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(CBS News)   Cardiologist questions government recommendation that EKGs not be used for routine screening. Says tests are easy to administer, helpful in early detection, a quick way to bill patients $150   (cbsnews.com) divider line 33
    More: Asinine, detections, EKG, visual routine, cardiologist, Annals of Internal Medicine, recommendations, primary care doctors, sudden cardiac death  
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1059 clicks; posted to Geek » on 06 Aug 2012 at 9:16 AM (2 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-08-06 09:23:35 AM
And the move from "We don't think you need this" to "We've decided you don't need this and won't pay for it....and good luck finding a private doctor to do it for you" has begun.
 
2012-08-06 09:25:27 AM

taurusowner: And the move from "We don't think you need this" to "We've decided you don't need this and won't pay for it....and good luck finding a private doctor to do it for you" has begun.


You know how I know you didn't read the article?
 
2012-08-06 09:32:09 AM
In May, the task force issued controversial guidelines recommending against screening for prostate cancer with a prostate-specific antigen (PSA) blood test, saying a positive test was more likely to cause harm than good because of side effects from surgery or radiation. -- I'm confused.
 
2012-08-06 09:54:26 AM

capitafun: In May, the task force issued controversial guidelines recommending against screening for prostate cancer with a prostate-specific antigen (PSA) blood test, saying a positive test was more likely to cause harm than good because of side effects from surgery or radiation. -- I'm confused.


I'm not surprised.

The thing is these tests come out, some people jump on them and it quickly becomes the standard of care (you better not be less aggressive than the next doctor about testing or you're liable to get your ass handed to you in a malpractice lawsuit) even though their usefulness has never been established.

They're now going through and seeing if the tests actually help and they're finding some that aren't a good idea.
 
2012-08-06 09:58:11 AM
EKGs are a standard thing now?

I've only gotten one once and that was because it felt like someone punched my heart.
 
2012-08-06 10:06:44 AM
On my last trip to the ER, after I'd been loaded with opioids by the doc, "We want to send you up for some CT scans, is that OK?" Me: "Whaaatevver." Ten minutes, two scans, and $3400 later: "Well, I guess we didn't really need to do that."

/When the bill came, I made a stink about standards for informed consent and they knocked off a couple grand.
 
2012-08-06 10:06:57 AM

HotWingConspiracy: EKGs are a standard thing now?

I've only gotten one once and that was because it felt like someone punched my heart.


For older patients I don't see why it shouldn't be. Unlike Mammograms an EKG isn't shooting radiation into you for no apparant reason. Don't see an issue with non-invasive testing if, as in the case of the EKG,since it can't be a way for total diagnosis, it is used to determine only if further testing is needed.
 
2012-08-06 10:07:00 AM
Had three EKGs in my life. I'd like to know where subby got one for $150, though, as that's a far better price than I got. :(
 
2012-08-06 10:08:11 AM

Gough: On my last trip to the ER, after I'd been loaded with opioids by the doc, "We want to send you up for some CT scans, is that OK?" Me: "Whaaatevver." Ten minutes, two scans, and $3400 later: "Well, I guess we didn't really need to do that."

/When the bill came, I made a stink about standards for informed consent and they knocked off a couple grand.


So that's where that last bill from the hospital tacking on $5k to my original bill came from...


/seriously, never have heart problems or BP problems with complications.
//$65k+ in medical bills is a big number.
 
2012-08-06 10:08:33 AM

taurusowner: And the move from "We don't think you need this" to "We've decided you don't need this and won't pay for it....and good luck finding a private doctor to do it for you" has begun.


Thank goodness we have kool-aid sippers willing to make every aspect of live a politicized tear fest. Do you tea-cups ever get tired of living in little girl like fear of everything? Be sure to drink a lot of water before November so you don't dehydrate before the election.
 
2012-08-06 10:18:27 AM
My last "free" annual exam cost almost $400. None of the tests are covered.
 
2012-08-06 10:23:11 AM

Kit Fister: Had three EKGs in my life. I'd like to know where subby got one for $150, though, as that's a far better price than I got. :(


No kidding. Add about a grand to that $150.
 
2012-08-06 10:25:35 AM
Melnikow says healthy, low-risk people are not likely to develop heart disease, so an abnormal EKG in this group is more likely to be a false positive test result.

Only for a shiatty doctor.

My regular doctor was out and I needed a physical. The guy filling in thought my EKG was "abnormal" and I neded up getting a heart ultra-sound, 24 hour monitor and a stress test. Come to find out froma regular doctor that my original EKG was perfectly normal for somebody who runs (I was training fro a marathon at the time).

Point is the rational for not using them here is stupid. A bad doctor looking to waste your/inusrance companies money is going always find a reason for more tests.
 
2012-08-06 10:47:45 AM
Eh, since I work 12-14 hour shifts at 2.6 miles above sea level, my job requires (and pays for) annual spirometry (for lung function) and cardiac stress test (EKG while running on a treadmill), and a chest X-ray every 5 years.

Amusingly, the EKG while running on a treadmill takes place at about 20 feet above sea level, and let me tell you, if you're used to walking, climbing and sometimes running in air density only 60% of what you get at sea level, you're not going to be at all bothered by jogging at 5 mph for a couple minutes at sea level.

/And for the Farker pilots out there, no, I do not put on oxygen when I go above 10,000 feet. ;)
 
2012-08-06 10:50:18 AM

capitafun: In May, the task force issued controversial guidelines recommending against screening for prostate cancer with a prostate-specific antigen (PSA) blood test, saying a positive test was more likely to cause harm than good because of side effects from surgery or radiation. -- I'm confused.


In short, unneccessary surgeries causing increased complications. Prostate Cancer is one of the weird ones. Chances are if you have it you will die from old age. It's the rare ones which end up spreading and killing someone. Uterine cancer is another one which gets misdiagnosed a lot as well. Usually it's either the routine pap smears that cause "malformed" cells or a diagnosis that "errs on the side of caution". There is a new theory that mammographies may actually be causing increases in breast cancer as well.

This book is a good read:
Should I be Tested for Cancer
 
2012-08-06 11:06:58 AM
As having been diagnosed with a dangerous heart condition after getting a routine EKG while at the doctor for some muscle pain, I'm getting a kick... Seriously, if it wasn't for my docs standard "might as well do an EKG" attitude, I'd never have known that my heartbeat had been abnormal all my life and that I'd probably have a heart attack by the time I'm 5. Instead, I got it fixed and feel incredible -- I had no idea before just how limiting a factor it had really been. If anything, we should be encouraging more screening, not less.
 
2012-08-06 11:23:21 AM
For-profit healthcare is disgusting.
 
2012-08-06 12:04:53 PM
Isn't screening and preventive care suppose to save the system money?
 
2012-08-06 12:20:29 PM

cchris_39: Isn't screening and preventive care suppose to save the system money?



Not if the screening catches very few things wrong. Let's say that one screening costs $100 and this screening is done for 1 million people and catches a disease of 10,000 people that were likely to develop said disease. That is 100 million dollars + the cost of treating those 10,000, let say $1,000 each for the "we caught it in time cheaper treatment", That is $110,000,000.

Now lets say that you did no screening and those 10,000 came down with the harder (more expensive) to treat version of the disease. 1,000 die because you didn't get to them in time but 9000 get the now $10,000 treatment. That is 90,000,000 .

You save 20 million in not doing the screening.
 
2012-08-06 01:04:19 PM

liam76:
Point is the rational for not using them here is stupid. A bad doctor looking to waste your/inusrance companies money is going always find a reason for more tests.


Which is why the system needs to be changed to no longer be "pay-per-procedure" but to pay for prevention and treatment per condition with a set cost per condition based on what treatment of that condition should cost. At the largest and most successful medical groups in the nation (Kaiser Permanente, Cleveland Clinic, etc) they have already moved to all physicians being salaried instead of being paid per the procedures they do.
Admittedly though, it helps that the majority of their patients are on the health insurance plans they run, so reducing unnecessary tests and procedures saves the entire organization money and allows them to keep the insurance premiums lower while having money for the really expensive treatments like chemotherapy.
 
2012-08-06 01:54:17 PM

powtard: As having been diagnosed with a dangerous heart condition after getting a routine EKG while at the doctor for some muscle pain, I'm getting a kick... Seriously, if it wasn't for my docs standard "might as well do an EKG" attitude, I'd never have known that my heartbeat had been abnormal all my life and that I'd probably have a heart attack by the time I'm 5. Instead, I got it fixed and feel incredible -- I had no idea before just how limiting a factor it had really been. If anything, we should be encouraging more screening, not less.


Curious what the dangerous heart condition was... A-fib? 1st degree AV block? Wenckebach?

/don't share if you don't want to.
 
2012-08-06 02:28:02 PM

machoprogrammer: For-profit healthcare is disgusting.


Absolutely. When I was in on the 2nd day no less, a doc finally figured out what was wrong with me and was figuring out how to fix me when I nearly passed out trying to stand. Another doc yelled "SEIZURE!!!!" and I wasn't even all the way out! I told the other doc, no, and even if so, how would it change treatment? He didn't have an acceptable answer, but they shipped me by ambulance over to the other campus for a damn MRI and set my treatment back another damn day. I was not pleased. Hell, they had to transfer me anyway to University of Iowa luckily...

/NCSB...
 
2012-08-06 02:31:17 PM

taurusowner: And the move from "We don't think you need this" to "We've decided you don't need this and won't pay for it....and good luck finding a private doctor to do it for you" has begun.


Pretty much. Those not in the system don't know how the system works. If you are on a government run health insurance and it will not pay for anything you won't get anything. This means we are no longer getting the best of care. YEAY.

powtard: As having been diagnosed with a dangerous heart condition after getting a routine EKG while at the doctor for some muscle pain, I'm getting a kick... Seriously, if it wasn't for my docs standard "might as well do an EKG" attitude, I'd never have known that my heartbeat had been abnormal all my life and that I'd probably have a heart attack by the time I'm 5. Instead, I got it fixed and feel incredible -- I had no idea before just how limiting a factor it had really been. If anything, we should be encouraging more screening, not less.


All of this.
 
2012-08-06 02:50:36 PM

Gough: On my last trip to the ER, after I'd been loaded with opioids by the doc, "We want to send you up for some CT scans, is that OK?" Me: "Whaaatevver." Ten minutes, two scans, and $3400 later: "Well, I guess we didn't really need to do that."

/When the bill came, I made a stink about standards for informed consent and they knocked off a couple grand.


Except that you gave your informed consent to diagnose and treat you when you explicitly signed the forms at the very start of your visit.

And, no one knew the results of the CT-scans would be negative until they were actually negative. Had they found something that was causing your pain (which is my guess why you went in to the ED in the first place), then you would have been signing their praises for deciding to get the test . . .
 
2012-08-06 04:53:49 PM

PatoDeAgua: Gough: On my last trip to the ER, after I'd been loaded with opioids by the doc, "We want to send you up for some CT scans, is that OK?" Me: "Whaaatevver." Ten minutes, two scans, and $3400 later: "Well, I guess we didn't really need to do that."

/When the bill came, I made a stink about standards for informed consent and they knocked off a couple grand.

Except that you gave your informed consent to diagnose and treat you when you explicitly signed the forms at the very start of your visit.

And, no one knew the results of the CT-scans would be negative until they were actually negative. Had they found something that was causing your pain (which is my guess why you went in to the ED in the first place), then you would have been signing their praises for deciding to get the test . . .


It was my fifth round of kidney stones; I was pretty familiar with what was going on. They had a brand-new CT. Coincidence? The price of each visit is exponential higher than the last with no improvement in the level of care or the outcome.

Fair point about the informed consent. The issue that I raised with the billing department was that I would have liked to have had a chance to discuss the costs/benefits of those tests with the doc, but wasn't in a position to do so. One of the objections that I have had for some time is that the docs order up tests and procedures to CTA. None has ANY idea about costs. When I finally had lithotrypsy done, I asked the doc about the costs and he estimated $3-4K. He was off by a bit: the bill was for $17K.
 
2012-08-06 06:32:18 PM

Kit Fister: Had three EKGs in my life. I'd like to know where subby got one for $150, though, as that's a far better price than I got. :(


My Cardiologist charges $125 if it is done in his office. The hospital he is connected to charges $625.
 
2012-08-06 09:12:49 PM

Gough: I asked the doc about the costs and he estimated $3-4K. He was off by a bit: the bill was for $17K.


Medical is the only business where they normally won't tell you how much something will cost (even if you ask), and if they do tell you, they're typically a magnitude off. If an auto repair shop worked that way, they'd be shut down in a week.
 
2012-08-06 09:18:00 PM
Perhaps the solution isn't ditching the screening, but making it a $10-$15 procedure.
 
2012-08-06 10:33:43 PM
$150... that's cute.
 
2012-08-07 01:17:30 AM

capitafun: In May, the task force issued controversial guidelines recommending against screening for prostate cancer with a prostate-specific antigen (PSA) blood test, saying a positive test was more likely to cause harm than good because of side effects from surgery or radiation. -- I'm confused.


It's called the false positive paradox. Let's consider the numbers behind PSA screening. PSA has a specificity of about 70% - that is, if you actually do not have cancer, the test correctly identifies you as negative 70% of the time (and 30% of the time gives a false positive).

Even at the high end of the risk curve (African-American), the overall incidence is about 240 per 100,000 people per year who get the disease.

Assume you screen 1,000,000 African-Americans yearly. Of these, you expect 2400 to actually have prostate cancer. Let's assume the test has perfect sensitivity - all 2400 are identified as true positives. Of the remaining 997,600 (who actually do not have cancer), you end up with 299,280 false positives because of the 70% specificity.

So in total, of the 1,000,000 people, you tell 301,680 that test positive for prostate cancer - except of that group, only 0.8% actually HAVE cancer - 99.2% of your "positives" are false positives instead of true positives. In statistical terms, the positive predictive value is only 0.8%. The "paradox" (which isn't really a paradox) is that, while the test will correctly identify a negative individual as negative 70% of the time, of the group it identifies as positive, only 0.8% are true positives. If you were to treat this group for cancer, for every person getting beneficial treatment, 124 people are getting unnecessary (possibly harmful) treatment.

In fact, even if the specificity were 99% accurate, you'd end up with 10,000 false positives and still would only have a 19% positive predictive value - you'd still have four false positives for every true positive.

This is the real problem with screening exams in general - if the false positive rate is high compared to the rate of incidence, almost every positive exam is a false positive, not a true positive. That changes when you're restricting the exam to a group of people already showing symptoms of the condition; the incidence of cancer is obviously going to be much higher in those who show symptoms of cancer than in the general, asymptomatic population.

Screening is really only effective when the incidence is high in a given population, or the specificity of the exam is extremely good.
 
2012-08-07 01:23:33 AM

cchris_39: Isn't screening and preventive care suppose to save the system money?


Preventative care, yes; it always makes sense to try to reduce the risk of disease.

Whether screening is effective depends on the risk of the condition you're screening for among the population being screened, the specificity of the test, the harm that would be caused if you delayed the exam until symptoms emerged, and the harm that would be caused by falsely identifying a negative individual as positive.
 
2012-08-07 05:27:55 AM
The idea of personally paying for anything medical sounds so weird to me.

/So glad I don't live in the US.
//My meds cost 1000/month.
///Probably need them for another 60 years
////Now you understand my first slashie
 
2012-08-07 03:25:50 PM

Jaap_null: The idea of personally paying for anything medical sounds so weird to me.

/So glad I don't live in the US.
//My meds cost 1000/month.
///Probably need them for another 60 years
////Now you understand my first slashie


You're why societies fail.
 
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