORE it becomes cancer. I believe this has made a difference for your lovely wife. Mammogram is more controversial. Studies have shown it saves lives in the 50+ set. But 40-50 it’s not so clear. There are certainly women who in their 40s who have cancers detected and cured because of mammo. But would you believe that the ionizing radiation associated with a yearly mammo started at age 40 likely CAUSES a significant number of breast cancers that women will eventually experience in their 60s?
These are the complicated decisions policy makers and physicians have to make when deciding on the implementation of screening procedures in asymptomatic patients. And it should really involve a balanced discussion between an informed, educated doc and the patient.
I’ll stop here. Keep up the great work! Love hearing about you travels and the new baby :)
Thanks Doc RadOnc, for your thoughts and for sharing some great examples of harm caused by unnecessary testing.
I’m not really interesting in arguing about the price of healthcare in the US, which is why I left any inflammatory comments out of the blog post itself. Arguing on the Internet is (arguably) a waste of time, but I’ll respond to comments. I agree with you that the topic is complex
My missing the mark is probably largely due to us aiming at a different target. I’m sharing our decisions and experience, not setting policy.
Case in point, would an amnio be the right thing to do for every pregnancy? Probably not. But I wasn’t going to debate it.
I think the example you give for mammograms is an interesting one. The right answer isn’t black and white, and cost is most certainly a factor. The woman that is cured of cancer in her 40s probably has a different opinion on pros and cons than somebody looking at the statistics.
As a Radiation Oncologist, have you seen the xkcd Radiation Dose Chart? From the chart: the absorbed radiation from a mammogram is roughly the same as 5 round-trip flights between NYC and SF. How many policy makers wouldn’t hesitate to spend 5 weekends on the other coast in a given year, but would advise against radiation based testing?
We will be cranking up the travel in the coming months. Hopefully that generates some less controversial blog posts (and a safe amount of radiation.)
All in good fun
Jeremy
Dear Currycracker,
I love your site. Dr., FI in my forties, now working in third world. Great article and site. Check this out. It’s about rank order of cost effective care.
Blessings on baby and your exploits,
Hunter
Just wanted to thank the posters above who recommended Dr. H. Gilbert Welch’s book Less Medicine, More Health. The book is well written and informative. I’m almost done reading it. Have you had a chance to check it out yet, Jeremy?
In my own family I’ve seen some of the results of the over medicalization Dr. Welch discusses in the book. Several times my wife’s doctors have found “unusual” things during her annual exams. These findings have led to referrals to specialists for further testing – just to be sure everything’s okay. Referrals to specialists have led to referrals to other specialists, who then after more blood tests, poking, prodding, biopsying, etc., ultimately concluded that there was nothing to worry about. Was there a cost to all of this testing? Yes, definitely. It depends on the patient, but for some people the stress of worrying about the inconclusive results of medical tests can actually cause disease, even if it wasn’t there to begin with.
In 1998 my dad went to his physician for an annual physical, which included a PSA test, which at that time was standard. A high PSA reading prompted his PCP to refer him to a specialist who conducted more tests and then referred him to a surgeon who was an expert at removing prostates. The surgeon looked over all of the test results, conducted some of his own tests, and then suggested my dad have his prostate removed – “just to be safe.” In hindsight, it turns out that the type of cancer my dad had in his prostate was probably what Dr. Welch refers to as a “turtle,” which is a type of cancer that grows very, very slowly, if at all. Most likely, if my dad hadn’t done anything except wait and monitor his prostate cancer, he would’ve ended up dying with prostate cancer, but not from it.
If I have an appendicitis, get into a bad car crash or bar fight or fall and hit my head hard and get a concussion, I’ll definitely go to a doctor to get treated. In big cities in the U.S. (and I’m sure in Taipei as well) trauma/emergency care is top notch. But, I’m a lot less interested in going to a doctor for regular check ups. If you eat healthy food, like I know you and Winnie do, Jeremy, and exercise and have a good, positive mental outlook on life, chances are you’re going to live a long and healthful life. Conventional wisdom is that more information about our bodies and early detection of “problems” is always good. After reading Dr. Welch’s book and reflecting on some of the experiences of close family members, I’m not so sure. Sometimes ignorance can be bliss…