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Mon Jul 9, 2018, 03:52 PM

Clinical pet peeve: Patients who want me to order lab tests to "check for everything."

There are hundreds of commonly-ordered lab tests to assess countless medical conditions. So to 'check for everything' is unrealistic and impractical in the extreme.

While there are, to be sure, conditions that in the early stages are asymptomatic, ordering a huge panel of lab tests for anything other than a routine annual physical exam is not likely to be appreciated by one's insurance provider, and therefor one is likely to be declined.

Sorry. Just needed to vent...

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Reply Clinical pet peeve: Patients who want me to order lab tests to "check for everything." (Original post)
Aristus Jul 9 OP
gratuitous Jul 9 #1
Aristus Jul 9 #2
greatauntoftriplets Jul 9 #3
The Velveteen Ocelot Jul 9 #4
virgogal Jul 9 #5
The Velveteen Ocelot Jul 9 #6
virgogal Jul 9 #7
LeftInTX Jul 9 #8
The Velveteen Ocelot Jul 10 #10
LeftInTX Jul 11 #13
The Velveteen Ocelot Jul 11 #15
LeftInTX Jul 11 #14
csziggy Jul 10 #9
malthaussen Jul 10 #11
MicaelS Jul 10 #12
sarge43 Jul 11 #16

Response to Aristus (Original post)

Mon Jul 9, 2018, 04:35 PM

1. Ask me to go through the mail at the post office in case something got put in the wrong bin

It's about as useful. If you suspect you have some condition, talk to your medical professional. Maybe it's something, maybe it's nothing, but instead of going through every possible condition ("Ma'am, I don't really think you need a prostate exam, even if your husband had one" ), tell the doctor or nurse that you're thinking you have the epizootic (or whatever) because of these specific symptoms. The quality of your health care can improve markedly by your quality as a patient.

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Response to gratuitous (Reply #1)

Mon Jul 9, 2018, 04:37 PM

2. Well said.

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Response to Aristus (Original post)

Mon Jul 9, 2018, 04:44 PM

3. Do they know what they're getting into when they ask to "check for everything"?

I get Remicade infusions and periodically have to have blood draws where they take seven vials of blood. That's pretty daunting, and they always give me something to eat and drink before they'll let me stand up afterwards.

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Response to Aristus (Original post)

Mon Jul 9, 2018, 05:24 PM

4. Are people reading WebMD and freaking out from self-diagnosing

because they imagine symptoms they've read about? My mother was an RN and she told me about how when she was in nursing school in the pre-Salk vaccine days, the nurses and the med students were constantly diagnosing themselves with polio and scaring themselves silly.

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Response to The Velveteen Ocelot (Reply #4)

Mon Jul 9, 2018, 05:41 PM

5. Actually I was around pre-Salk days---it was a scary time,some years worse than others,of course.

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Response to virgogal (Reply #5)

Mon Jul 9, 2018, 05:44 PM

6. Me, too, but I was just a little kid. We weren't allowed to go swimming in pools in August

for reasons that were puzzling to us, but my mom watched us like a hawk during the summers.

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Response to The Velveteen Ocelot (Reply #6)

Mon Jul 9, 2018, 05:48 PM

7. We could go the the ocean,but no pools,ponds,river coves,or lakes.

I guess the Moms all knew something about the spread of the disease.

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Response to Aristus (Original post)

Mon Jul 9, 2018, 10:05 PM

8. I'm a master gardener and people think soil tests are "magic"

The only time we recommend is if people do alot of vegetable gardening. Otherwise they won't tell you anything.

They will not tell you, if your neighbor threw arsenic in your garden. They will not tell you if your plants have a disease. They will not tell you if there are pathogens in your soil. They will not tell you if your soil has toxins in it. Soil tests will only tell you: Nitrogen, Phosphorous, Potassium, pH and micronutrients. These are all things that we already know about our native soil. Adding nutrients doesn't move the needle much because the soil tends to revert back to the native state.

Only when soil has been altered and heavily fertilized, those numbers can change.

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Response to LeftInTX (Reply #8)

Tue Jul 10, 2018, 12:41 AM

10. Master gardener here, too. It depends on where you get the soil tested and what you ask for.

The University of Minnesota will give you quite a lot of data, including soil texture, organic matter, pH, buffer index, P, K, nitrate (NO3-N), effective neutralizing power, and specific recommendations for amending soil and fertilizing specific crops or vegetables. We recommend soil testing when things just aren't growing normally, but we also caution that the tests won't reveal diseases or toxins - although I've never had anyone specifically ask about those things.

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Response to The Velveteen Ocelot (Reply #10)

Wed Jul 11, 2018, 02:26 AM

13. We're on caliche with soil pH of 8 - 8.5 (Tap water is often 8.5)

Almost everyone's test comes back the same around here!!!


Soil tests are essential for people in agriculture or experienced gardeners who have brought in new soil and fertilize heavily. I will also recommend if they have been using the wrong NPK ratios in their fertilizer. (For instance, we don't recommended balanced unless it is for potted plants)

Most people who call wanting soil tests are new gardeners who have neglected their yards. Teaching them about alkaline soil and our soil profile, goes much further than ordering soil tests.

The main reasons garden fail: Homeowners don't water them. (This is South Texas....)

There have also been concerns about results from the Texas A&M soil lab. It could be because the extreme alkalinity.


Here's what our former agent says.

http://plantanswers.com/calvin_finch_articles/soil_tests_not_useful.htm


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Response to LeftInTX (Reply #13)

Wed Jul 11, 2018, 10:39 AM

15. Your conditions are so much different from ours. I don't think we even have caliche here.

The soil types in Minnesota are really variable because of glaciation, forests, old prairies, old lakes and river beds, etc. The soil in my yard in Minneapolis is sandy loam with good drainage but there are areas of clay soil within the city and surrounding county. A bit north of here is an area called the Anoka Sand Plain which is exactly as its name suggests - ancient deposits of sand. Farther north there's peat. The soil in this area tends to be a bit alkaline so if people want to grow something like blueberries they need to know how to acidify it (it takes several years). Insufficient water isn't usually a problem here (this year there's been too much and my yard looks like someplace in the Amazon, minus the anacondas). Because there is so much variation in soil types and composition even within the county we do recommend soil tests for people starting a new garden or if things aren't growing well.

Master gardeners rock. It's a great program.

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Response to The Velveteen Ocelot (Reply #10)

Wed Jul 11, 2018, 02:26 AM

14. Great to see another MG on DU!!!

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Response to Aristus (Original post)

Tue Jul 10, 2018, 12:41 AM

9. My sister wanted to get a CT scan earlier this year

She was freaked out because I was diagnosed with a mass on one kidney - purely accidentally while getting a CT in preparation for an aortic valve replacement.

The day they took my kidney out our mother was diagnosed with metastasized liver cancer while being X-rayed for pain in her neck (she also had two cracked cervical vertebrae and a cracked rib).

Since both our conditions were completely asymptomatic, my sister was worried she could have something she didn't know about. She badgered her doctor who was willing to order a CT scan but her insurance company wouldn't approve it since there was no medical indication of any problem.

She's finally calmed down about it but I am worried she is still fretting about it. She's not a hypochondriac but she had seen our oldest sister diagnosed with glioblastoma which was well advanced before being diagnosed and our brother in law whose pancreatic cancer was not diagnosed until it was Stage IV. She's 70 and is finally feeling her age and wants to stay as active as she has been since she retired.

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Response to Aristus (Original post)

Tue Jul 10, 2018, 11:10 AM

11. Here's a pint of blood...

... get right on that, willya?

-- Mal

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Response to Aristus (Original post)

Tue Jul 10, 2018, 02:44 PM

12. Tell them they have to donate a whole pint...

Of blood for all the tests, and it will cost them $5,000 out of pocket.

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Response to Aristus (Original post)

Wed Jul 11, 2018, 07:59 PM

16. Hand them a bunch of jars

then tell them you'll need a full jar of each one of their body fluids, a full bottle is critical, starting with tears through fecal material. Just to be sure, some dander and toe jam would be a good idea.

Yeah I know, you'll be yelled at for being a smart ass

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