6 ms·

I was just talking to my wife about this. I've recently been to the doctor because of some headaches I was having. They did some blood work, and when it came ba

by cesarbs 12y ago

I was just talking to my wife about this. I've recently been to the doctor because of some headaches I was having. They did some blood work, and when it came back I got a call from the doctor saying we should check my liver function again in 3 months. I wasn't very concerned because ever since I was a kid I have heard that (I guess some normal values for me are outside the range considered normal for most people). This week, I logged in to their patient portal because I wanted to look at some previous blood test results. I was absolutely startled when I saw that my AST and ALT counts were pretty high, about twice the upper limit for what is considered normal. But then I realized that I had that blood work done around the time I had started strength training and increased the amount of protein in my diet. A quick online search revealed that a single strength training session increases AST and ALT levels for up to seven days. Considering I had been exercising multiple times a week, it was completely normal for my levels to be elevated. Now, why didn't the doctor simply ask me if I had been strength training? Such a simple question would have explained the abnormal test results and saved me some distress.

robomartin 12y ago
The part that blows me away is that you have a patient portal and can see your test results online.
- cesarbs 12y ago
  I thought that was a common thing. Where do you live?
  - deleted 12y ago
    [deleted]
  - tdfx 12y ago
    I've been to doctors in New Jersey, Pennsylvania, and Florida, and never heard of any such online system for reviewing your results. There's no incentive to provide the results to the patient without an in-person consultation they can bill the insurance company for.
    - laurenstill 12y ago
      This year is the first for physician attestation for MUS2, give it some time. Chances are you will have to actively ask for login information if you are seeing a doctor in a small(er) private practice, as it's likely not a core priority of their EHR software (think 'it's there because it has to be, not because we actually expect anyone to use it'). Of my 6 doctors, 3 have EHRs with patient portals, but none of them are populated with encounter data or visit notes; two don't use an EHR and one is associated with UCSF and uses Epic, so I get MyChart. Last month I was trying to get a copy of my MRI from UCSF, but their cd burner on the PACS was down. They are participants in RSNA image share so patients can opt to import scans into a portal but it took me 3 people in the radiology library before finding someone who knew anything about it.
    - mdd820 12y ago
      Yes there is,.. the empowered patient,.. Nj Hitech has just has assisted 5,500 physicians to EHR's systems, the hospital's are required as well. Patient Portals (PHR's) will follow. We are a start up working with Personal Medical Records (PHR's), making it feasible for you to use set aside insurance funds for wellness products ad services. Keep the faith, maintaining your health and promoting wellness is getting easier !!
- sixothree 12y ago
  Meaningful Use - Stage 2. Completely amazing to me that more Americans have no idea what's going on in health IT.
- elpachuco 12y ago
  Recently rolled out at my local hospital. The best part is I get e-mail reminders for all appointments. I also get an e-mail notification when a test result has been logged.
brandonmenc 12y ago
This exact thing happened to me - at the Mayo Clinic, of all places. I found the same info after the initial test, then refrained from lifting for a week before the follow up lab work. Tests were normal the second time but had they not been, I'd have been given a (presumably more expensive) ultrasound. My only guess is that the lifting-bad-liver-panel effect isn't something that happens often, since so many people strength train these days.
fnordfnordfnord 12y ago
>I logged in to their patient portal Is this "Patient Portal" software some kind of off-the-shelf crapware? It is terrible.
- 0xfffafaCrash 12y ago
  Unlikely. It's probably the healthcare organization's version of Epic's MyChart which gives patients the ability to access some of their own medical records.
  - zaroth 12y ago
    Epic seems to have completely taken over EMR... And watching doctors and nurses try to use it, just wow.
untilHellbanned 12y ago
AST and ALT change all the time. Depending on circumstances, 2x normal isn't particularly notable. Also, strength training isn't necessarily the cause nor is it something a doctor automatically, nor even commonly, flags for concern. The doctor should have asked you about changes in your daily routines, but you have to give them the benefit of the doubt. It's only the doctors job to find relevant data regarding your chief complaint. If they thought 2x changes were something to care about they would have followed up with you about that. Not to be impolite but only to make a point: if you read enough to be distressed, you could have read enough to de-distress yourself.
toasted 12y ago
your doctor knew it was probably unimportant, could be caused by a myriad of things, and a repeat blood test in a few months would be normal and mean they could forget about it. Because of the patient portal with its ability for patients to access info they don't understand the significance of, you were "absolutely startled" and "distressed". If you didnt have access to those results then you wouldn't have been concerned. Regardless of all that, you should still have repeat LFT's because you don't know for sure that "strngth training" was the cause of the problem. Honestly, Doctors find navigating the minefield of clinical decision making difficult enough, trying to make judgements on sensitivity/specificity of tests and investigations, positive predictive values, remove confounding, drug company propaganda, publication bias etc etc without patients trying to get into it all as well. Should I spend 1 hour explaining to every fucker with a headache why a CT head is more likely to cause brain cancer than it is to diagnose it? The solution to the US healthcare woes is NOT more patient autonomy and decision making. The solution is moving towards a less money orientated system and trying to encourage altruism and alignment of patient's goals with doctor's actions.
- nitrogen 12y ago
  Should I spend 1 hour explaining Yes, absolutely. Medicine needs to descend from its status as a high priesthood and be a little more accessible.
  - VLM 12y ago
    The question is if that's the best possible use of his time to improve the lives of the most patients. A stereotypical micro vs macro problem where the best possible micro solution is likely not the best possible macro solution. To some extent its a systemic problem with levels of support. Every customer that calls into a call center claiming space aliens are controlling their minds should not be transferred to argue with the VP of software development for an hour.
    - nitrogen 12y ago
      Possible solutions: reduce the scarcity of doctors capable of explaining ionizing radiation, add more non-doctors who can do more than just draw blood and check vitals, etc. Part of the macro problem is that a lot of micro problems are caused by insufficient communication and a lack of patient knowledge.

by cesarbs 12y ago

robomartin 12y ago

The part that blows me away is that you have a patient portal and can see your test results online.

cesarbs 12y ago
I thought that was a common thing. Where do you live?
- deleted 12y ago
  [deleted]
- tdfx 12y ago
  I've been to doctors in New Jersey, Pennsylvania, and Florida, and never heard of any such online system for reviewing your results. There's no incentive to provide the results to the patient without an in-person consultation they can bill the insurance company for.
  - laurenstill 12y ago
    This year is the first for physician attestation for MUS2, give it some time. Chances are you will have to actively ask for login information if you are seeing a doctor in a small(er) private practice, as it's likely not a core priority of their EHR software (think 'it's there because it has to be, not because we actually expect anyone to use it'). Of my 6 doctors, 3 have EHRs with patient portals, but none of them are populated with encounter data or visit notes; two don't use an EHR and one is associated with UCSF and uses Epic, so I get MyChart. Last month I was trying to get a copy of my MRI from UCSF, but their cd burner on the PACS was down. They are participants in RSNA image share so patients can opt to import scans into a portal but it took me 3 people in the radiology library before finding someone who knew anything about it.
  - mdd820 12y ago
    Yes there is,.. the empowered patient,.. Nj Hitech has just has assisted 5,500 physicians to EHR's systems, the hospital's are required as well. Patient Portals (PHR's) will follow. We are a start up working with Personal Medical Records (PHR's), making it feasible for you to use set aside insurance funds for wellness products ad services. Keep the faith, maintaining your health and promoting wellness is getting easier !!
sixothree 12y ago
Meaningful Use - Stage 2. Completely amazing to me that more Americans have no idea what's going on in health IT.
elpachuco 12y ago
Recently rolled out at my local hospital. The best part is I get e-mail reminders for all appointments. I also get an e-mail notification when a test result has been logged.

brandonmenc 12y ago

This exact thing happened to me - at the Mayo Clinic, of all places. I found the same info after the initial test, then refrained from lifting for a week before the follow up lab work. Tests were normal the second time but had they not been, I'd have been given a (presumably more expensive) ultrasound. My only guess is that the lifting-bad-liver-panel effect isn't something that happens often, since so many people strength train these days.

fnordfnordfnord 12y ago

>I logged in to their patient portal Is this "Patient Portal" software some kind of off-the-shelf crapware? It is terrible.

0xfffafaCrash 12y ago
Unlikely. It's probably the healthcare organization's version of Epic's MyChart which gives patients the ability to access some of their own medical records.
- zaroth 12y ago
  Epic seems to have completely taken over EMR... And watching doctors and nurses try to use it, just wow.

untilHellbanned 12y ago

AST and ALT change all the time. Depending on circumstances, 2x normal isn't particularly notable. Also, strength training isn't necessarily the cause nor is it something a doctor automatically, nor even commonly, flags for concern. The doctor should have asked you about changes in your daily routines, but you have to give them the benefit of the doubt. It's only the doctors job to find relevant data regarding your chief complaint. If they thought 2x changes were something to care about they would have followed up with you about that. Not to be impolite but only to make a point: if you read enough to be distressed, you could have read enough to de-distress yourself.

toasted 12y ago

your doctor knew it was probably unimportant, could be caused by a myriad of things, and a repeat blood test in a few months would be normal and mean they could forget about it. Because of the patient portal with its ability for patients to access info they don't understand the significance of, you were "absolutely startled" and "distressed". If you didnt have access to those results then you wouldn't have been concerned. Regardless of all that, you should still have repeat LFT's because you don't know for sure that "strngth training" was the cause of the problem. Honestly, Doctors find navigating the minefield of clinical decision making difficult enough, trying to make judgements on sensitivity/specificity of tests and investigations, positive predictive values, remove confounding, drug company propaganda, publication bias etc etc without patients trying to get into it all as well. Should I spend 1 hour explaining to every fucker with a headache why a CT head is more likely to cause brain cancer than it is to diagnose it? The solution to the US healthcare woes is NOT more patient autonomy and decision making. The solution is moving towards a less money orientated system and trying to encourage altruism and alignment of patient's goals with doctor's actions.

nitrogen 12y ago
Should I spend 1 hour explaining Yes, absolutely. Medicine needs to descend from its status as a high priesthood and be a little more accessible.
- VLM 12y ago
  The question is if that's the best possible use of his time to improve the lives of the most patients. A stereotypical micro vs macro problem where the best possible micro solution is likely not the best possible macro solution. To some extent its a systemic problem with levels of support. Every customer that calls into a call center claiming space aliens are controlling their minds should not be transferred to argue with the VP of software development for an hour.
  - nitrogen 12y ago
    Possible solutions: reduce the scarcity of doctors capable of explaining ionizing radiation, add more non-doctors who can do more than just draw blood and check vitals, etc. Part of the macro problem is that a lot of micro problems are caused by insufficient communication and a lack of patient knowledge.