4 ms·

> High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course

> High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives. How do you know if you’re at high risk for something? This assumes a medically literate and motivated person will seek care based on … what? Realizing that grandpa, great-grandpa and dad all didn’t live past their 60’s? High cholesterol and hypertension can be “silent killers” - how do you know to check for them?

arcticbull 3y ago
For what it's worth hypertension is a good example of a bad test - or a routinely poorly executed one, anyways. According to the AHA, blood pressure is supposed to be taken with feet flat on the floor, relaxed, and quiet for five whole minutes before, on an empty bladder, without caffeine and not having exercised within 30 minutes. I can count on zero hands the number of times I've had my blood pressure measured in accordance with this procedure in a doctor's office during a check-up. [1] It's a highly variable thing that can spike instantaneously and take a long period of time to return to normal without issue. Which is probably part of why 30% of people who get their blood pressure taken in a doctor's office will register a higher than normal blood pressure principally only in the doctor's office. This is called 'white-coat hypertension' and doctors and researchers are pretty split on whether or not this represents an actual problem. With that in mind, it makes this a pretty worthless test in the context of an annual physical. The optimal way to make a hypertension determination is a 24-hour continuous blood pressure monitoring cuff. You should take your blood pressure at home, on your own time, in a relaxed environment and if you see a consistently elevated reading, only then reach out to your doctor and set up an appointment to confirm with a 24h test. [1] https://www.heart.org/-/media/files/health-topics/high-blood-pressure/tylenol-hbp/aha_toolkit_poster_final_102618.pdf https://www.heart.org/-/media/files/health-topics/high-blood...
- akiselev 3y ago
  > Which is probably part of why 30% of people who get their blood pressure taken in a doctor's office will register a higher than normal blood pressure principally only in the doctor's office. This is called 'white-coat hypertension' and doctors and researchers are pretty split on whether or not this represents an actual problem. With that in mind, it makes this a pretty worthless test in the context of an annual physical. My favorite conspiracy theory is that this is why we always have to wait so long after we're in the exam room but before the nurse comes in to take BP. My BP monitor's instructions say to sit calmly for 15 minutes for an accurate reading and I think that's what they're doing. Meanwhile, since the kids are so hyper it's not even worth trying the delay tactic so the pediatricians come in much faster.
  - hgsgm 3y ago
    That's impressive excus-making for doctor-priority scheduling density. It's not "calm" to be on edge for 15minutes wondering when the provider will appear. Also my office takes my BP as soon as my appointment time starts and then we sit waiting for doctor.
- heisenbit 3y ago
  It is not worthless. After getting a series of higher test results my doctor suggested a 24h test snd only then diagnosed mild hypertension. Baseline blood measurements can also be invaluable. When getting sick you don‘t want to go down rabbit holes. The US has a comparatively high hurdle to access to doctors. When doctors see patients they need to assume it is bad (liability another factor) driving costs up. Also people are not used to reach out to doctors letting them hesitate when they should not - regular contact can help here. Every year major bloodwork and investigations may not be worth it but seeing your doctor regularly, being able to communicate effectively, doctor having a baseline of you as a person and some bloodwork too makes other countries a lot more efficient in providing health care.
  - specialist 3y ago
    > seeing your doctor regularly, being able to communicate effectively In other words, building a relationship. Continuity of care improves health outcomes.
- avidphantasm 3y ago
  I addition to the not-waiting-five-minutes part not being observed, I’ve heard from medical assistants that automated blood pressure cuffs always read high and that “good” doctors don’t trust them. In fact, when I go to the cardiologist, they seem to always use the non-automated method. However, every ER, urgent care, PCP, etc. seems to use the automated method.
  - kevviiinn 3y ago
    Weird because the automated one I have at home reads normal but my PCP's always shows high. The difference is that I do mine after being still and quiet for 5 minutes while they rush me into the office, ask me a ton of questions and immediately read my blood pressure while I sit on that bed thing with no back support
    - specialist 3y ago
      I bring all my home gear in with me, to compare the measurements. FWIW, my cheap OMRON blood pressure thing has agreed with the pro results, thus far.
      - kevviiinn 3y ago
        Yea, I also have an OMRON and I'm sure it would agree in the same setting but I actually check my BP according to guidelines at home
    - haldujai 3y ago
      White coat hypertension is also a potential contributor. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/white-coat-hypertension/faq-20057792 https://www.mayoclinic.org/diseases-conditions/high-blood-pr...
      - kevviiinn 3y ago
        I highly doubt that, the situation in which it's measured (no back or foot support while talking) is literally against the AHA and other guidelines for BP measurement. When I replicate it at home, it's the same and higher but if I wait and use a proper chair and don't talk then it's fine
- specialist 3y ago
  What's your position on wearable health monitors? For stats like blood glucose, heart rate, blood pressure, etc.
  - bumby 3y ago
    The general consensus from MDs that I’ve heard is that the non-FDA approved ones have way too much variance to be useful. They just aren’t very accurate.
- haldujai 3y ago
  No physician should (and I expect would) diagnose hypertension on a single office-based blood pressure measurement. We suspect it based on the office measurement and then confirm. I last worked in primary care back in 2016 but even back then we would either do multiple visits or ask the patient to check multiple times at a pharmacy (or at home if they could afford a cuff). 24 hour ABPM is the preferred method for diagnosis as you stated but has limited (albeit growing) availability today. Fortunately consumer health-tech advancements has resulted in cheaper accurate BP cuffs but this is a recent-ish phenomenon.
- dkn775 3y ago
  Is there a form of passive blood pressure wearable? I am trying to find a way for my mom to track her BP throughout the day after meals etc. she does this with a libre for blood sugar
morsch 3y ago
I suppose considering your family history or having your DNA analyzed is one way. But the more direct way is to consider your own medical history. Chronic diseases may coincide with risk for other ailments and you get regular checkups for those. If you had a heart attack, you have a yearly visit with a cardiologist. Etc.
pessimizer 3y ago
This isn't an article claiming you should never have gone to a doctor. It's about annual checkups.

arcticbull 3y ago

For what it's worth hypertension is a good example of a bad test - or a routinely poorly executed one, anyways. According to the AHA, blood pressure is supposed to be taken with feet flat on the floor, relaxed, and quiet for five whole minutes before, on an empty bladder, without caffeine and not having exercised within 30 minutes. I can count on zero hands the number of times I've had my blood pressure measured in accordance with this procedure in a doctor's office during a check-up. [1] It's a highly variable thing that can spike instantaneously and take a long period of time to return to normal without issue. Which is probably part of why 30% of people who get their blood pressure taken in a doctor's office will register a higher than normal blood pressure principally only in the doctor's office. This is called 'white-coat hypertension' and doctors and researchers are pretty split on whether or not this represents an actual problem. With that in mind, it makes this a pretty worthless test in the context of an annual physical. The optimal way to make a hypertension determination is a 24-hour continuous blood pressure monitoring cuff. You should take your blood pressure at home, on your own time, in a relaxed environment and if you see a consistently elevated reading, only then reach out to your doctor and set up an appointment to confirm with a 24h test. [1] https://www.heart.org/-/media/files/health-topics/high-blood-pressure/tylenol-hbp/aha_toolkit_poster_final_102618.pdf https://www.heart.org/-/media/files/health-topics/high-blood...

akiselev 3y ago
> Which is probably part of why 30% of people who get their blood pressure taken in a doctor's office will register a higher than normal blood pressure principally only in the doctor's office. This is called 'white-coat hypertension' and doctors and researchers are pretty split on whether or not this represents an actual problem. With that in mind, it makes this a pretty worthless test in the context of an annual physical. My favorite conspiracy theory is that this is why we always have to wait so long after we're in the exam room but before the nurse comes in to take BP. My BP monitor's instructions say to sit calmly for 15 minutes for an accurate reading and I think that's what they're doing. Meanwhile, since the kids are so hyper it's not even worth trying the delay tactic so the pediatricians come in much faster.
- hgsgm 3y ago
  That's impressive excus-making for doctor-priority scheduling density. It's not "calm" to be on edge for 15minutes wondering when the provider will appear. Also my office takes my BP as soon as my appointment time starts and then we sit waiting for doctor.
heisenbit 3y ago
It is not worthless. After getting a series of higher test results my doctor suggested a 24h test snd only then diagnosed mild hypertension. Baseline blood measurements can also be invaluable. When getting sick you don‘t want to go down rabbit holes. The US has a comparatively high hurdle to access to doctors. When doctors see patients they need to assume it is bad (liability another factor) driving costs up. Also people are not used to reach out to doctors letting them hesitate when they should not - regular contact can help here. Every year major bloodwork and investigations may not be worth it but seeing your doctor regularly, being able to communicate effectively, doctor having a baseline of you as a person and some bloodwork too makes other countries a lot more efficient in providing health care.
- specialist 3y ago
  > seeing your doctor regularly, being able to communicate effectively In other words, building a relationship. Continuity of care improves health outcomes.
avidphantasm 3y ago
I addition to the not-waiting-five-minutes part not being observed, I’ve heard from medical assistants that automated blood pressure cuffs always read high and that “good” doctors don’t trust them. In fact, when I go to the cardiologist, they seem to always use the non-automated method. However, every ER, urgent care, PCP, etc. seems to use the automated method.
- kevviiinn 3y ago
  Weird because the automated one I have at home reads normal but my PCP's always shows high. The difference is that I do mine after being still and quiet for 5 minutes while they rush me into the office, ask me a ton of questions and immediately read my blood pressure while I sit on that bed thing with no back support
  - specialist 3y ago
    I bring all my home gear in with me, to compare the measurements. FWIW, my cheap OMRON blood pressure thing has agreed with the pro results, thus far.
    - kevviiinn 3y ago
      Yea, I also have an OMRON and I'm sure it would agree in the same setting but I actually check my BP according to guidelines at home
  - haldujai 3y ago
    White coat hypertension is also a potential contributor. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/white-coat-hypertension/faq-20057792 https://www.mayoclinic.org/diseases-conditions/high-blood-pr...
    - kevviiinn 3y ago
      I highly doubt that, the situation in which it's measured (no back or foot support while talking) is literally against the AHA and other guidelines for BP measurement. When I replicate it at home, it's the same and higher but if I wait and use a proper chair and don't talk then it's fine
specialist 3y ago
What's your position on wearable health monitors? For stats like blood glucose, heart rate, blood pressure, etc.
- bumby 3y ago
  The general consensus from MDs that I’ve heard is that the non-FDA approved ones have way too much variance to be useful. They just aren’t very accurate.
haldujai 3y ago
No physician should (and I expect would) diagnose hypertension on a single office-based blood pressure measurement. We suspect it based on the office measurement and then confirm. I last worked in primary care back in 2016 but even back then we would either do multiple visits or ask the patient to check multiple times at a pharmacy (or at home if they could afford a cuff). 24 hour ABPM is the preferred method for diagnosis as you stated but has limited (albeit growing) availability today. Fortunately consumer health-tech advancements has resulted in cheaper accurate BP cuffs but this is a recent-ish phenomenon.
dkn775 3y ago
Is there a form of passive blood pressure wearable? I am trying to find a way for my mom to track her BP throughout the day after meals etc. she does this with a libre for blood sugar

morsch 3y ago

I suppose considering your family history or having your DNA analyzed is one way. But the more direct way is to consider your own medical history. Chronic diseases may coincide with risk for other ailments and you get regular checkups for those. If you had a heart attack, you have a yearly visit with a cardiologist. Etc.

pessimizer 3y ago

This isn't an article claiming you should never have gone to a doctor. It's about annual checkups.