Foo - Is my doctor ordering too many tests?

Here's the scenario: I've had repeated swelling in my right knee for several years now. It's currently swollen to a size I've never seen before, rendering my leg stiff and of minimal use. It hasn't happened for a little over a year. Anyways, I'm concerned because it's always the same knee and it recurs. I went to the hospital a few days ago, and they x-rayed the knee to find nothing wrong with the bone.

I was referred to an orthopedist, who I saw this morning. She drained 85ml of joint fluid from the knee and sent it off to a laboratory for testing. She then ordered a blood test for uric acid and something else (forget exactly what). I got a call later today saying that they suggest I get an MRI and my insurance has authorized it already.

I'm certainly not a doctor, but I feel like this is moving very fast and the MRI is excessive. I would have thought that the joint fluid and blood test would be conclusive enough, am I wrong? Even though my insurance covers an MRI, it's still probably very expensive and I'd rather not do it if my doctor is just ordering the test without crucial need.

MRIs are amazing. Get it done. Hopefully it will enable the doc to find out what's wrong.

It's a last ditch effort by the doctor to avoid amputating the leg,that's all.

I don't understand why amputation was not discussed yet.

Hack doctors!

BTW, if you're worried about claustrophobia, I have some things in my medicine bag that will help :thumb:

I don't understand why amputation was not discussed yet.

Hack doctors!

They always try to run away,very dramatic and sad.

Obviously the fluid they drew from your joint needs to be tested for bacterial or viral infection. The uric acid test is to see if you have gout. The MRI will tell them if there is any physical damage to your knee.

Sounds appropriate to me - they're testing three (probably most) likely causes of your joint inflammation and swelling.

It's quite amazing what athletes do with a carbon prosthetic leg these days.

They always try to run away,very dramatic and sad.

They also forget the free drumstick!

Obviously the fluid they drew from your joint needs to be tested for bacterial or viral infection. The uric acid test is to see if you have gout. The MRI will tell them if there is any physical damage to your knee.

Sounds appropriate to me - they're testing three (probably most) likely causes of your joint inflammation and swelling.

I see. I'll know the results of the two tests before I go to the MRI. If indeed I have some infection or gout, I guess that waives the need for an MRI?

It's not like his present leg is that usefull.He stated that himself.
Hopefully they can retain his leg till he gets that janitor job at the big law firm this summer.

It's not like his present leg is that usefull.He stated that himself.
Hopefully they can retain his leg till he gets that janitor job at the big law firm this summer.

I went ahead and accepted that job, by the way. They sent me a mop with a carbon fiber handle as a welcome gift.

If you are unsure about a test, ask the doctor what action he would suggest in the case of each possible test outcome.

It's not like his present leg is that usefull.He stated that himself.
Hopefully they can retain his leg till he gets that janitor job at the big law firm this summer.

Did you use the proper work attire suggestions by your friends here in BF?

Not only can we get you employed in BF but I'm sure there are also experts here on using/buying a prosthetic leg.

I can make my own prosthetic leg. I actually referred my future employer to the post you're referencing in foo. So impressed were they with my ambition and desire to succeed in their organization that they handed me the carbon end of the mop on the spot.

If anything worry about them not doing enough. :lol: Seriously though man, that sucks. I've always thought I have problems with my knees but I just feel lucky now.

Did you ever injure the knee?

If not, did you ask about seeing a rheumatologist? It could be some kind of arthritic issue.

Alas, they order lots of tests, too.

I see. I'll know the results of the two tests before I go to the MRI. If indeed I have some infection or gout, I guess that waives the need for an MRI?

Not necessarily. The MRI is a good idea, especially if it's covered by insurance.

Not all of the time MRIs are authorized. You are very lucky to be able to get one. It's shows a very detailed section by section picture of what your knee and surrounding tissue looks like. If there is a tear in there, it will show. It's just an x-ray for soft tissue.

I spent 10-years fighting swollen knees and ankles. I'd get 3-6 months of great training in and almost get back into full shape and then my knee or ankle would swell up and hurt like hell for 2-3 weeks. I'd be on the couch the whole time taking all sorts of opiate drugs. The stupid thing was that they didn't do enough tests. They looked at me and figured I had a sprained ankle/knee and sent me on my way with pain-killers. One time they did do an xray, but of course I've never broken a bone in body.

So... this went on and off for 10-years straight until I met my wife. She pondered my symptoms, looked over my medical receipts and declared, " you might have gout!".. We went to a rheumatologist who stuck a huge fat needle in my ankle and tried to suck out some fluid. But it was on the tail end of an episode and most of the swelling had gone down. Found nothing! Blood-test showed slightly high uric-acid content, but that itself isn't conclusive as about 50% of gout patients don't show high uric-acid anyway. So... MRI was next and it showed the telltale signs of damage from rubbing and embedded uric-acid crystals. Been on some gout drugs for the past 2-years and haven't had a single attack since!

If they had done these tests 10-years ago when I first went in, I may still have had a chance as a pro bike racer.

I spent 10-years fighting swollen knees and ankles. I'd get 3-6 months of great training in and almost get back into full shape and then my knee or ankle would swell up and hurt like hell for 2-3 weeks. I'd be on the couch the whole time taking all sorts of opiate drugs. The stupid thing was that they didn't do enough tests. They looked at me and figured I had a sprained ankle/knee and sent me on my way with pain-killers. One time they did do an xray, but of course I've never broken a bone in body.

So... this went on and off for 10-years straight until I met my wife. She pondered my symptoms, looked over my medical receipts and declared, " you might have gout!".. We went to a rheumatologist who stuck a huge fat needle in my ankle and tried to suck out some fluid. But it was on the tail end of an episode and most of the swelling had gone down. Found nothing! Blood-test showed slightly high uric-acid content, but that itself isn't conclusive as about 50% of gout patients don't show high uric-acid anyway. So... MRI was next and it showed the telltale signs of damage from rubbing and embedded uric-acid crystals. Been on some gout drugs for the past 2-years and haven't had a single attack since!

If they had done these tests 10-years ago when I first went in, I may still have had a chance as a pro bike racer.

This same thing happened to me, but I had a doctor who couldn't be bothered to run a $15 uric acid test, but he could charge me and my insurance company for a super-expensive MRI! He kept telling me I had tendonitis, then when I got into nursing school I figured it out myself and went to a doc in a box and got a uric acid test, a diagnosis of gout and a $10 prescription and the problem was solved.




And people wonder why doctors aren't trusted.

At least PC2's doctor is being thorough.

And it'sw good to 1mm resolution, too. Far better than a CT scan.
Not all of the time MRIs are authorized. You are very lucky to be able to get one. It's shows a very detailed section by section picture of what your knee and surrounding tissue looks like. If there is a tear in there, it will show. It's just an x-ray for soft tissue.

Given my history with swollen knees (turned out to be cancer), I'd say get as many tests as you need. Though if it were osteosarcoma, it probably would have shown up on the X-ray.

Don't worry, you probably just have gonococcal arthritis.:rolleyes:

I called my orthopedist today. Apparently my white blood cell count is high in the synovial fluid, I don't have high uric acid levels, and my CRP level is 65. She said that while a full result will be available by Thursday, she doesn't expect it to be conclusive either. I'm scheduled for an MRI Friday morning, and I'll keep that appointment. Thanks for the replies.

you can never have too many tests

This same thing happened to me, but I had a doctor who couldn't be bothered to run a $15 uric acid test, but he could charge me and my insurance company for a super-expensive MRI! He kept telling me I had tendonitis, then when I got into nursing school I figured it out myself and went to a doc in a box and got a uric acid test, a diagnosis of gout and a $10 prescription and the problem was solved.

And people wonder why doctors aren't trusted.

At least PC2's doctor is being thorough.Like any other profession, you have good ones and you have not-so-good ones to downright QUACKS! I checked up on the backgrounds of many doctors before I visit and you'd be surprised at how many have 30-40 malpractice suits in their history! Having none (or a few cases in their favour) is one of the criteria I use to choose a Dr. And having good referrals from happy patients is another criteria. And taking cash-payments up front is another benefit; cut out all that insurance bureaucratic red-tape.

In PC2's case, it appears all the tests are about right as they look at different areas that may be the cause of the issue. And a lot of times, you really do have multiple problems that require multiple treatments.

I think going to hospital or seeing a Dr. is worse than women taking their cars in to the auto-mechanic; everyone gets snowed!

Its how they make their bucks. I went in 'cause I was having trouble breathing, two days and like a bazilion test later I left with a $14,000 bill and no diagnosis.

Given my history with swollen knees (turned out to be cancer), I'd say get as many tests as you need. Though if it were osteosarcoma, it probably would have shown up on the X-ray.

And I thought my diagnosis was going to be tough on him:cry:

you can never have too many tests

Easy for you to say,it's all free in the Kingdom.

I called my orthopedist today. Apparently my white blood cell count is high in the synovial fluid, I don't have high uric acid levels, and my CRP level is 65. She said that while a full result will be available by Thursday, she doesn't expect it to be conclusive either. I'm scheduled for an MRI Friday morning, and I'll keep that appointment. Thanks for the replies.

So no gout, but still a lot on the table ( high WBC and CRP sounds like infection ). With multiple bouts and a knee that is bad then take all the tests they will approve. Even if it is infection there may be underlying physical issues that can be fixed to limit future infections.

I'm certainly not a doctor, but I feel like this is moving very fast and the MRI is excessive. I would have thought that the joint fluid and blood test would be conclusive enough, am I wrong?

Your doctor is doing exactly the right tests. Relax.

Its how they make their bucks. I went in 'cause I was having trouble breathing, two days and like a bazilion test later I left with a $14,000 bill and no diagnosis.

The tests described by the OP will cost 1/10 of that and are entirely appropriate given his symptoms.

And I thought my diagnosis was going to be tough on him:cry:

Tough? Lightweight! ;)

http://www.indy.com/photos/42319/post.jpg

Tough? Lightweight! ;)

http://www.indy.com/photos/42319/post.jpg

Reds incomming! Quick call the troops!

http://www.myfitnessstudio.co.uk/wp-content/uploads/jeanclaude_van_damme.jpg

and to OP: God luck with the MRI.

Sorry Ruben,
Save your intensity,embrace apathy,things will not be near normal here for at least another 6-12 months in America.

And yes, good luck to OP on the MRI!

So no gout, but still a lot on the table ( high WBC and CRP sounds like infection ). With multiple bouts and a knee that is bad then take all the tests they will approve. Even if it is infection there may be underlying physical issues that can be fixed to limit future infections.

The specimens they sampled all need to be cultured, so I'm told that I can expect more thorough results -- like whether or not I have an infection -- Thursday morning. Thanks for the good replies, all.

Yep. That's where I'd go for informed medical advice.





The 41 on BF.

Like any other profession, you have good ones and you have not-so-good ones to downright QUACKS! I checked up on the backgrounds of many doctors before I visit and you'd be surprised at how many have 30-40 malpractice suits in their history! Having none (or a few cases in their favour) is one of the criteria I use to choose a Dr. And having good referrals from happy patients is another criteria. And taking cash-payments up front is another benefit; cut out all that insurance bureaucratic red-tape.
. . .
I think going to hospital or seeing a Dr. is worse than women taking their cars in to the auto-mechanic; everyone gets snowed!

How do you find out?

Its how they make their bucks. I went in 'cause I was having trouble breathing, two days and like a bazilion test later I left with a $14,000 bill and no diagnosis.

you were lucky. i went in with a wart and came out with a new liver!

How do you find out?About what? A particular doctor's history? By law in California, all malpractice suits that have been concluded is public and available at the county courthouse. Also available from the Medical Board of California. The Medical Board won't disclose information on pending or dismissed malpractice suits.

In addition to lawsuits, for any licensed Dr. the law provides that the following information is public and would appear on a record under Public Disclosure:

* If a physician has been disciplined or formally accused of wrongdoing by the Board.

* If a physician has been disciplined by a medical board of another state or federal government agency.

* If a physician has been convicted of a felony reported to the Board after January 3, 1991.

* If a physician has been convicted of a misdemeanor after January 1, 2007 that results in a disciplinary action or an accusation being filed by the Board, and the accusation is not subsequently withdrawn or dismissed.

* If a physician has been issued a citation for a minor violation of the law by the Board within the last five years. This is not considered disciplinary action.

* Any hospital disciplinary actions that resulted in the termination or revocation of the physician's privileges to provide health care services at a health care facility for a medical disciplinary cause or reason reported to the Board after January 1, 1995.

* After January 1, 1998, all malpractice judgments and arbitration awards (between January 1, 1993 and January 1, 1998, only those malpractice judgments and arbitration awards more than $30,000 were required to be reported to the Board).

* After January 1, 2003, malpractice settlements over $30,000 that meet the following criteria:

** Four or more in a 10-year period (beginning 1/1/03) if the physician practices in a high-risk specialty (obstetrics, orthopedic surgery, plastic surgery and neurological surgery)

** Three or more in a 10-year period (beginning 1/1/03) if the physician practices in a low-risk specialty (all other specialties)

How do you find out?

The hard way.

Yep. That's where I'd go for informed medical advice.





The 41 on BF.


But that is where you go for advice about everything.

Speakign as a healthcare risk manager, I can say that DannoXYZ is spot on. A growing number of states now provide some sort of malpractice or licensure disciplinary information on the website of the medical licensing/disciplinary agency of the state. However, the total number of states who do so is still quite small, and the amount and type of information varies widely. California is one of the bellwether states in terms of providing a good range of information.

There is no centralized database, accessible to the public, that has this information. There is a centralized database, accessible to some of us in healthcare, that does. It is called the National Practioner Data Bank, run by the Feds, and has records of reported malpractice payouts and some disciplinary actions taken by hospitals, states and professional societies. Even the NPDB is not complete, though, due to loopholes in the law. As an example, most academic institutions and large integrated health systems do not report malpractice payouts on behalf of individual physicians. They take the attitude that since it is the corporation making the payout, not the individual physician, that physician does not need to be reported.

Finally, you would have to take the malpractice and disciplinary information with a grain of salt. These issues are not always a proxy for clinical quality.

Finally, you would have to take the malpractice and disciplinary information with a grain of salt. These issues are not always a proxy for clinical quality.

Ain't that the truth. Having a lawsuit does not make one a bad doctor. And there are a lot of bad doctors who have never been sued.

Well, there's the Law of Large Numbers, averages and the bell-curve. I usually go for the middle of the bell-curve as that's the strongest correlation. Sure, you can always find extremes on either end. Such as George Burns smoking cigars all the way up to his death at 100. However, the middle of the bell-curve will show that smoking is hazardous to your health (and those 400,000 people who die every year from it).

So, with a larger sampling size, such as 1000s of hospital visits over the course of a person's lifetime, tens of thousands of visits per doctor per clinic, that frequency of disciplinary actions do correlate to quality of care. It's a feedback loop.

Looks like my synovial fluid and blood tested negative for infections. I'm getting the MRI very shortly.

Well, there's the Law of Large Numbers, averages and the bell-curve. I usually go for the middle of the bell-curve as that's the strongest correlation. Sure, you can always find extremes on either end. Such as George Burns smoking cigars all the way up to his death at 100. However, the middle of the bell-curve will show that smoking is hazardous to your health (and those 400,000 people who die every year from it).

So, with a larger sampling size, such as 1000s of hospital visits over the course of a person's lifetime, tens of thousands of visits per doctor per clinic, that frequency of disciplinary actions do correlate to quality of care. It's a feedback loop.

The problem with this, Danno, is that very few individual clinicians get enough disciplinary actions or complaints to be subject to the laws of large numbers. The sample size here is not number of patient visits, it is disciplinary actions. Clearly, some physicians due incur significant complaints, either in number or content, that are a proxy for their clinical skills. However, disciplinary complaints for non-clinical issues, such as moral turpitude, although it may say something about the physician, does not say anything about the clinical competence of the clinician.

Your argument would be better made against larger medical settings. Using your definition, then Kaiser Permanente or Sharps in California are clearly a death trap, based on the number of disciplinary actions made against the providers in the system. Yet both of those systems have won national awards for the quality of their care.

If you really wanted to use a proxy for clinical competence, then you would be better advised to look at actual malpractice payouts. Very few insurance companies any more make nuisance settlements. If they make a large payout, it is usually because the standard of care could not be defended. If a physician had a number of malpractice payouts, I would give them a hard look. Perhaps they were unlucky, perhaps they practice in a high-risk area of medicine, or perhaps they are just not very good.

Since I do malpractice defense for a living, I can say that malpractice claims history is a major consideration in underwriting a clinician for malpractice insurance. The more claims that have been paid out, the more likely the physician has a problem.