Hangry Patients

IMG_2294

A while back I had a patient yell at my staff for telling her she should fast for six hours before her physical.

My response?

“If she is like that when she isn’t starving, I certainly don’t want her here when she is!”

Seriously, though, let’s look at this fasting thing more closely…

I hate fasting, personally. Not so much because I am hungry but rather because it forces me to deviate substantially from my routine. I like my routines. And my coffee. Ever smell coffee but know you can’t have it? Makes me turn into a raving lunatic, so I understand where patients are coming from.

So, the questions is, do you HAVE to be fasting for your physical?

Nope.

You sure don’t.

Gasp! I know right? All this time and NOW we say you don’t have to fast?

Here is the thing. We used to diagnose diabetes based on two fasting blood sugars over 120. The problem was there were actually a number of people who technically probably had diabetes who did not meet that criteria. Now, we can use a thing called the Hemoglobin A1C to diagnose it. This test is a way of estimating your blood sugars over a three month period and it is independent of whether or not you are fasting for the test. If you are not fasting for your physical and your blood sugar is showing elevated? No problem. I slap on a HgA1C and find out the truth.

The other test in question is the cholesterol panel. The main part of that test, the one we are most concerned with, is the LDL (bad cholesterol) that increases your cardiovascular risk (likelihood of having a heart attack or stroke). My feeling was always that if you were fasting, you were sort of cheating anyway because really how much time do we spend fasting? Our bodies live in the non-fasting realm. The advice to fast was never based on actual scientific data. It was a bunch of doctors who sat around in a conference room somewhere and said, “Hell, it is my professional opinion that we should make everyone suffer!” (Cue curmudgeonly fist slam on the table.)

But research earlier this year shows that the predictive value of your LDL number is not affected by whether or not you were fasting for the test.

“Woohoo!” I hear you say?

Absolutely.

I have now been pinning down patients for their physicals when they come for their first visit in two years when they have a head cold.

“Look, you and I both know you are not going to come back for your physical in a couple of weeks so let’s just do it now…”

The, “But I haven’t been fasting!” excuse no longer flies, people.

And BONUS, my staff no longer has to harass hangry patients into coughing up copays.

And YOU no longer have to starve!

The END.

Advertisements

69 thoughts on “Hangry Patients

  1. WHEEEEE! So I can “pig out” on food before my cholesterol test! (Just kidding).

    There is one advantage in fasting that you didn’t mention: the nurses are inclined to see the fasting patients early and first!

    Liked by 1 person

  2. My personal physician has that very same sneaky way of turning any appt into a “let’s just do it while you’re here” sort of thing. You realize that you just outed yourself and a large number of other practitioners as well… πŸ™‚

    Liked by 2 people

    • I am pretty straight forward about it with my patients. “See, if you would just come in for your yearly physical, God wouldn’t have to strike you down with the cough to get you in to do your bloodwork!” BUT with most US health plans if I code the visit as a physical it saves the patient a copay so it is a win-win sort of thing. πŸ™‚

      Like

      • My doctor (who is a saint) always winds up coding my annual physical as a diabetes followup, so I have to pay the copay anyway. Why does he do it? Because I ask him to. I’m wheelchair bound and it’s hard enough to get out and about that I only do it when I can’t get out of it. So rather than having one visit one week and a followup the next, I can use combine the two and pay for the extra. Frankly, I know what the Insurance Pay Schedules are for most Insurance Companies and doctors get little enough for their time and effort. I don’t mind chipping in my part when I ask for extra time.

        Liked by 1 person

      • It is probably more financially adventagious for you to have the diabetes follow up coded as a physical. Check your insurance but your cholesterol panel and many things are covered 100% for many insured patients. Doing it as two separate visits is a waste of time and money! πŸ™‚

        Like

      • More financially adventagious to me? Definitely. But not to the Doctor. Plus, it’s asking the Dr. to participate in Insurance Fraud (re-coding for monetary purposes), which I’m not going to do, not even for the princely sum of $25.

        [BTW: I’m a retired paralegal who specialzed in medical contracts, so I know whereof I speak.]

        Liked by 1 person

      • It is more financially adventageous for the physician to charge for a physical exam. There is a higher reimbursement rate for a physical visit than a regular office visit. If you are saying that your physician is making less from you because you are not coming in for a separate physical between your diabetes visits, then you are correct there, but why is that necessary? Seeing someone for their physical during a sick visit is not illegal or unethical, nor does it constitute fraud. Now if I went back later after your visit and coded a higher code for something I didn’t do, that WOULD be fraud. πŸ™‚

        Like

      • The last time I checked, a doctor received more income for a follow-up visit vs. a physical if you include the copay (which the Dr. doesn’t get on a physical). However, since I’ve been retired for a couple of years now, I realize that may have changed, so thanks for the update.

        BTW: I worked closely with doctors on a daily basis for thirty years and I can tell you that the positive attitude you have towards helping your patients is unfortunately rare. While most doctors probably start out idealistic, many get bogged down in the business side of the business and become preoccupied with maximizing income in order to meet the incredibly high expenses that tend to drag them down.

        I have a lot of respect for what you do, and I hope you have a good business manager that can allow you to continue to focus on quality of care instead of quantity…

        Liked by 1 person

      • Thank you for the complements! Yes, physical codes are higher than office visits, but the copay is applied toward the office visit (the insurance company says it is your part of the charge and deducts it from the amount they would otherwise pay your physician) so don’t think it is extra money by any means! Do talk to your doctor about what is best for you. Sounds like if you already have him doing the work for a physical, you may as well save yourself some money and help him out at the same time! πŸ˜‰

        Like

      • Oh, and BTW: contrary to what many doctors think, “fraud” is not just about coding higher on the chart. Coding lower on the chart is also fraud. Anytime your code does not truly reflect the procedure that was done, it is considered to be fraud. Since no single ICD code truly reflects everything you do, this is, of course, a Catch-22. Fortunately, with the exception of Government plans, most insurance doesn’t care if you code low. However, federal agents will go after doctors who consistently code low for Medicare and will charge them with fraud. The penalty ($10,000 per line item) makes it worth their time.

        Liked by 1 person

      • You are absolutely right. And that is something that many patients don’t understand. If I am audited, I could face heavy fines or lose my license for down coding. (I still do it sometimes, though. Don’t tell anyone!)

        Like

  3. Oh ask me something serious before having food. Hopeless. Expect me to do multitasking before food. Hopeless. I can’t multitask at the best of times. Feed me and I am all ears, content, docile and able to think/speak coherently otherwise beware. πŸ™‚
    What about hangry doctors? Those appointments just before lunchtime. They must be the worst. What lollies do you have in your top drawer? :p

    Liked by 1 person

  4. I am curious – If I know I have to get labs done within two weeks for an apt coming up in four weeks, will an increased diligence in taking my fish oil pills TID make a difference? Or am I just another one of those silly patients trying to fool you guys? But hey, my HDL is awesome! I want that to count for something πŸ™‚

    Liked by 1 person

  5. Smiling here at your somewhat contrarian view. I concur with your perspective. My cardiologist, on the other hand, would speak otherwise.

    Always curious, I often wonder why practitioners of Western Medicine, even in their varied specialties, cannot come to consensus when it comes to what’s best for us (the patients).

    Liked by 1 person

      • I was/am aware of the research. Alas, I know through experience that: 1) teaching older dogs new tricks can be challenging and; 2) many specialists are skeptical of new findings that come out seemingly every day, only to be later refuted by yet another study. Their comfort zone and M.O. is to remain entrenched in their foundational teaching and thus, long-term practical practice. My own primary openly besmirch’s the words that other specialists proclaim as gospel. In the end, I have learned to and do make my own wellness decisions given the absence of consensus among many who practice today. You seem to be an exception. Perhaps, even (said smilingly) a tad blasphemous.

        Liked by 1 person

  6. LOL, my favorite blood sugar torment is from the olden days of pregnancy. You’ve already got morning sickness, so they used to take away your only source of relief, your saltines. If you survived that, they expected you to drink this horrible, slimy, sweet stuff. One time it was actually colored blue, as if drinking slimy syrup in the throes of morning sickness is going to be more pleasurable in pretty pastel colors.

    Liked by 2 people

  7. lol! but will a person get diagnosed for type 2 diabetes if they eat jelly beans non stop for 24 hours before an A1C even if it takes the average glucose level…never mind they should just be called stupid and sent home…

    Liked by 1 person

  8. Good, good point. My other half aka pain in the *ss, has high cholesterol and he fasted first. He’s extremely fit, but we discovered that his protein/whey/shake stuff had extremely high cholesterol and I might make him way to many eggs and non lean cuts of meat (maybe, most likely.)

    Liked by 1 person

  9. Pingback: My Article Read (11-23-2014) | My Daily Musing

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s