Who to see for abdominal and groin pain?

February 19, 2010 10:44 AM

I know you aren't a doctor, or if you are you're not my doctor, but maybe you can help me figure out what sort of doctor I should see for my abdominal and groin pain.

For the past few months I've had a slight pain in my abdomen, a few inches to the left of my right hip bone. It doesn't hurt at all if I press there, so I don't suspect appendicitis. Instead, I assumed the pain was referred pain from when I hurt my back -- the two pains occurred around the same time.

For the past several weeks, I've also started feeling perineal pain and a slight pain in my scrotum when I also feel the pain in my abdomen. It seems like this pain occurs most when I have a full bladder.

Go to a doctor, you cry!

And I will, but there's a hitch. I have a high deductible health plan, and my regular doctor wants me to get a full blood workup done, which will cost me almost $2000 out of pocket. Instead of going this (expensive) route, I'm wondering if I should rather make an appointment with a urologist of whom I've been a patient in the past.

Do urologists normally address pain not only of the groin but also of the abdomen? If this pain all turns out to be related to my back, would a urologist be able to refer me to someone who can diagnose and treat the underlying issues? Is there a different type of doctor I should look for right now?

Thanks in advance for your help.

posted by anonymous to health & fitness (14 answers total)

I have a high deductible health plan, and my regular doctor wants me to get a full blood workup done, which will cost me almost $2000 out of pocket. Instead of going this (expensive) route, I'm wondering if I should rather make an appointment with a urologist of whom I've been a patient in the past.

Call your generalist on the phone and ask them whether seeing a specialist instead of getting the blood work would be a better idea. They will be in a much better position to answer this question than any of us.
posted by grouse at 10:56 AM on February 19, 2010

I am about as far from a medical doctor as you can get, but I do have a husband who recently experienced very similar symptoms as yours. They turned out to be kidney stones, and were diagnosed by his regular GP. Good luck to you.
posted by msali at 11:23 AM on February 19, 2010

There are very few doctors (none?) of any specialty who can look at your outsides and tell what is going on inside. Any doctor that you visit will most likely start by wanting to conduct some sort of lab work. You have already invested in one office visit. Going to a second or third doctor will result in charges for initial office visits (always more expensive than follow-up visits) and put you right back into the "we need lab tests" loop.

I suggest you contact your doctor and explain your financial issues. Ask if there is an initial set of tests that might be a window to the problem and might be less expensive than a full panel. He might be willing to take a more conservative approach once he understands that insurance isn't paying the tab.
posted by Old Geezer at 11:25 AM on February 19, 2010

If they're looking to do a cat scan or such, can you suggest they do an ultrasound instead (for diagnosing conditions like kidney or gall bladder stones)? Ultrasounds are much cheaper.
posted by pointless_incessant_barking at 11:49 AM on February 19, 2010

Check to see if there is anything like this in your area that'll provide relatively low cost testing.
posted by SoulOnIce at 11:56 AM on February 19, 2010

You need your good ol' plain primary care doctor. You don't even know if this is urologic at this point. Say you assume it is, and it turns out not to be; a urologist won't do any further workup, will refer you back to your primary care doctor, and you'll have wasted a ton of money. This is like taking your computer to a repair shop because it won't turn on, when you actually need an electrician because the wall socket's broken.

If they're looking to do a cat scan or such, can you suggest they do an ultrasound instead (for diagnosing conditions like kidney or gall bladder stones)? Ultrasounds are much cheaper.

But in some cases, much less sensitive and in other cases, completely worthless. It all depends on the differential diagnosis your doctor comes up with.
posted by gramcracker at 12:01 PM on February 19, 2010

Let me add my voice to the ones saying stick with your original physician. He should be willing to work with you on alternatives to getting $2000 worth of labs done at once.
posted by TedW at 12:07 PM on February 19, 2010

It's also probably worth giving your "regular" doctor a call and saying "That's too expensive, give me a cheaper option." There will be one. There's no reason something this simple should cost $2000, even in the bizarro world of the US health care system.
posted by valkyryn at 12:08 PM on February 19, 2010

If you haven't seen your primary care doctor yet, go see your primary care doctor. He or she can help you figure out whether you need to see a specialist, and if so, what specialist you need to see. A specialist visit will almost certainly cost more than a visit to your PCP PLUS basic lab tests, so you may end up saving money by going to your regular doc.

Off the cuff, it sounds to me like you may have an inguinal hernia. Your primary care doctor will be able to test for this without referring you to anybody. Disclaimer: I'm a med student, so I don't yet know much of anything of any practical value. Go see your PCP!
posted by killdevil at 1:06 PM on February 19, 2010

Also, I don't know what lab tests your doctor wants to do, but a comprehensive metabolic panel + complete blood count plus whatever other blood tests he orders shouldn't add up to anywhere near $2000, unless they're wierd ones I don't know about (which is certainly possible).
posted by killdevil at 1:19 PM on February 19, 2010

Just a thought...how are your bowel movements? Maybe a wee dose of Miralax to clear the pipes?
posted by littleflowers at 7:18 PM on February 19, 2010

Please try to see if your symptoms match Testicular Varicocele. (mefi me if you have questions)
posted by bbyboi at 4:25 AM on February 20, 2010

I'm a doctor.

Your primary care physician is definitely the best doctor for this job, since as noted it might not even be urologic problem, and PCPs are able to recognize and treat many urologic problems anyway without a specialist's help.

I'm a little confused because it doesn't sound like you've actually gone in to see your doctor, but yet you seem to know exactly what testing he wants to order and what it will cost - I'm not sure how that could be clear unless you had already had a visit with him and gone through all the details of what was going on.

If all you did was call your doctor and say "Here's a one sentence summary of my symptoms - how much do you estimate it will cost to figure out what's going on?" Then that sounds pretty unreliable. If you actually go in and go through your symptoms, it could be that it will become much clearer what is going on (because a hernia or testicular issue could be found on physical exam alone), or at least that the projected lab workup could become much more focused. Most doctors order the full battery of tests up front, but if they know you are trying to save on costs then you could take a more step-wise approach.
posted by treehorn+bunny at 7:41 PM on February 20, 2010

Yes, I am surprised by the estimated costs of those tests; having had a million and one tests 2k sounds wild.

Given the advice above, I suggest that you go to your doctor.

From my experience don't let them draw blood until you know what tests are being done and why. Docs are used to checking off tests on a sheet and getting them done without worrying about costs, but you need to have more control over the process than that.

Keep in mind that if you end up in the ER you'll spend the 2k deductible anyway.

Good luck.
posted by internet fraud detective squad, station number 9 at 3:14 PM on February 21, 2010