[FAQ] How to work with the medical system
Caveat: This is US centric. I have a little experience with Japan and EU medical systems and think it will work differently there. The US system has big issues (cost mainly), but in a typically American fashion you can get what you want if you work at it and can pay for it. Some advice is probably generally useful however.
I'd like to post information on how to successfully navigate the medical system. I'd encourage people to use the system the way it's meant to be used - to help patients live disease free - rather than going through other channels to get what they need. It's not hard to get a lot using conventional means, but like any system medicine has a culture that has to be navigated properly, so I'm here to help you learn how to do that.
Using this approach has gotten me to where I've got all the treatments I want, at very reasonable costs, and all within the aegis of the medical system with prescriptions to back them. up. You can buy overseas but that carries more risk and expense, I took the approach of doing everything by the book, and while it took some work it wasn't that hard. Also consider that this is supporting more physicians offering these services as there's money in it. Here's how I did it.
- Make a game plan. I'm talking tests, medications and treatments. You can get a lot for cheap or free through your MD and existing health insurance. Had your GI tract checked? What about the arteries into your heart, or the condition of your heart valves?
- Be clear to yourself what you want. Don't be cowed by the medical system. Always remember that it is there to serve you. If you get somebody who has the proverbial stick in a dark place, don't get upset just go elsewhere. Medical treatments are all opinion based, so find somebody that aligns with your opinion.
- Do lots of research and use the support here. What you are doing is not weird. This is all science based.
- However, messaging is important. I find that coming to it from a standpoint of I want to have a good health span (combined with a concern such as family history) rather than "I want to live forever" is something that people can understand better and works really well.
- Family history counts for a lot with them (it shouldn't). Had any cancer in your family, heart disease? Trot it out.
- Harden yourself, go in expecting you might get a hostile physician. These can be hard to deal with if you're not prepared. Just follow my advice below, and if they are such then politely say that "we're probably not a good fit" and go elsewhere. That's normal and fine, but know that due to the Hippocratic oath they can't refuse you, so what they'll do is try to shut you down. Don't let them, just walk.
General advice to finding an MD to work with, broken down to the different categories. Realize you might get (and want) to have a team of physicians, all working independently on different aspects of your health.
Expect you have to go to a specialist to get Senolytics, NAD and the other newer treatments. Don't expect a regular GP to be comfortable with using a cancer drug as a senolytic, no matter the peer reviewed research. The clinics run about 10 years behind the research, and they generally only move forward as a group.
- Before you start write down what you want. Do your research, different people have different approaches, know what yours is.
- Come in with blood work and history in hand. It goes much smoother when they can review all your detailed data before hand. I give them the following
- LE Male Elite panel within the last year
- Most recent focused blood work (e.g. hormones)
- List of all the supplements and quantities I take
- Life medical history description in one page, including parents and family medical issues such as any cancer and heart disease
- Any medications (e.g. Metformin)
- Genome work (I supply 23andMe and a full genome report, usually MD's don't look at it but it's there anyhow)
- General clinical stats (weight, height, BP, etc)
- Start with the physician directory on this site
- Try people locally, expect that you may have to do more or less travel (nobody said aging was easy, nor anti-aging!)
- (USA) Some of them do telemedicine and might be licensed for your state (physicians have to be licensed to work in each state, it's not a federal licensing)
- Talk to their admin first over the phone. They're usually quite knowledgeable and you can discover if the MD will be a good fit or not. If it looks good set up an appointment.
- Let the admin know, or when you first meet what specifically you are looking for. Find out if they can help you. If they can't or won't, politely offer to save their time and cancel the appointment. Initial consults are expensive, if you can duck out after 10 minutes because of a bad fit, see if you can pay prorated for the visit. No point in barking up the wrong tree, and MD's are bound by the Hippocratic oath to help you even if they can't, so be proactive about cutting it off.
- I look for the following
- There are no silver bullets, I don't trust MD's that think there are. Ones that admit grey areas is a good thing to me.
- Understand their thinking and why. Do they base it on the original research, plus their interpretation? That's a good approach, really the only one.
Yes a lot can be done with your local GP! Metformin, for example. Check your fasting, is it below 100? Mine started to rise to 100, probably due to hormones doing poorly with aging. But with my state of health this shouldn't be occurring. Now a fasting 100 is gold to my physician, but my local aging MD was happy to give me script for Metformin (at $180/visit twice a year). So with a script in hand, and simply telling my personal GP that while 100 was not diabetic I wanted to keep it below 85. Anyhow they were fine with 'taking over' the script. They prescribe a lot of Metformin, and coming in with already having another MD prescribe it paved the way, plus my personal desire to get it really in good shape. So long story short my insurance pays for it 100% and I get refills simply by requesting it via my online account portal.
- Realize that doing Senolytics is unlikely with a GP, but Metformin and even NAD are possible.
- Other things to thing about is testing, such as a CACS (have you done one???). Or a pill cam, or all sorts of checkups that your insurance will pay for. I got a cardiosonogram, a CACS, numerous EKG's and a halter practically for free, just on the basis of some heart skips, and because I approached it the right way. All that just verified no issues with the heart (CACS score of 0.8%!) which is great peace of mine and proof I'm doing the right thing.
- I find the following works with MD's, don't give a windup, simply start off with what you want and give them an option to offer their opinion. This is important! Let them give you their thoughts, if it's too different from yours then you know it won't work, no hard feelings. But much of the time, if given a chance to speak they'll go along with you anyhow.
- For example "I would like to do a pill cam to check out my entire GI track, what do you think of that?"
- If they say no way, they don't believe in it, they won't do it, then say no problem and go find another physician! These are reasonable requests that any MD should support, but I've seen plenty of chuckleheads who think they know everything.
- If they're not completely adamant then countering with "I understand what you're saying, but I still feel that this is a good course for me" works very well.
- The key is to state your intentions, and the importance of giving them a chance to state their opinion. Most of the time they are open to it.
- A lot of the time they'll mention costs, it helps to have a HSA account, I always counter with "I'll pay" or "I have a high deductible plan so will pay" to get that out of the way.
- If they demure, nicely stick to your guns that you would like to do it, and usually they'll relent.
- I found that getting into the science isn't necessary (I never had to do it). Basically either they support it or not, touting some research makes no difference and just drags on the visit.
- Pro tip - work with a Nurse Practitioner rather than a MD. They are always (in my experience) much more open and easier to work with, the MD's are much more opinionated. Also, one that is younger, female (common) and a generally relaxed person are much more open (SP types in MBTI speak, rather than SJ). I hand picked one such and we work wonderfully together. She gets that I'm a health nut and is fine with it.
- Pro tip - keep your intentions clear. Don't muddy the visit with irrelevancies, basically you're looking for something specific, don't demand, but keep it on topic and don't let them wash over you with their opinion. You are the consumer.
- Pro tip - functional medicine is big these days. I've been to a handful. Be a little cautious here but don't discount them. Again it really depends on the MD. Some of them will send you to a million tests and want to sell you special branded supplements and such. It's a great money maker. But not all, my present MD is listed as functional but I think that's just so he can do newer things like senolytics, but otherwise I'm not seeing much of a functional approach.
- Pro tip - beware of the 'one size fits all' approach. For diet I follow Dr Fuhrman and company. Whole foods vegan, but I'm not religious about it and I have disagreements. But to the practitioners in the field it's sacred. They believe that everything is fixed by food and they stay away from pills and general medicine. I take a hybrid approach because No Virginia, food alone won't slow down aging.
- Pro tip - while physicians and pharmacies have to be state licensed you can have a pharmacy mail to an address in a state they are licensed in. Where it goes from there is your business. For example consider friends, relatives and forwarding mail box brick and mortars. An exception is hormones which are ‘controlled’, they have to go to you directly on a verified home address (e.g. drivers license), but it’s perfectly fine to have a general prescription filled order forwarded to your address (disclaimer: this is not legal or medical advice). Having said that a lot of physicians and compounding pharmacies are multi licensed, check around. Consider
- Pack and ship stores
- Local physicians to the source (e.g. a pharmacy) that are licensed in your state (they can prescribe and forward the medications). Again look into telemedicine, a few phone calls can get you set up.
- Pro tip - realize that time is money to an MD. Typically their bonuses are paid based on how quickly they see patients (yes this is how it works according to a MD friend of mine). Don't waste time talking about this and that. I mean some small talk and peripheral talk is part of the visit, but be clear that you are there to get something specific. You know what you want and it's their job to either give it to you, or to not, you're not there to get their learned opinion which is decades out of date. But again be sure to let them say their piece, it's won't work and isn't relationship building to just demand without some give and take. So before a visit I am clear in my mind what I want (e.g. a test or a medication typically, sometimes a question as yes there are cases where their experience is valuable, and sometimes a referral). Then as I said above I'm clear from the beginning, then it's basically a dicker between to two of us as to how to proceed.
- Pro tip - related to the previous one, realize that they are balancing the following. One is the length of the visit, they have another patient coming up and are probably running late anyhow. Two they don't ever want to come up to a medical review board, so they have a comfort zone. Three is they do have tremendous leeway in what they can do. So again picking MD's that already have lots of background in something, such as prescribing Metformin, is a good thing. Finally I think the more general a MD the better. Specialists oftentimes (not always) have very particular ideas and are set in their ways. Finally getting a read on their personality. The things I look for is
- Are they relaxed (good) or super particular (usually not good)
- Are they detail oriented (usually not good) or do they see the big picture (good)
- Do they want to stick you in a category? Important one - on finding that you are trying to extend your life most or many MD's will check a box that says "Health nut" or some such. Ideally you don't want to trigger that.
- Pro Tip - Watch for body language. If you say something they don't like, with female MD's it's common for them to look down. With male MD's typically they'll give you a little smile. In either case they won't say anything. If you see this reaction then gracefully drop whatever you were talking about and continue along another tactic. Story about this - I experienced blood in my ejaculate some years ago. Scary, but my Urologist found nothing wrong and thought we could dig into it but would not be likely to find anything. We did copious research on the internet and found a lot of men with the same issue and guess what? They all mentioned that they were rather dehydrated from drinking alcohol or whatever. So I did an experiment and could turn it on or off like a tap! Rather amazing, I then started tracking my H2O consumption using an app and never got it again. I told my Urologist as a FYI and got the little smile ... oh well.
If you're getting your heart checked out (which I highly recommend) then you need a cardiologist referral. A few tips for navigating that
- I don't have a lot of experience with cardiologists and specialists, but family history and wanting to 'trust but verify' seems to work well. Asking for more procedures is OK, again with the reminder that you'll pay for it. CYA appears to be big to these folks.
- You need a referral. Start with your MD using the techniques above. As mentioned I managed to get thousands of dollars worth of test for $500 copay with a high deductible plan, on the basis of I experienced some heart skips. They never saw it in the clinic, but using the above techniques I got to see a Cardio and had a battery of tests. I can't tell you the peace of mind knowing my heart is structurally, arterially and electrically good. Being above the age of 50 makes it easy to check these things out, and don't forget your family history! Who doesn't have heart disease, cancer or diabetes in their family?
Alternative Medicine Practitioner/MD
Naturopath and Functional fall into this category. Sometimes they have MD degrees, usually not. In my experience these are hit or miss. Functional has gotten popular, and the approach has a lot of merit but it all depends on how they do it. I've seen some who use it to send you to batteries of tests with lots of self branded supplements. To appearances it's a money maker, I'm sure their intentions are good but that's not an approach for me. On the other side many aging docs call themselves that just to give themselves an umbrella to be under (since aging isn't a recognized discipline, geriatrics is different). So again having a conversation with their assistant is a free way to figure out their modus operandi.
Here's a story to show how the system works, in inverse to how we approach it. There's been some cancer in my family, so armed with this my sister (who takes the opposite approach I do to health) has an oncologist (she never had cancer) set her up with an estrogen blocker as a cancer preventative. Her MD has 'had good success with this approach' (good success? What does that mean, they took the drug and didn't get cancer? That's meaningless! Its like clapping your hands on a sunny day and claiming that you know how to prevent it from raining, just clap your hands!).
In point of fact the research shows that lack of estrogen is a cancer promoter, as is dairy which are primary causations. Now to be fair hormones haven't gotten the amount of research that they need, and there's a lot of bad research on the books. But still, if somebody can get a hormone blocker just on the supposition that it will prevent cancer, it's as reasonable to get a senolytic, bio-identical hormone, NAD or Metformin in the supposition that it will help prevent cancer. Because, it does, according to a lot of excellent research.
I tell this story to illustrate that having an approach, a story to back it up and a sympathetic physician is how the system works, and there's a lot of variation in what that means. In these two posts I've shown two opposite approaches, both based on science, that both worked*
Long story short; get the idea out of your head that you're doing something unusual or weird. there's plenty of weird stuff already going on in the industry because medicine is tough.
* The key is interpretation. I think what the oncologist is missing is that once you have reproductive cancer then yes, hormones feed that process. But she's missing that hormones are not a cancer promoter. Otherwise all these young people would be getting cancer. I think old people get cancer because of declining hormones, then when they get a cancer, the hormones feed the process. Kind of like this, lack of hormones cripple the reproductive system because it 'feeds' off of them (e.g. the prostate uses T to make sperm). So an impaired system is prone to cancer, especially with the way people take care of themselves. But conversely reproductive cancers also feed of hormones (because they are derived from the reproductive system), so in that case it is appropriate to pull the hormones. But not before!
Even then opinions still differ, my Urologist said that they can still give T to men with prostate cancer, even though medical castration (removal of T production) is a working approach.
A very informative post, but as a physician, I am going to disagree with several of your points, and hopefully add to everyone’s understanding of how the health care system works or doesn’t work.
First off, everyone should understand that what they are doing is NOT normal or usual. It may cutting edge and a glimpse of the future, like taking penicillin in the 1930’s, but it is “weird”.
Secondly, the medical system is NOT here to SER VE you. It is here to help you. There is a troubling trend in medicine towards “the customer is always right attitude”. But in healthcare, the customer is often wrong. The easiest example of this is the patient that wants a prescription for antibiotics to treat a cold. A provider wants to help the patient, as long as the treatment is medically, scientifically the right thing to do.
I completely agree that finding a doctor from the list on this website is the best option. If you can’t, then you should expect a challenge, but don’t be demanding or hostile towards doctors you try. If you do find a doctor that will help you with this, you should be grateful, and I will explain why shortly.
You seem to put a lot of weight in a doctor’s “opinion”. A doctor’s opinion is certainly important, especially in putting together a diagnosis, but the readers here are not going to the doctor for a diagnosis. There is significantly less opinion when it comes to treatment. Treatment is strongly influenced by scientific data, the standard of care, the FDA, CMS (Medicare), Insurance companies, and medical boards and societies. None of these currently recognize Life Extension therapy.
So, most importantly, anyone that wants to go down this road of Life Extension therapy needs to understand that a doctor that helps you is going way out on a risky limb for you. They will be treating a disease that doesn’t medically exist yet. They are writing prescriptions for medications that have toxic, potentially lethal side effects and are NOT indicated for you as you do not have any illness for which the FDA has approved these drugs and for which there is no standard of care. If something bad happens to you, and you sue the doctor, that doctor will not be able to defend himself/herself. This is why so few doctors are doing this, and why people are finding ways to get these drugs without a prescription.
Again, I hope that we are on the cutting edge of a great new treatment for aging, but for now it is a challenge to go down this road.
Karl said: as a physician, "
Karl , I don't believe you.
Your posts here suggest widespread confusion in your thinking that I don't see from most other posters here.
Forums which explore "weird" therapies, often have paid agitators sent in to cause chaos and confusion to discredit everything on the forum. I'm assigning you to that category, until I see more information.
The original poster here, Dan , has often been the target of similar attacks. It is a common tactic on the Internet. Getting easier to recognise quickly,
@ Dan wrote: “This is US centric. I have a little experience with Japan and EU medical systems and think it will work differently there.”
Things certainly will work differently outside of The Homeland. I'm a retired American man, living in a foreign country for over 12 years. Here are some of the differences:
1. You don't need a doctor or hospital for most lab tests. Independent labs serve “walk ins” without an appointment. Just select the tests you want from a “menu”. Results delivered by email, most the next day.
2. Most pharmacies will sell anything you want, “over the counter”. Even benign injectables. No prescription. No doctor needed. I have bought testosterone that way.
3. Out here, away from the USA, everyone knows the “medical system” is NOT here to serve patients. Patients bring money, that's about all. Anything more than that is just good luck. So what to do? Avoid doctors and hospitals as much as possible. What I'm learning on various forums and websites helps me to be my own doctor.
4. “Science” has very little to do with anything among doctors and hospitals out here. To “be a doctor” is not a “life calling”, rather it is a title of prestige and status. Once “MD” is attached to the name, little additional effort is required.
“due to the Hippocratic oath they can't refuse you, so what they'll do is try to shut you down. Don't let them, just walk.”
Yes, indeed. And I have “walked” several times, out of hospitals and private clinics. And when I have, the staff seem shocked that I, a mere patient, can make my own decisions to act.
David Hanson said:
He could humbly ask what people here are trying to accomplish, outside the Big Doc system, and make kind suggestions. No finger pointing but something like “that rapamycin dose looks a little high to me” and here is my suggestion for a better dose.
Excellent analysis. Thank you David Hanson
Another factor, not previously mentioned: In The West today, religion has been relegated to an object of ridicule. It's place has been taken by "the health care system" and government-approved "science" by "peer review". Doctors and scientists have become the "priests" of our era.
To even suggest this, as I have just done, is heresy combined with treason. Back in The Homeland, either one of those would be a hanging offense. As suggested by Dan in a post above, "just walk". I already have. Medical care outside The Homeland is not better, but it certainly allows for more personal liberty to think for one's self.
Mike Almerjanski David Hanson Karl Thanks everybody for keeping this a civil discussion. Ultimately the medical system is an intersection between practitioners and clients, both with varying degrees of expertise. It's certainly true that the Dr isn't always right, and obviously the patient/client isn't always either. We all live in a world of evolving uncertainty. And also I'd like to make clear that I have the highest respect for medical practitioners, they are trying to help people in a difficult system. Having said that my respectfully our bodies and lives and we're the ultimate decision makers. Too often I've had physicians forcefully attempt to help me for my own good, when the advise was based on their limited experience and knowledge, or on other criteria that weren't relevant. Which is the basis for this post.