See Doctors. Not Too Much. Mostly When Sick.
Doctor, looking concerned: “So, no PSA?”
Me: “Right.”
Doctor, more concerned: “Can I send a CBC and a Chem-7, check your renal function?”
Me: “Nah, I’m feeling pretty good, but thanks.”
Doctor, borderline panicked: “Mr. Newman. You gotta let me check your cholesterol, at least!”
Me: “Oh lord, no. But again, thank you so much for your concern.”
Last time I saw my doctor it was to get the $100 cash card my insurance promised me for making, then keeping, the appointment. He was delightful—smart, kind, interesting. Was a pleasure talking to him.
Before the visit I looked for updates to an infamous paper in the respected Cochrane database. Originally published in 2011, the review aggregated data from more than 150,000 people in randomized trials assigning them to receive either annual doctor visits, or no visits. The former group had health check-ups, typically with blood and other screening tests for conditions like heart disease, diabetes, and more. The latter group, conversely, carried on with life as usual. No check-ups.
Participants were then followed for up to 30 years, and the results were a wake-up call to the medical establishment: People who had the check-ups didn’t live longer. They also didn’t have less heart disease or cancer, and they didn’t end up in hospitals any less.
In fact, despite the absence of any long term benefit, the check-up group reported more medical diagnoses and more chronic conditions.
There was a caveat, however, that critics of the review pointed to. A number of the studies began in the 1960s and ‘70s and didn’t include data from after the year 2000. This was upsetting to people who believe statins, widely prescribed beginning in the 1990s, changed the landscape of preventive health by saving millions of lives. Fortunately, this gap was filled in by a 2019 update, which added data from 80,000 people in newer trials, including some focused entirely on cardiovascular health.
Again: no benefits, just more diagnoses.
Doctors are generally wonderful and smart, and modern medicine is exceptionally good at taking care of disease. If you get hit by a truck, are diagnosed with cancer, or come down with pneumonia, you’re in luck—we have the disease-care system you need. But ‘healthcare’ is not a great strength of the modern medical machine.
Perhaps one day that will change. In the meantime, I have no license to practice medicine and would never make individual recommendations for health to anyone. But for my own best life, I use a mantra adapted from Michael Pollan:
See Doctors. Not Too Much. Mostly When Sick.