what medical tests to have for prevention?

December 12, 2008 9:36 AM

i finally have good health insurance and i'm going to the doctor! what sort of tests should i have done to make sure everything is ok?

i finally have health insurance that covers testing, and i'd like to have a round of lab work done to make sure everything is running smoothly. i am certainly going to have a gynecological exam, but i was hoping y'all could give me some advice on some other tests to request. i'm going to ask to have my triglycerides and cholesterol tested. a while ago, i had heard something about a blood test that people should do that is an early indicator of heart disease, but i can't remember what it is. if you could tell me that one, or anything else that you think i should do, i'd really appreciate it. i haven't had health insurance in a while, and consequently, i haven't had any tests done in a while. while i understand this is weird, i'm REALLY excited to have bloodwork done. so aside from the standard physical and gyno exams, what should i request?

about me: i'm a 27 year old female in seemingly good health. i'm very active, i eat well and exercise and get plenty of rest. however, my dad died 4 years ago and i ate to deal with it. i gained 40 pounds. i have since lost about 25, and am 5'6" and about 175 pounds. my goal is to lose about another 25, to put me in a better place than i was before. i'm doing this slowly and healthily, so i don't need any diet coaching. i am worried about what the weight gain could have done to different systems in my body. i gained mostly in my abdomen, which i know is bad for adding a risk of heart disease and diabetes. also, my dad had demensia, and there is a risk of heart disease and high blood pressure in our family. finally, i had bronchitis last winter and still have a tight feeling in my chest (although i'm fine otherwise, and not producing anything from my lungs). the tightness isn't severe, it doesn't affect my exercise (actually, exercise makes it feel better usually) and it comes and goes, but i haven't been able to shake it.

thank you so much for your help! i really appreciate your time in reading and responding. take care, everyone.

posted by binocularfight to health & fitness (11 comments total)

I think if you just explain to your doctor that you haven't had insurance and you want "everything," they'll take it from there. You'll have to fill out the forms about family history and all that, so they'll know what specific tests to check for for that -- and they'll also know the general-health-related ones.

I was in a similar boat 15 years ago when I first got health insurance -- I got to my doctor's appointment, and when they asked what I was there for, I joked, "what have you got?"
posted by EmpressCallipygos at 9:47 AM on December 12, 2008

I concur. Your doctor will know what tests to run. I was in the same boat a couple of years ago and my doctor ran all kinds of tests and went down the list point by point explaining what each of the results meant. (At the end of the explanation, he wrote "A+" on the top of the results sheet! -- Whew!)
posted by trip and a half at 10:12 AM on December 12, 2008

yep, what those above have said. if you know there's a history of diabetes (for instance) in your family, and you may be concerned about it, be sure to let the docs know that. also, if you've been sexually active since your last gyn exam, be sure to ask for the full range of std tests, just in case. generally, they are not done unless asked for or if there is something suspicious.
posted by misanthropicsarah at 10:32 AM on December 12, 2008

ask for a full physical. They will probably order all the standard blood work and tests beforehand, and then your doctor will address anything of concern at your appointment. My doctor sent out a questionnaire beforehand, so he knew what to talk about at my physical.
posted by smalls at 10:41 AM on December 12, 2008

At 27, I don't think you need any tests beyond pap smear, gyn exam and cholesterol, unless you have health issues of some sort. Maybe blood test for adequate blood iron.
posted by theora55 at 10:53 AM on December 12, 2008

When you go to your appointment, you'll be asked a for detailed health history. This will probably be in the form of a written questionnaire before you are examined. If you have access to any medical records from previous providers that might be pertinent, take copies along. This can range from prior surgeries to immunisation records.

Once you're in the examining room, you'll be asked what concerns brought you there, such as a routine physical and/or specific complaint. I agree that your primary care doctor [or PA or Nurse Practioner] will know which tests to start with.

That said, I'd like to make a suggestion about a different kind of test.

If you haven't been in the health care system for a while, you should put the healthcare providers to the test, too. Observe how you are treated, observe everything you can about the process and place. Does it seem a good fit? Would you feel comfortable going there again?

Finally, make note of how your insurance handles the charges and any interactions with you.

Get a feel for how your doctor's office and health insurance work (or don't). A routine physical is a good place to start. It's better to learn this all now rather than in an emergency!

Good luck!
posted by subatomiczoo at 10:56 AM on December 12, 2008 [2 favorites]

I'd be careful about this from a $ perspective.

Your policy, however "good," likely has some very specific limitations upon physical exams and test batteries in the absence of specific complaint or high risk factors. They will also have coverage relationships with certain labs and not others.

There's also risk that if you have a full physical done by your GYN all of the procedure codes and tests outside of the standard of care for a GYN annual might get rejected, unless special processing (or even a parallel bill) is submitted.

Given the diversity of insurance and programs for each insurer, you cannot expect your doctor or his/her staff to know how to manage all of this upfront. Call your insurance well in advance to discuss your desire to have a well-adult physical and then arrange (if possible) a conference call between your insurance and the doctor's billing desk to get everything which is covered set up to be properly billed.

You may well find that there are certain things that you want that aren't covered: that's not a reason not to have them. As a cash pay you can often negotiate surprisingly attractive rates for the service. (Lab tests are harder to negotiate.)
posted by MattD at 11:29 AM on December 12, 2008

The days when doctors ordered lab tests by the dozen are gone. Insurance companies will pay only for what they call "medically necessary."
posted by Carol Anne at 11:47 AM on December 12, 2008

thanks everyone for your responses! i work at a university and called my insurance to check on all the warnings many of you have posted about testing fees, and it turns out that working for a university is awesome. all of my tests are covered, be they routine, diagnostic or whatever. so if anyone knows good tests to have for assessing heart disease risk, i'd appreciate a heads up. thanks so much!
posted by binocularfight at 12:33 PM on December 12, 2008

Someone else will explain this better, I'm sure, but medical tests are much more fallible than people think they are. Why? Because generally the inaccuracies of any random test for X (false positives and false negatives) greatly outweigh most people's pre-existing risk for condition X. It takes a great deal of statistical work and judgment to know exactly whom to apply a given test toward. There are dozens of medical journals and giant governmental agencies devoted to exactly this. Subatomiczoo's advice is great: you are paying your trusted doctor to help you wade through all of this so you are much better off devoting your energy to evaluating the doctor that is going to help you with all this than trying to decide what tests you want to ask for. I really don't mean to be paternalistic but I think and research about this stuff a lot every day and it is still difficult for me.

That said, the universal tests that are always indicated for an apparently healthy 27 year old: Pap test, cholesterol, blood pressure, screening for depression and substance abuse, probably fasting blood glucose, possibly HIV, and possibly screening for other STDs. Everything else is risk based.

I believe the test you are alluding to is the CRP, c reactive protein, which correlates with the future development of heart disease. I don't do them routinely unless the patient can tell me they are going to do something different with their life with the information the test provides. You can't do anything to lower your CRP, we don't know exactly why it correlates with heart disease, not every study shows that it does correlate with heart disease, and to my knowledge, no one has shown that you can avoid heart disease any better than with the standard set of modifiable risk factors we already evaluate.*

*Disclaimer: I've been so friggin busy at work lately I haven't picked up a journal in like 3 months, so I could be talking out of my ass on this last point.
posted by Slarty Bartfast at 1:32 PM on December 12, 2008 [2 favorites]

Tacking on after Slarty Bartfast's useful comment. Disclaimer: unlike him, IANAD.

Here is a list of biomarkers that are sometimes checked during a well-adult physical, plus a few others that may not be. (The fact that it's hosted by the Calorie Restriction Society website is not too relevant, so ignore that.)

You might as well ask for all of what they call Tier 1 and Tier 2, since these are common and usually inexpensive tests. Tier 2 is frequently done all at once as a "package deal" anyway. You may want to double-check with your doctor to make sure the full fasting lipid panel is done, not just total cholesterol and HDL.

It's very unlikely that you need any of Tier 3 unless you have specific reason to be concerned about your levels of circulating sex hormones, stress hormones, etc.

At age 27 it's usually sort of hard to get any particular test done that's going to have strong predictive value re: cardiovascular disease. As Slarty Bartfast said, the jury is still out on CRP. Your total cholesterol-to-HDL ratio is a good number to know, though.

If you think you have reason to currently be concerned about diabetes risk, you can ask your doctor about having the oral glucose tolerance test and HbA1C/glycated hemoglobin done in addition to the standard fasting blood glucose, or you can wait to see if your fasting blood glucose comes back at all elevated and then decide. If you've been eating well and losing weight for a while, you are probably not going to see anything interesting in the fasting blood glucose. On occasion I've asked for the OGTT/HbA1C to be done anyway because my family is diabetes-prone and these can sometimes reveal things that fasting blood glucose does not. But YMMV. Ask your doc what s/he thinks.

Other things you might be interested in getting if you feel you have a need for them are a thyroid panel (sometimes a very inexpensive add-on to the standard bloodwork) if you think you might have any thyroid issues; vitamin D (usually 25-hydroxy vitamin D) if you are not white, or don't get at least 15-20 minutes of non-sunscreened sunlight every day or two during summer, or live in a northern area; ferritin if you have any concerns about anemia (e.g., you usually have moderate to heavy menstrual bleeding or suffer from fatigue or lightheadedness, and/or your hemoglobin and hematocrit turn out to be below normal). (It's not necessarily a bad thing to be in the low-normal range for something like hematocrit.)

Welcome to the club of Quaint Eccentrics Who Delight in Having Bloodwork Done. I wish we had a newsletter or a secret handshake or something, because everyone else I know thinks I'm just a strange fetishist. (Have you ever donated blood? That's almost as interesting.)

[Because IANAD, just a scientist who happens to be sometimes interested in this stuff as an unrelated hobby, I'd appreciate corrections.]
posted by jeeves at 12:42 AM on December 13, 2008