21 ms·

I am EXCITED to see how this plays out. It is astounding to me how locked down certain medical tests are. Like, if I want an EKG, why can't I just walk in to

• dickeytk 7y ago
  Well if it’s just an EKG you’re after: https://www.alivecor.com/ https://www.alivecor.com/ But I agree with your overall point regardless
• WillDaSilva 7y ago
  >Are there legitimate safety reasons these mundane diagnostics are so locked down? Healthcare is not my area of expertise either, but my understanding is that the short answer to your question is yes. For a longer introduction to the issues surrounding letting anyone get whatever diagnostics they want to pay for, this Medlife Crisis video that came out today seems appropriate: https://youtu.be/yNzQ_sLGIuA https://youtu.be/yNzQ_sLGIuA
  • jwbwater 7y ago
    This crazy. It's like saying no one should have access to medical tests without a doctor's approval because some people will misinterpret their tests.
    • SilasX 7y ago
      More than “like”, I’d say “equivalent to”.
    • jrowley 7y ago
      Time on an MRI scanner (and to interpret and communicate the result) is a limited resource. I fear unrestricted access would lead to over utilization by some people at the cost of less utilization by others. It could also lead to nontrivial psychological stress for people who can’t get a full understanding of the results. But I do think we need to strive for increased transparency from price lists to EHR interoperability to patient access to their own records.
      • gowld 7y ago
        MRI is profitable and not made from scarce materials. Increased demand will increase production. Doctors are only scarce because they are members of a guild that uses monopoly power to restrict competition to prop up prices.
        • jrowley 7y ago
          MRIs depend on liquid helium, a scarce material by definition, but that's besides the point. There is a high bar to becoming a physician because the consequences for error can be so incredibly high. I want there to be more physicians/access to medical care than ever but I don't think compromising on quality is the way to get there.
          • polishdude20 7y ago
            Actually helium being scarce is a myth.
• wahern 7y ago
  CVS has already provided this for over 10 years: https://en.wikipedia.org/wiki/MinuteClinic https://en.wikipedia.org/wiki/MinuteClinic Because it fell off everybody's radar, I assume CVS MinuteClinic hasn't been as revolutionary as originally hoped. OTOH, if Walmart is joining the fray then either the retail clinic market has been steadily growing in general, or Walmart thinks they can do something different.
  • delfinom 7y ago
    Problem is MinuteClinic is just that, a clinic, it's just a nurse that can do "office treatments" such as vaccines, shots, prescribing blood tests, bandaging wounds, etc. But ultimately anything else has to be referred out.
    • Double_a_92 7y ago
      Prescribing blood tests might already save doctors time. Most of the time when I'm sick the doctor just asks broad questions and takes a blood samples... and I'm told to come back tomorrow when the results are back from the lab.
    • swebs 7y ago
      Right, but that seems to be exactly what the parent comment wants.
    • apcragg 7y ago
      Maybe it is different where I am but in my experience, it is always an MD on staff.
  • abawany 7y ago
    I tried it once in 2007 and it was quite pointless. The person in charge at that location was I think a real MD but she appeared to be encumbered by hard policies that restrained her from pretty much doing anything. I regretted wasting time there since I had to go to a regular doctor anyways and haven't been back.
    • 7y ago
• yellow_lead 7y ago
  Medical tests can also be counter productive. Hear me out. There's studies that regularly show the optimal age for i.e breast cancer screening. Screening too early can cause an increase in misdiagnosis I believe. There are other such cases for not just cancer screenings - I know not exactly what you're talking about. EEG and blood test make sense. But for more advanced tests, you could be right in saying "there are legitimate safety reasons" - maybe not so much from the test itself but from the impact of a false positive.
  • eru 7y ago
    Yes, but that argument would prove too much. People get very anxious just from browsing medical information on the Internet and matching up their easily observable symptoms.
  • ohazi 7y ago
    I'm so fucking tired of this perspective. Yes, it's technically correct. Many of us have done the canonical "cancer screening false positive / false negative" example demonstrating the problem in a statistics class. But at the end of the day, I'm paying a doctor to care for me, not the general public. I may be a member of the general public, but the public interest and my interests are not identical. If I'm willing and able, I should be able to pay to have a test done (anonymously), and be left alone to deal with the statistics of what the results actually mean for myself. The fact that I have to fight my doctor to do this is condescending bullshit.
    • jcims 7y ago
      PREACH! It's a bunch of gatekeeping bullshit and drives me crazy. My wife went through two years of misery and the number of times I had to argue over getting labs done that ultimately influenced her treatment left me with a rather deep mistrust and skepticism over the medical community that is going to take a lot of time to repair.
    • KptMarchewa 7y ago
      This attitude is another example of why private healthcare is a very bad idea.
• Melting_Harps 7y ago
  > As important as health is, and as much as Americans spend on it, it is shocking to me how gated everything is. Agreed I had this issue as an uninsured university student with an Xray, and as one covered by my employer's insurance with an MRI. In both cases I was stone walled to just get either, in the former I had to go to a clinic see an MD, come back get a physical and then get a referral for imaging off-site. And in the latter, I had to see 3 specialists, get a physical, have several weeks of Physical therapy and Xray imaging before the Insurance would cover it. > Again, I pay for health insurance, but I still feel like if I want a quick EKG, it will take me 3 weeks to see a doctor, and by then I might be dead. It was so exhausting just trying to make all the appointments and follow ups with a full work schedule that I haven't been able to get that MRI after all. I just assumed the worst and started to take matters into my own hands and started to do my PT exercises into my daily gym routine and will monitor the results myself. > What am I missing? Are there legitimate safety reasons these mundane diagnostics are so locked down? Its a protected Industry, the very supply of MDs is drastically capped in this country, its a controlled cartel.
  • catblast 7y ago
    MRIs are actually very expensive. Like they are just expensive... even in Europe. They’re costly to own and operate and maintain correctly.. just the labor alone. Unless you’re willing to pay out of pocket, I don’t see a problem with exhausting other options before jumping to MRI. Also as for X-rays.. I think people freely getting Ionizing radiation isn’t exactly the brightest thing ever. Also who pray tell, is going to read these studies?
  • deleted 7y ago
    [deleted]
• killjoywashere 7y ago
  As a physician, please, get more tests. My wife wants some new shoes!
  • tathougies 7y ago
    Well there are lot of rich health conscious people in this country that would love to do that for your wife.
    • phaemon 7y ago
      Now there's a comment you don't want taken out of context.
  • ijidak 7y ago
    I'm absolutely fine with that. :-) After all, businesses exist to provide a service, and when I pay for that service if the owner gets to buy his wife shoes, that doesn't bother me. What does bother me is that I can't walk into a clinic, let's call it "EasyLabs", and ask for an EKG right now, for $100, $200, $300. It's the immediacy and tranparency of pricing, that's lacking and eliminating the doctor as middle man for tests and diagnostics that aren't harmful. Money is not my concern. The inefficiency is what is shocking to me. To put the inefficiency of medical diagnostics in perspective, it is likely faster and easier for me to go out right now and buy a new $50,000 car, than it is for me to order my own MRI. To me that just seems crazy. But, as I said, maybe I'm missing something about the danger of getting tests like an EKG or an MRI needlessly. For example, we know accumulated radiation from unnecessary x-rays would be harmful. So clearly not every medical diagnostic is safe to self-request.
    • DanBC 7y ago
      MRIs are harmful for patients without symptoms. https://www.amjmed.com/article/S0002-9343(13)00967-4/pdf https://www.amjmed.com/article/S0002-9343(13)00967-4/pdf http://www.lessismoremedicine.com/blog/video-do-more-screening-tests-lead-to-better-health-docmikeevans http://www.lessismoremedicine.com/blog/video-do-more-screeni... (There are lots of posts about over testing on the Less is More site: http://www.lessismoremedicine.com/blog/tag/overtesting http://www.lessismoremedicine.com/blog/tag/overtesting ) Take a patient who has smokes about five cigarettes every day. Should we MRI their lungs to see if they have lung cancer? The patient has the MRI, and doctors see some small spots in the lungs. Is this cancer? Or is it something that is completely harmless, such as scarring from childhood disease? To find out a needle biopsy is used. This is low risk, but it isn't no risk. The biopsy comes back clear. Does that mean that these spots are harmless, or does it mean that the person doing the biopsy missed them? At each stage we're perhaps causing fear and alarm and distress, and not really getting any useful information. But we do know that this person smokes, and we do know that their health would be improved if we could help them stop smoking, and we know that nicotine replacement and support is an effective way to stop smoking for many people. It's probably a better way to spend the money.
• michaelmrose 7y ago
  Because they are too incompetent to be trusted to handle anything more complicated than shoes and canned food. As a former employee I could tell you stories.
• deleted 7y ago
  [deleted]
• quantumwoke 7y ago
  > Like, if I want an EKG, why can't I just walk in to a place and get it done at a reasonable price? And without a doctor's approval? You're also paying for interpretation of your EKG at the same time. There are plenty of places happy to sell you home BP/HR/EKG monitoring kits, but you have to remember that you are paying for a doctor's time and clinical expertise when getting them in a hospital. It's not like a single EKG will tell you all that much about your heart anyway.
  • szanni 7y ago
    This is precisely the reason: a doctor’s interpretation as well as the liability that comes with it. Good luck on reading an EKG graph yourself. It is apparently not even easy for a trained doctor to discern what exactly is going on. Source: I worked on a long term ECG holter monitor sold by GE.
• troydavis 7y ago
  > I would gladly even pay $50 per month for unlimited access to a place to just come in, get my blood sugar, kidney function, heart function, liver function, etc. tested once per month! Walk-in labs like AnyLabTestNow and Quest will gladly do a CBC as often as you want: https://www.anylabtestnow.com/tests/complete-blood-count/ https://www.anylabtestnow.com/tests/complete-blood-count/ , https://questdirect.questdiagnostics.com/products/complete-blood-count-cbc/f9297753-b19f-4c9a-8a1f-f69564220a3b https://questdirect.questdiagnostics.com/products/complete-b... Other tests: https://www.anylabtestnow.com/test-finder/ https://www.anylabtestnow.com/test-finder/ (I agree with the other commenters that frequent asymptomatic blood testing is unlikely to help, even more so when done alone - not because of false positives, just because CBC results vary a lot for no detectable reason/problem)
  • ijidak 7y ago
    Thank you. Making a note of these.
  • big_chungus 7y ago
    Just checked the price on CBC from any lab test now, $50. That's still pricey for most people, especially for a half-dozen similar tests per month. Walmart has historically proven very good at forcing prices down through economies of scale.
    • troydavis 7y ago
      No one without symptoms needs these tests every month. Meaningful changes manifest with symptoms or happen slowly or both. As an example of the first case, a person’s white blood cell count isn’t going to go haywire overnight with no other symptoms. An example of the second case is fasting blood glucose: it's important to know before symptoms appear, but is not going to change dramatically (beyond the draw-to-draw/day-to-day variation) in a month, or even in 3-6 months. Getting these monthly with no medical need is like telling someone you’re aiming for 300% test coverage :-)
• lowercased 7y ago
  > I would gladly even pay $50 per month for unlimited access to a place to just come in, get my blood sugar, kidney function, heart function, liver function, etc. tested once per month! I've noticed my gym offers somewhat regular screening days which offer some (or all?) of that stuff, but it still costs extra. Reasonable (~$30?) but it would probably be something used more regularly if it was just part of the membership, and considered a normal thing. I don't even think they offer it monthly - I think it's quarterly.
• soared 7y ago
  This argument is comparable to thinking that a painting is only worth the materials it’s made out of, and everything else is worthless. A doctor and their staff have trained for decades in order to handle your health, why in the world do you think you can do it after some googling? Compare it to your own job - if I had the same tools as you, could I walk in and do the same job you do?
  • mrfredward 7y ago
    >Compare it to your own job - if I had the same tools as you, could I walk in and do the same job you do? Should access to a compiler be gated just because amateur programmers probably don't know as much as people with a degree? The fact that you need to go to a doctor, to get referred to a facility which will run a test, which will then send that test data back to the doctor, and at the second appointment the doctor will go over the data with you to see if you needed to go to the doctor in the first place...is just an absurd waste. It shouldn't be so hard to get a few measurements done on your own body.
    • soared 7y ago
      My point is that a random person with access to any highly specialized tool will not output usable results. If I try to use a compiler and mess up, nothing bad happens. If I go get myself an EKG and mess up the reading, well.. death is somewhere in the list of possibilities. (To be fair, I fall into the group of people who believe in very strong government regulation to protect people from themselves, because the world is too complicated to make well-informed decisions. Easy example is seatbelts - if Ford could sells cars for $1500 cheaper if they didn't have seatbelts then some people would buy them and they'd die. Not everyone will do the proper research, so everyone needs protecting.)
  • khafra 7y ago
    > A doctor and their staff have trained for decades in order to handle your health, why in the world do you think you can do it after some googling? Counterpoint: Doctors have an average IQ of 115, and train across a huge variety of disciplines; mostly while sleep-deprived. Many doctors' training was decades ago. Anyone with a somewhat abnormal condition, access to Google Scholar, and able to learn how to follow citations and simultaneously weigh competing models can outdo anybody except a dedicated specialist. The relevant job comparison isn't to a painter, it's to a programmer with a hundred clients, each of whom he talks with for 30 minutes, once a year. Sure, the programmer has much more knowledge and skill--but is he really going to be able to adequately replace the every client's home-brewed solution spread across 4 excel sheets, 3 batch files, and an archived website? Should the client really be restricted from downloading Python or Visual Studio for their own use, unless a real programmer signs off on the requirement and supervises them?
• Medicalidiot 7y ago
  It's a massive waste of money and resources to get an EKG without a clinical presentation. It's a massive resources to get a CBC and CMP without some positive predictive value. Why don't we throw every test at you? Because there's a significant chance you will be a false positive/negative. This is dangerous to look at this way.
  • blaser-waffle 7y ago
    What are those risks, like, what do they look like quantified? "Waste of money and resources" is relative if you're only blowing ~$200 bucks. Even if there is a 8-10% chance of a false positive, they're cheap enough to do two... or 8. Kinda like how people by multiple cheap birth control tests. Anecdote: I've had hernia problems off and on courtesy of the USMC and did no less than three (3) sonograms after being referred by different GPs to do so -- and they found nothing. Symptoms didn't go away and I kept going back. This was in the Inova system around Washington DC, one of the better systems in the US. One afternoon I double over in pain and end up in emergency surgery because, low and behold, I did actually have a hernia and it was strangulated; my intestine was literally dying one inch at a time. Emergency surgery saved my life, but I paid ~3-4K for all of those sonograms & consults + more for the actual surgery. All in maybe $8-10K. Walmart-tier medical may not be great, but one of the better health systems in the US failed me just as effectively, and at a greater cost. Would 5 Walmart sonograms have found it? 10 scans? Maybe not, but I probably could have done 10 scans and still saved money.
    • labawi 7y ago
      If a test has 5% false-positive rate, you can't just test 5 times and expect to have a <0.000001 false positive rate, maybe not less than 1% or even 4% - depends on the test and how you repeat it. If they test you for antibodies, and your blood reacts, doing the same thing 5 or 50 times is not going to help. If you have a wobble on your EKG, it's not going away just because you measure it 10 times. Though it might, if you were just stressed the first time. Or they might find something 2 out of 10 times and then what - do you just ignore it? To be clear, I'm not against non-invasive voluntary testing, but procedures need to be adjusted, otherwise people get treatments they don't need and suffer the effects (while also tying up actual doctors and equipment). BTW sorry about your issues. Those were false negatives, and you had symptoms, where better/additional/more tests are warranted.
• catblast 7y ago
  > and as much as Americans spend on it, it is shocking to me how gated everything is. It didn’t always use to be this way. Then people started getting poisoned, sick and dying. It’s not like the FDA existed when they ratified the constitution. The opium epidemic proves the system is flawed and broken, it does not however prove that just throwing everything away will make things better.