It depends. If your breasts are dense, ultrasounds (which are the same as sonograms) may differentiate between a fluid filled cyst (usually non cancerous) and a solid tumor (usually cancerous).
The tests can (and maybe should be) used together. Mammograms, tho’, are the gold standard for detecting cancer. The ultrasound alone isn’t considered adequate for detection alone.
A mammogram exposes a woman to 0.4 millisieverts (mSv) of radiation which is less than that which one is exposed to in a chest X-ray.
A woman is exposed to that amount of radiation in her natural surroundings during a seven week period.
Why do an annual physical? I don't. Don't do preventative healthcare and my Dr is fine with that... See them when I need to (usually for a sick certificate) and we chat about medicine and our careers
From a retired physician. I do not blame you for feeling that way. Most doctors feel the same. The. system has degraded MDs. Insurance companies now limit the reimbursements, control referrals, require prior authorizations, and second guess doctor opinions and decisions. MDs cannot order some tests because they are too expensive. Doctors have to see a certiain number of patients daily to pay for their overhead, ten minute visits. Inflation in medicine far exceeds the overall inflation or COLA increases..Be thankful that most MDs are hanging in there, most are burned out. High debt load from training (a mortgage of about 200,000 dollars). It won't be any different, either . It is a downward spiral...It is a sign of the decline of the American Empire. Unaffordable housing, increase in homelessness, Unaffordable gas, groceries, Military bases throughout the world. Mediocraty rules, wokeism, gays, transgenders,
I always try to frame my recommendations as suggestions….ones which the pt can take or leave. Ultimately, I’m only there to provide (hopefully scientifically correct and medically sound) advice; I’m not there to make decisions for them.
I also practice in Canada, where we are not handcuffed to EMR decrees. It’s unfortunate that these EMRs suffer the same limitation as guideline writers…they mistake the “evidence” for the totality of evidence-based medicine, and neglect pt comorbidities and pt preferences in the equation.
I will give a new doctor a couple of "tries" before I search for a new one and I have done this several times. If he/she is more interested in her computer screen than me, then I will try to find a new one. You insist I have a vaccination for something, a test for something or whatever and you don't like me telling you NO, then I move on.
I finally have a doctor who listens to me and not her computer and respects my NO to certain 'requests'. She understood when I told her "I finally have control of my body back" after covid. There aren't many doctors like her left.
I’m a nurse in Canada. It is nearly as bad here. So much is about collecting data and metrics that have nothing to do with the outcome for the patient in front of me. Despite the instructions from management that I am supposed to be “ contemporaneously” charting on the computer, I don’t. I can’t stand it when my own doctor does it. And I know that I have not disclosed important information to her because I don’t feel heard. I can manage just fine with a couple of quick handwritten cues, and with my incredibly important skills of eye contact, listening, and smiling I can get a much fuller story.
I have noticed in the last year that I have more and more patients tell me how kind I am or what a great nurse I am, when in fact, I am doing nothing different than I’ve always done. I think it has more to do with their experience elsewhere, the lack of care in their healthcare, which makes me very sad.
I fully agree that us Gen- Xers need to start speaking up for the importance of owning our own health (and encouraging our patients to to so) and our own professional practice. We are a notoriously silent generation.- it is time to speak as the adults in the room. Thank you for this post Autumn!
I was just thinking that. I was not expecting cancer at the age of 50. My previous abnormal mammogram had lead to a biopsy that was benign. I am a busy doctor and couldn't get through to the mammogram scheduler, so I rolled the dice and lost. 3 years later, my cancer was 9/9 on the aggressiveness scale and I was hoping I hadn't accidentally/negligently killed myself. THAT is an emotional roller coaster. Without that mammogram mandated by the army, I would been long dead.
I remember a woman patient years ago in the hospital who had advanced metastatic breast CA. The CA was “pinging” out her cranial nerves one at a time. This informed my approach to breast check-ups and mammograms, and made me vigilant.
We all die of something. I personally would prefer a sudden death w/o pain or terror. But I don’t have a cardiac profile that might assure that.
I too am an RN who actively practiced nursing since 1967 when the family doc took care of families and patients mostly believed whatever the doc said. I’ve watched the deterioration of the “health” industry and it’s pitiful when we discover the cheating and lies that go into “research”, while big pharma and the insurance industry run most of what they call health. I’ve told many patients - this is your body and you are the general contractor. Choose your services wisely, learn everything you can and work in partnership with your provider. If you don’t believe in a treatment, don’t do it. And remember the third leading cause of death for several years is medical mistakes often as a result of poor communication from both ends. It’s time for people to take responsibility for their own health and live wisely for their best health.
Ms. Bennett—God knows, nurses NEVER make mistakes. And don’t forget to promulgate the conspiracy theory that doctors are secretly IN LEAGUE with big Pharma and the government to deprive patients of their autonomy. Yeah, when I was practicing, I sat up nights trying to think of new ways to cause my patients as much pain as possible.
And don’t forget the teams of ROGUE NURSES who travel around the country seeking to destroy, like heat seeking missiles, any sense of trust a person might have in her/his doctor and their personal, respectful relationship.
Yeah, newsflash, the health care system is broken. And gee, it is Not doctors ‘ fault. It is due to the emergence of amazing and lifesaving advances in medicine over the last 100 years. And guess what? The old ways of doing things no longer suffice and new ways haven’f yet been implemented. Along with the amazing new drugs, came Big Pharma’s greed and insco rapacity without the necessary government regulations.
But by all means, blame doctors! Pile it on so even more will run screaming from the field.
Any patient who doesn’t know that they can refuse a treatment or walk right out the doctor’s door if they don’t like something, might not be awake, or even conscious. It’s really easy. Get up from the exam room or waiting room chair, point yourself towards the exit, and place one foot in front of the other, until you can walk out of that door. You can even slam it if you want.
But go ahead. Expend your righteous rage and keep giving useless advice about things people already know. After all, it gives you something to do.
Ever since insurance companies were allowed to be for-profit, we've been headed this way. It's absolutely disgusting that they ALL make money from the misery of others.
As many of these comments reflect, there are doctors who will listen and explain, but they may be hard to find and system incentives to do that may be absent. Medicine has become increasingly corporate and transactional and financial incentives have always been a little perverse. I have been retired for 3 years and was an advocate for computers, but never could manage data entry, written or on computer, while talking to a patient. The younger doctors are much better at it. Mammography is complicated and I’ve written a entire newsletter about it, but the discussion has to be documented for liability protection and that documentation is more onerous when it is declined (which may partly explain some of the negative reactions).
I am retired after 52 yes as RN The medical cartel has been crumbling for decades Part of every rn s job was to protect md when there was negligence or malpractice We were beholden to doctors who could make or break us. Now it is hospital admin or ceo who can make or break mds. Pharma owns it all. I trust eastern holistic care, yoga, chiropractors etc i wont use western allopathic care?
They're just a different flavor of BS. I did a decade in TCM, was accepted to Bastyr. Like the teacher who was shocked at what she heard in the teachers' lounge, the natural med crowd is laughing all the way to the bank, after charming the socks off clients.
Not really. For what NDs do well, you don't need to pay them. Eat real food, sleep well, move. Everything else is a rip-off. Plenty of NDs who have seen the light and can't believe how much time, money, and credibility they have lost.
"I need to do the adulting task of scheduling my annual doctor’s visit."
Maybe you *don't* need an annual visit. Maybe you *don't* need a mammogram. Seriously. If you're not feeling sick, why schedule the visit? Because you want labs done to monitor your health? Then you have your reason. Just ask for them. Because someone told you to? Why? Some of the healthiest people are the ones who don't do regular checkups but stay intensely aware of how their bodies are feeling.
I've stopped going to certain female annual visits because the emotional toll of being dressed in a horrible paper gown, letting things "hang" uncomfortably, and being poked and prodded in my privates is abuse for me - it's like being molested by a stranger, BTDT, don't need that in my life anymore. I'm low risk one life partner, no HPV. As for breast cancer, same fears as you - no family history of breast cancer, but I don't want the radiation, and I know that there will be a series of tests to follow up the cysts that I've had over 40 years, and that roller coaster isn't worth the ride (haven't killed me for 40 years, why biopsy them?). So I monitor myself. Any pains, any redness, any soreness. And I keep a diary.
You're not alone if you want to say no. Your mental health is just as important. And if a doctor's blowing you off, making you feel bad, it's not mentally healthy - that's an abusive relationship and it *will* take a physical toll. If you can't find someone who *will* respect you, maybe it's better not to see the ones who won't.
I also decided a long time ago that I would only see female doctors if I could (though, if I had cancer, I'd make an exception and see Dr. Prasad because I know he'll give me the most up-to-date and informed advice). Advocate for yourself. It's *your* body, *your* life.
Excellent advice. If you are having problems that seem to be beyond the normal ups and downs of everyday life, then see a doctor and get a diagnosis. That is their proper function. No one can tell you how to prevent disease, promote health, or ensure a long life.
Saw 13 doctors since 11/2019 who dismissed my symptoms, at 59, as "old age." I had been active, had a physically demanding job, cooked from scratch plant-based before it was trendy, great vitals, never sick, but suddenly couldn't hold myself up, at mid back/diaphragm. One doc really threw a wrench into things by typing another patient's HPI into my medical record. It's really difficult to get EHR errors removed.
After each doc referred out to someone else, the most benefit came from physical therapists who went online during 2020. I did decide to get a PE in Feb this year and it was exactly as the author described: long lecture about screenings, little interest in the disabling problem I am still recovering from, except to state "huh, weird symptoms" and a handful of referrals for all the screenings and a podiatry exam for a sore toe.
An eye roll could be an expression of free speech, guaranteed by the Constitution. The eye roller is communicating that they disagree with your choice (to which you are certainly entitled) and maybe even think it’s stupid.
But America is all about freedom of choice and you certainly can choose to die a horrible death from covid, thereby joining the 3100/million people who have already died.
It depends. If your breasts are dense, ultrasounds (which are the same as sonograms) may differentiate between a fluid filled cyst (usually non cancerous) and a solid tumor (usually cancerous).
The tests can (and maybe should be) used together. Mammograms, tho’, are the gold standard for detecting cancer. The ultrasound alone isn’t considered adequate for detection alone.
A mammogram exposes a woman to 0.4 millisieverts (mSv) of radiation which is less than that which one is exposed to in a chest X-ray.
A woman is exposed to that amount of radiation in her natural surroundings during a seven week period.
Why do an annual physical? I don't. Don't do preventative healthcare and my Dr is fine with that... See them when I need to (usually for a sick certificate) and we chat about medicine and our careers
From a retired physician. I do not blame you for feeling that way. Most doctors feel the same. The. system has degraded MDs. Insurance companies now limit the reimbursements, control referrals, require prior authorizations, and second guess doctor opinions and decisions. MDs cannot order some tests because they are too expensive. Doctors have to see a certiain number of patients daily to pay for their overhead, ten minute visits. Inflation in medicine far exceeds the overall inflation or COLA increases..Be thankful that most MDs are hanging in there, most are burned out. High debt load from training (a mortgage of about 200,000 dollars). It won't be any different, either . It is a downward spiral...It is a sign of the decline of the American Empire. Unaffordable housing, increase in homelessness, Unaffordable gas, groceries, Military bases throughout the world. Mediocraty rules, wokeism, gays, transgenders,
Great post. And a great reminder.
I always try to frame my recommendations as suggestions….ones which the pt can take or leave. Ultimately, I’m only there to provide (hopefully scientifically correct and medically sound) advice; I’m not there to make decisions for them.
I also practice in Canada, where we are not handcuffed to EMR decrees. It’s unfortunate that these EMRs suffer the same limitation as guideline writers…they mistake the “evidence” for the totality of evidence-based medicine, and neglect pt comorbidities and pt preferences in the equation.
AMEN!
I will give a new doctor a couple of "tries" before I search for a new one and I have done this several times. If he/she is more interested in her computer screen than me, then I will try to find a new one. You insist I have a vaccination for something, a test for something or whatever and you don't like me telling you NO, then I move on.
I finally have a doctor who listens to me and not her computer and respects my NO to certain 'requests'. She understood when I told her "I finally have control of my body back" after covid. There aren't many doctors like her left.
I’m a nurse in Canada. It is nearly as bad here. So much is about collecting data and metrics that have nothing to do with the outcome for the patient in front of me. Despite the instructions from management that I am supposed to be “ contemporaneously” charting on the computer, I don’t. I can’t stand it when my own doctor does it. And I know that I have not disclosed important information to her because I don’t feel heard. I can manage just fine with a couple of quick handwritten cues, and with my incredibly important skills of eye contact, listening, and smiling I can get a much fuller story.
I have noticed in the last year that I have more and more patients tell me how kind I am or what a great nurse I am, when in fact, I am doing nothing different than I’ve always done. I think it has more to do with their experience elsewhere, the lack of care in their healthcare, which makes me very sad.
I fully agree that us Gen- Xers need to start speaking up for the importance of owning our own health (and encouraging our patients to to so) and our own professional practice. We are a notoriously silent generation.- it is time to speak as the adults in the room. Thank you for this post Autumn!
Autumn would do well to soldier through those mammograms. This comes from a breast cancer survivor with NO family history of it.
I was just thinking that. I was not expecting cancer at the age of 50. My previous abnormal mammogram had lead to a biopsy that was benign. I am a busy doctor and couldn't get through to the mammogram scheduler, so I rolled the dice and lost. 3 years later, my cancer was 9/9 on the aggressiveness scale and I was hoping I hadn't accidentally/negligently killed myself. THAT is an emotional roller coaster. Without that mammogram mandated by the army, I would been long dead.
My sympathies.
I remember a woman patient years ago in the hospital who had advanced metastatic breast CA. The CA was “pinging” out her cranial nerves one at a time. This informed my approach to breast check-ups and mammograms, and made me vigilant.
We all die of something. I personally would prefer a sudden death w/o pain or terror. But I don’t have a cardiac profile that might assure that.
The best of luck and science to you!
I too am an RN who actively practiced nursing since 1967 when the family doc took care of families and patients mostly believed whatever the doc said. I’ve watched the deterioration of the “health” industry and it’s pitiful when we discover the cheating and lies that go into “research”, while big pharma and the insurance industry run most of what they call health. I’ve told many patients - this is your body and you are the general contractor. Choose your services wisely, learn everything you can and work in partnership with your provider. If you don’t believe in a treatment, don’t do it. And remember the third leading cause of death for several years is medical mistakes often as a result of poor communication from both ends. It’s time for people to take responsibility for their own health and live wisely for their best health.
Ms. Bennett—God knows, nurses NEVER make mistakes. And don’t forget to promulgate the conspiracy theory that doctors are secretly IN LEAGUE with big Pharma and the government to deprive patients of their autonomy. Yeah, when I was practicing, I sat up nights trying to think of new ways to cause my patients as much pain as possible.
And don’t forget the teams of ROGUE NURSES who travel around the country seeking to destroy, like heat seeking missiles, any sense of trust a person might have in her/his doctor and their personal, respectful relationship.
Yeah, newsflash, the health care system is broken. And gee, it is Not doctors ‘ fault. It is due to the emergence of amazing and lifesaving advances in medicine over the last 100 years. And guess what? The old ways of doing things no longer suffice and new ways haven’f yet been implemented. Along with the amazing new drugs, came Big Pharma’s greed and insco rapacity without the necessary government regulations.
But by all means, blame doctors! Pile it on so even more will run screaming from the field.
Any patient who doesn’t know that they can refuse a treatment or walk right out the doctor’s door if they don’t like something, might not be awake, or even conscious. It’s really easy. Get up from the exam room or waiting room chair, point yourself towards the exit, and place one foot in front of the other, until you can walk out of that door. You can even slam it if you want.
But go ahead. Expend your righteous rage and keep giving useless advice about things people already know. After all, it gives you something to do.
Ever since insurance companies were allowed to be for-profit, we've been headed this way. It's absolutely disgusting that they ALL make money from the misery of others.
As many of these comments reflect, there are doctors who will listen and explain, but they may be hard to find and system incentives to do that may be absent. Medicine has become increasingly corporate and transactional and financial incentives have always been a little perverse. I have been retired for 3 years and was an advocate for computers, but never could manage data entry, written or on computer, while talking to a patient. The younger doctors are much better at it. Mammography is complicated and I’ve written a entire newsletter about it, but the discussion has to be documented for liability protection and that documentation is more onerous when it is declined (which may partly explain some of the negative reactions).
Beautifully said.
I am retired after 52 yes as RN The medical cartel has been crumbling for decades Part of every rn s job was to protect md when there was negligence or malpractice We were beholden to doctors who could make or break us. Now it is hospital admin or ceo who can make or break mds. Pharma owns it all. I trust eastern holistic care, yoga, chiropractors etc i wont use western allopathic care?
They're just a different flavor of BS. I did a decade in TCM, was accepted to Bastyr. Like the teacher who was shocked at what she heard in the teachers' lounge, the natural med crowd is laughing all the way to the bank, after charming the socks off clients.
Proving once again, that humans are humans no matter where you find them.
Well, it’s just another example of “buyer beware.” There are good allopathic an naturopathic doctors—but not all of them.
Holistic practices can contribute to health generally.
Not really. For what NDs do well, you don't need to pay them. Eat real food, sleep well, move. Everything else is a rip-off. Plenty of NDs who have seen the light and can't believe how much time, money, and credibility they have lost.
"I need to do the adulting task of scheduling my annual doctor’s visit."
Maybe you *don't* need an annual visit. Maybe you *don't* need a mammogram. Seriously. If you're not feeling sick, why schedule the visit? Because you want labs done to monitor your health? Then you have your reason. Just ask for them. Because someone told you to? Why? Some of the healthiest people are the ones who don't do regular checkups but stay intensely aware of how their bodies are feeling.
I've stopped going to certain female annual visits because the emotional toll of being dressed in a horrible paper gown, letting things "hang" uncomfortably, and being poked and prodded in my privates is abuse for me - it's like being molested by a stranger, BTDT, don't need that in my life anymore. I'm low risk one life partner, no HPV. As for breast cancer, same fears as you - no family history of breast cancer, but I don't want the radiation, and I know that there will be a series of tests to follow up the cysts that I've had over 40 years, and that roller coaster isn't worth the ride (haven't killed me for 40 years, why biopsy them?). So I monitor myself. Any pains, any redness, any soreness. And I keep a diary.
You're not alone if you want to say no. Your mental health is just as important. And if a doctor's blowing you off, making you feel bad, it's not mentally healthy - that's an abusive relationship and it *will* take a physical toll. If you can't find someone who *will* respect you, maybe it's better not to see the ones who won't.
I also decided a long time ago that I would only see female doctors if I could (though, if I had cancer, I'd make an exception and see Dr. Prasad because I know he'll give me the most up-to-date and informed advice). Advocate for yourself. It's *your* body, *your* life.
For a long life, don't fall and stay away from doctors.
I never go unless I'm sick.
Excellent advice. If you are having problems that seem to be beyond the normal ups and downs of everyday life, then see a doctor and get a diagnosis. That is their proper function. No one can tell you how to prevent disease, promote health, or ensure a long life.
Saw 13 doctors since 11/2019 who dismissed my symptoms, at 59, as "old age." I had been active, had a physically demanding job, cooked from scratch plant-based before it was trendy, great vitals, never sick, but suddenly couldn't hold myself up, at mid back/diaphragm. One doc really threw a wrench into things by typing another patient's HPI into my medical record. It's really difficult to get EHR errors removed.
After each doc referred out to someone else, the most benefit came from physical therapists who went online during 2020. I did decide to get a PE in Feb this year and it was exactly as the author described: long lecture about screenings, little interest in the disabling problem I am still recovering from, except to state "huh, weird symptoms" and a handful of referrals for all the screenings and a podiatry exam for a sore toe.
Boomer here, I get the eye rolls ever time I turn down the covid vaccinationssssssss.
An eye roll could be an expression of free speech, guaranteed by the Constitution. The eye roller is communicating that they disagree with your choice (to which you are certainly entitled) and maybe even think it’s stupid.
But America is all about freedom of choice and you certainly can choose to die a horrible death from covid, thereby joining the 3100/million people who have already died.
Have at it!