Preventive Care

Back to the 1950s with New Prostate Guidelines

Posted on March 1, 2011. Filed under: Breast Cancer, Cancer, Preventive Care, Prostate, Recommended Medical Guidelines | Tags: , , , , , , , |

A new study on prostate biopsies from The Journal of the National Cancer Institute wants to take us back 60 years. The  study not only concluded that using PSA velocity for prostate cancer detection is ineffective and leads to “unnecessary” biopsies — but it also contends that all references to it should be removed from professional guidelines.

PSA (prostate specific antigen) is one way we can monitor prostate health. PSA velocity refers to the amount of change in a PSA from year to year. When doctors see a rise in PSA, they often order a biopsy. Granted, many prostate biopsies do turn out to be negative for cancer. But right now, there is no other way to determine if prostate cancer — whether it’s aggressive or non-aggressive — exists without a tissue diagnosis through biopsy.

The best way to determine whether or not a biopsy is necessary is by measuring PSA.  Waiting for a patient to exhibit symptoms of prostate cancer or to be able to detect a nodule by digital rectal exam equates to a later diagnosis, and if the patient does have cancer, it may be more advanced.

A similar problem exists for women and mammograms. In late 2009, the United States Preventive Services Task Force recommended shifting the age to start mammograms from 40 to 50, to reduce false positives that can lead to biopsies. A huge uproar ensued, leading to the American Cancer Society, among other organizations, continuing to recommended mammograms at age 40.

What’s lost in the uproar is this stark fact: These two cancers cause the second most common cancer-related deaths in men and women, and the only way we can ever hope to drop those alarming statistics down is by screening and catching those cancers early.  PSA is not perfect (nor is mammography), but both of those tests are the best means for detecting and intercepting potential problems.

Until something better comes along, it is in the best interest of potential cancer victims to implement screenings.  Not screening will result in the loss a huge number of lives.  Is it worth the cost savings of cutting back on biopsies?

One thing we can all agree on is that survivors of most cancers owe it to only one thing — “early” detection and treatment.

I have to add that on the medical malpractice side, the most common reason for damages is delay in diagnosis and treatment.  Juries will rarely be sympathetic to medical practitioners when all they see are delays that allow treatable cancers to become untreatable.

We have  to find better ways to screen and to do so affordably. Surely in 2011, we have the means to do that.

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Saving Money on Dental Care

Posted on September 10, 2009. Filed under: Affordable Health Care, Health Care Costs, Preventive Care | Tags: , , |

Dr. Greg contends to all health care costs are negotiable. That applies to dental care. Check out these tips from “How to Manage Dental Costs, With or Without Insurance” in the New York Times. In fact,the article uses some of Dr. Greg’ s own tips:

  1. Prevention
  2. Full disclosure about costs upfront
  3. Spread out the costs over time (different calendar years0
  4. Check out area dental school clinics

Read the whole article here.

— Posted by Cyndi Hughes




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Another’s Doctor’s View

Posted on July 15, 2009. Filed under: Affordable Health Care, Current Events, Health Care Reform, Preventive Care | Tags: , , , , , , |

The Doctor by Sir Luke FildesA must-read: This piece by Dr. Abraham Verghese in the Wall Street Journal: “The Myth of Prevention.” Inspired by Sir Luke Fildes’s 1891 painting, The Doctor (right).

More thoughts on this to follow!

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The Prostate Dilemma

Posted on July 13, 2009. Filed under: Affordable Health Care, Cancer, Preventive Care, Prostate, Recommended Medical Guidelines | Tags: , , , , , , |

Even the medical community can’t seem to agree about prostate screenings. In March, after a U.S. study suggested that screening for prostate cancer does not reduce death from the disease, a bigger European study suggested that screening can lower the death rate as much as 20 percent. (Both studies were reported in the New England Journal of Medicine.)

Then in April, the American Urological Association issued new guidelines lowering the age recommended for prostate-specific antigen (PSA) screening from 50 to 40 years.

Peter R. Carroll, professor of medicine and chair of the Department of Urology at the University of California, San Francisco, and chair of the AUA guidelines committee on PSA screening, said: “There is no patient for which there is no (more…)

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Bargains in Health Care

Posted on October 22, 2008. Filed under: Affordable Health Care, Preventive Care | Tags: , , , , , , |

Many of my patients are as concerned with costs as with the state of their health. Because of that, I work with them to make sure health care is both affordable and comprehensive. By far, the cheapest form of health care is prevention. So in my practice, I focus on  intercepting disease or health issues as early as possible or preventing them altogether. It does not take much to be a little creative. Here are some cost-saving ideas patients can take to their doctors.

Physicals do not have be administered exactly every 12 months.  There is nothing wrong with getting checkups every 15 to 18 months — a process I call “straddling.” For instance, last year many of my patients came for physicals in October, November or December, and if they were healthy, we will not schedule their next physical until early 2009. Yet only 13 to 16 months have transpired between physicals, allowing the patient to “straddle” two calendar years — 2007 and 2008 — with only one deductible payout (in 2007).

Lab tests can run in the hundreds of dollars. Again, with some thought and research, there are ways to save. For instance, for patients who are covering costs for bloodwork, we use the services of HealthCheckUSA, a nationwide company that offers discounted lab services at a savings of sometimes more than 50 percent. A complete health profile blood test valued at $530 only costs $200 at HealthCheck.

Another way to save on bloodwork is to have all basic tests run before the physical. That way, your doctor will have the test results in hand for the appointment, saving both of you the time and expense of a follow-up visit to review test results.

Your doctor can also shop around for lower costs. For tests like chest x-rays, which I always recommend for physicals, I refer patients to outpatient radiology facilities in San Antonio like South Texas Radiology, O’Neill and Associates and M&S Imaging San Antonio, where x-rays and a radiologist’s interpretation of them can be as low as $60. That’s considerably cheaper than at a hospital, where x-rays alone can run $125, and the radiologist’s interpretation could be $25 to $35 more.

These facilities are often cheaper for other tests as well. For patients who can pay with cash at the time of the test, many facilities will discount their fees. Ask your doctor for recommendations.

For women 40 and up, I recommend pelvic sonograms, which are noninvasive, safe and are cost effective. I ask the radiologist to examine the pelvis and provide additional views of the kidneys, which can give us valuable information about other organs. This type of sonogram has led to the early diagnosis of liver and kidney cancers as well as ovarian cancer well before the cancers could manifest. Insurance usually covers pelvic sonograms, especially if a woman has symptoms in the pelvic region.

I recommend colon cancer screening with a 60-inch scope for patients in their 40s.  However, most insurance covers only flexible sigmoidoscopies (24-inch scope) before age 50; that test is cheaper than a full colonscopy because it is performed without sedation in the specialist’s office rather than a surgical center. I get around this by asking the colon specialist to use the longer scope in the under-50 patients.  With the longer scope, he can perform a more thorough exam. The cost of around $150 is much less than $800 for the full colonoscopy.

If costs are a concern, don’t hesitate to have a frank talk with your doctor. Remember, your doctor is your advocate. He can shop around for cost savings and refer you to labs he uses regularly for discounts. Many doctors will often lower their own fees to their patients to help make healthcare affordable. After all, his goal is the same as yours: to ensure your health.

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