I picked up many of my patients from a doc who seemed to do shared decision making for PSA screening by telling people it was a useless test, and told them not to do it. It's been interesting to do my tap dance of pros and cons and see what people choose. It turns out I am very bad at predicting who will opt for it and who will not.
A further challenge for me is the 80+ year old patient who feels he needs a screening PSA. I do the whole talk, including the part about how PSAs tend naturally to rise as men get older, and we don't really know how to interpret PSAs of 83 year old men. And they still want it. It comes back slightly elevated and I send them to see a urologist who says, "It's fine, but let's keep an eye on it." They feel vindicated because "See! he said it's important to keep an eye on this!" This is not better medical care. He's not healthier; he's slightly less healthy (although he can afford the copay) and feels the hour spent at the urologist office was a good use of the hour. Certainly, he *feels* more healthy and maybe that benefit is enough to justify the test and the hour of urologist's time. (Thankfully, none of these has caused a patient to get a biopsy.)
TL;DR: I find it tremendously challenging to explain the rationale for stopping PSA screening at 70 to my patients.
Very much appreciate your time and writing. I like the idea of giving my patients all the information I have and then letting them decide but telling them no matter what their decision I will support them.
I picked up many of my patients from a doc who seemed to do shared decision making for PSA screening by telling people it was a useless test, and told them not to do it. It's been interesting to do my tap dance of pros and cons and see what people choose. It turns out I am very bad at predicting who will opt for it and who will not.
A further challenge for me is the 80+ year old patient who feels he needs a screening PSA. I do the whole talk, including the part about how PSAs tend naturally to rise as men get older, and we don't really know how to interpret PSAs of 83 year old men. And they still want it. It comes back slightly elevated and I send them to see a urologist who says, "It's fine, but let's keep an eye on it." They feel vindicated because "See! he said it's important to keep an eye on this!" This is not better medical care. He's not healthier; he's slightly less healthy (although he can afford the copay) and feels the hour spent at the urologist office was a good use of the hour. Certainly, he *feels* more healthy and maybe that benefit is enough to justify the test and the hour of urologist's time. (Thankfully, none of these has caused a patient to get a biopsy.)
TL;DR: I find it tremendously challenging to explain the rationale for stopping PSA screening at 70 to my patients.
Very much appreciate your time and writing. I like the idea of giving my patients all the information I have and then letting them decide but telling them no matter what their decision I will support them.