Question So I'm 65 and on medicare which will not cover a physical. What do older divers do for the required physical? How extensive should it be?

[boulderjohn]

While that sounds reasonable, it is also possible that the screening finds another “issue” that you didn’t know you have, is quite possibly not clinically significant, but now it’s found ropes you into additional testing and treatment that you never would have received if you didn’t look, and quite possibly never would have needed.

The opposite would also be true. I made a couple changes in what you wrote:

While that sounds reasonable, it is also possible that the screening finds another “issue” that you didn’t know you have, is quite possibly ... clinically significant, and leads to additional testing and treatment that you never would have received if you didn’t look, and quite possibly saves your life.

We are talking about the heart, after all. It might be good to know about anything wrong in there.

 

[The Chairman]

This was stated in different terms earlier....

I will have my annual Medicare medical review this coming week, fully paid for by Medicare. When I schedule it each year, my doctor's office calls it a physical. I have no idea what the difference is. I suspect they don't, either.

I get a wellness check as well as a physical each year thru Medicare. I opted for the AHA additional coverage rather than any of the other insurance offers out there.

 

[The Chairman]

We are talking about the heart, after all. It might be good to know about anything wrong in there.

I have been bradycardic since high school when I raced canoes and bicycles. It was so low that I had to run around the block just to give blood. This past year, my doc thought she heard a murmur, and that initiated a string of checkups. As a diver, I used that to get a bubble check for a patent ovale. They took the opportunity to check a lot more, including a heart cath. Result? Nada. The guy who did the cath said I had the heart of a 30 year old. I told him I wasn't giving it back. My resting pulse is mid-fifties which is a lot higher than when I was in college. I get the feeling that someone had a payment to make on their BMW.

The problem is that when anyone sees that I had a heart cath, they want to know WHY! They won't accept my word that they found nothing. They delayed my back surgery over this, and I was in dire pain. Everything has consequences. Some seen, and some not seen.

 

[kinoons]

The opposite would also be true. I made a couple changes in what you wrote:



We are talking about the heart, after all. It might be good to know about anything wrong in there.

This is why it is imporntant to perform randomized controlled studies for all proposed screening exams to see if they actually offer a benefit.

For example, most recent studies from Europe shows that colonoscopy does not improve all cause mortality. When you consider the cost, side affects, work time lost, it’s hard to justify routine screening colonoscopy for the average healthy adult.

Dr. Vinay Prasad frequently tells a story about an older man who got a screening exam (chest CT) for lung cancer. He was single, had no kids, only wanted to work on cars and smoke cigs. They found a spot on the CT and roped him into years of treatment and repeat scans. Somewhere around the 3rd course of chemo the old man said I’m done with all this crap, I didn’t want all of this anyways. That CT screening didn’t make him any healthier.

Dr. Prasad also notes that coronary artery calcium scans also never have had a randomized study powered enough to show all cause mortality. We simply don’t know if those screening exams offer any benefit. It is also very worrisome to assume benefit without evidence.

 

[The Chairman]

We simply don’t know if those screening exams offer any benefit. It is also very worrisome to assume benefit without evidence.

They're still trying to figure us out. While there might not be much benefit to the individual, which is the ultimate goal, there's a collective benefit to consider.

When I was mid 30s, I was diagnosed with sleep apnea. I wasn't obese and in fair shape, but the doc suggested I have a PPP (Partial Palatal Pharyngoplasty) and tonsillectomy. It didn't work and it ruined my high tenor. I've been on a C-Pap ever since. Damn, it really works, but they stopped honoring my prescription around the turn of the century. Sleep studies are thousands of dollars, and without insurance, I couldn't afford it. I got one c-pap off of ebay and another from a friend. I can always order parts of masks, but never a whole mask.

Last year I got Medicare. Wow. Insurance after 20 years without is wonderful. A couple months ago, I got around to see a sleep doc, jump through the hoops, and got a new machine and new mask. When I told him about my PPP, he apologized. There were a number of them done and almost all failed. So collectively, my needless surgery didn't help me, but it helped all those who followed. Such is the nature of medicine in America. They learn from each and everyone of us, good or bad.

 

[Scubagermany]

I cannot comment on the payment issues you all have with your insurance or medicare since I am not in the US and I know nothing about this system.

It is of course true that nobody must do medical tests if they do not want to.

Since I offer physicals for divers in Germany as a specialist for internal medicine in a country where you do not profit in any relevant way if you do your work thoroughly I can only advise any person to do yearly physicals as a diver. That is of course especially important if you are over 60 years old or if you have specific risk factors.

I usually do the following tests for my patients on demand (mostly free of charge here):
Blood test, urine test, pulmonary function test, ergometry and Ekg as well as a complete medical history check. If I find abnormal tests concerning the heart I would also include an echocardiography.

Free of charge means that I get about the same amount of money for the treatment if I see my Patient just once for 10 minutes or if I do the whole programm. I would not recommend these exams if I did not see any benefit in them as I can think of more fun ways of wasting time.

 

[kinoons]

They're still trying to figure us out. While there might not be much benefit to the individual, which is the ultimate goal, there's a collective benefit to consider.

When I was mid 30s, I was diagnosed with sleep apnea. I wasn't obese and in fair shape, but the doc suggested I have a PPP (Partial Palatal Pharyngoplasty) and tonsillectomy. It didn't work and it ruined my high tenor. I've been on a C-Pap ever since. Damn, it really works, but they stopped honoring my prescription around the turn of the century. Sleep studies are thousands of dollars, and without insurance, I couldn't afford it. I got one c-pap off of ebay and another from a friend. I can always order parts of masks, but never a whole mask.

Last year I got Medicare. Wow. Insurance after 20 years without is wonderful. A couple months ago, I got around to see a sleep doc, jump through the hoops, and got a new machine and new mask. When I told him about my PPP, he apologized. There were a number of them done and almost all failed. So collectively, my needless surgery didn't help me, but it helped all those who followed. Such is the nature of medicine in America. They learn from each and everyone of us, good or bad.

I’d have to look to ever see if there was a randomized controlled study for tonsil removal and PPP for sleep apnea. If there wasn’t and we had to do tens of thousands of procedures to finally realize they didn’t work, that’s a failure of the medical system.

I’ll admit that I agree very much with most Dr. Prasad’s views in the practice of medicine; he literally wrote the book on ending medical reversal, and addresses the need for well done research before making any medication, device, or procedure standard of care.

 

[The Chairman]

that’s a failure of the medical system.

I believe it's the status quo, not a failure. They do the best they can, until they find a better way. Our medical knowledge evolves however it can, and sometimes that's one patient at a time. I do miss my high tenor. My basso profundo, isn't. I don't understand how to harmonize nearly as well now. Meh.

But, the second solution, ie C-Pap was perfect. However, this latest machine is vastly better than my last one, which was far better than the one before, and so on. They evolved, just like our collective understanding evolved. The care I get today from my Nurse Practitioner, is far better than the care I got from my physician in 1966. Dr Chambers did his level best, but he lacked the last almost 60 years of accrued knowledge. Dr Lunn is far more in tune with what makes me tick, mostly because of all the advances that were the result of both good and bad practices. She's not even a "real" doctor, but she's certainly earned my respect.

 

[kinoons]

I believe it's the status quo, not a failure. They do the best they can, until they find a better way. Our medical knowledge evolves however it can, and sometimes that's one patient at a time. I do miss my high tenor. My basso profundo, isn't. I don't understand how to harmonize nearly as well now. Meh.

But, the second solution, ie C-Pap was perfect. However, this latest machine is vastly better than my last one, which was far better than the one before, and so on. They evolved, just like our collective understanding evolved. The care I get today from my Nurse Practitioner, is far better than the care I got from my physician in 1966. Dr Chambers did his level best, but he lacked the last almost 60 years of accrued knowledge. Dr Lunn is far more in tune with what makes me tick, mostly because of all the advances that were the result of both good and bad practices. She's not even a "real" doctor, but she's certainly earned my respect.

But my point is we do know better. The status quo isn’t acceptable. Nearly every week I read about a medication, Procedure, or surgery that is approved as the “standard of care” or something that gets its foot in the door as a salvage therapy because we can “try” based on either non-randomized studies, or randomized studies so poorly performed that anyone can see the results are not relevant to the majority of patients. None the less these therapies get approved, and therefor paid for. Then 5-10 years later we learn we were dead wrong because practice was changed based on poor evidence.

 

[Scubagermany]

https://www.gtuem.org/images/download/untersuchungsbogengtm-leerformular.pdf

This is what the GTÜM and the VDST recommend