Why See A Doctor If You Aren't Sick?

A reader question:

One thing I would like to see answered on your blog is, what do you do on a first visit? Especially if you're not sick?

When someone shows up in Doctor D's exam room with an advanced case of some truly nasty disease D will often ask them, “But why haven't you seen a doctor since the Clinton administration?” They always answer, “Because I haven't been sick, doc.”

Waiting till you get sick to see a doctor is like waiting till you're in the water to get a life jacket.

It is a common misconception that doctors save a lot of sick people. Only rarely do we “save” you after you are sick. Usually we hold off a disease which still gets you in the end, or your body heals itself (and we take the credit). The real lifesaving is in preventing diseases or catching them before you feel the first symptom:

First, we help you prevent or postpone serious illness:

• Your doctor can review your genetic and lifestyle risks. What diseases are you more likely to get in the future? What can we do to prevent them?
• We can help with healthy diet, exercise, weight management, and avoiding things that will kill you (like cigarettes). Of course, everyone knows this stuff from highschool health class, but how many of us are really doing it? Even Doctor D needs his doctor to regularly remind him to eat right and exercise. It just isn't as easy to do it as Happy Hospitalist says.
• Get your shots. Doctors have probably saved more lives with vaccines than any other treatment ever invented. Seriously, at least talk to a doctor about it, even if an Oprah guest told you not to.

Second, preventive visits can find serious problems before they cause trouble. Most people can't feel high sugar, high blood pressure, or high cholesterol until it is too late, but those things will kill ten times as many Americans as H1N1 this year. And some of the most common cancers can be caught with early screening—early enough to make a difference between surviving or not.

Remember these preventative things should still be done even if you already have a disease. People with chronic or frequent illnesses often understandably focus on what is giving them trouble. Don't be that guy that focuses so much on what is hurting, when the real thing that might kill you is hiding in plain sight!

So even if you aren't sick or you are seeing a specialist for something else, you really should see a Primary Care Doctor at least every year or two. We cover a lot in these visits.

Doctor D promises he is not trying to get you into get preventive care just to line his pockets. If he wanted to get rich Doctor D would have chosen just about any specialty other than primary care. He also wouldn't be spending all his off-time on this blog.

What is the longest you ever went without Primary Care? Do you think it affected your health? Doctor D would love to hear your experiences.

Review Of Systems

A question sent to Doctor D:

"Why do doctors ask for information that has nothing to do with what I'll be seen about?"

Doctor D asks his patients superfluous questions all the time. You come to Doctor D with ankle pain and next thing you know you are answering questions about your breathing, how much alcohol you drink, if you have fevers, and your sex life. Doctor D asks these questions because he is nosy.

Doctors are nosy, but the more pertinent reason we must ask those questions is because we are lazy. Doctors, like most people, have a nasty habit of jumping to conclusions before thinking carefully. To combat mental laziness the MD powers-that-be came up with the "Review of Systems" where doctors ask a whole lot of questions about your body that don't directly relate to what's bothering you. It forces your doctor to think outside the box. Usually it turns out to be the obvious diagnosis, but the Review of Systems helps your doctor recognize when it isn't.

Doctors also do this because we are greedy: insurance won't pay for your exam unless at least some Review of Systems is done. Fortunately this is one of those situations where your insurance company actually does something for your benefit. They know a Review of Systems is cheaper than a CT Scan.

When you come to Doctor D with a swollen ankle without any injury it is probably gout. But questions about your breathing or your genitals force Doctor D to at least consider that non-traumatic ankle swelling can be caused by a blood clot or a gonorrhea infection.

So now you'll know why we ask all those crazy questions.