Latest / Intellectual Medicine / Stop Saying Yes to Your Doctor: The Medical Tests You Should Be Refusing

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Stop Saying Yes to Your Doctor: The Medical Tests You Should Be Refusing · Intellectual Medicine

• 0:00
  Remember, it's your body, it's your health, you have access to
• 0:04
  information, you have this fabulous podcast, you have the
• 0:07
  Internet, you can AI stuff. It's a good starting point.
• 0:11
  Just don't believe it. AI is polluted with
• 0:15
  misinformation and it's going to get worse, but it's not a bad
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  starting point. Just don't lean heavily out of
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  it. No, by the way, if you're
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  following a body hacker without expertise, without a degree in
• 0:30
  medicine, nurse practitioner, there's a lot of self-proclaimed
• 0:34
  experts trying to guide you along a path of nonsense.
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  You notice something I've noticed about them, They're all
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  about 28 years old. I have a bias.
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  You know if you're going to really do anti aging medicine
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  you better be at least about 60. When I started medical school I
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  remember the anatomy professor getting up and telling us
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  liberal arts is over. Welcome to vo tech.
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  He's talking about the indoctrination process.
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  We're learning a skill set. We are becoming socially groomed
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  into the profession so we learn things based upon what was done
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  before and what's expected of us.
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  This is the dogma of medicine, the way it's taught, and this is
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  the way your doctor practices. Much of what is done is
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  established through habit and repetition.
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  Repetition makes it easy. Patterns make it easy.
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  Standard of care is simply doing what other doctors do.
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  But is it always necessary? And who gets to decide?
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  I'm going to share with you some things that I don't think should
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  be done, and I think that you will need to step up and request
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  that they not be done. Be prepared for some degree of
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  resistance. Doctors, after all, like to
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  believe that what they say is coming from a burning Bush.
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  Patients just acquiesce and move.
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  Not all good doctors will be able to be tempered and
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  conversational, but they're hard to find.
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  You see, primary care family medicine.
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  I'm a board certified family physician, an osteopathic Dr.
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  choosing that pathway because of its focus on health and
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  prevention. That folks that is not highly
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  reimbursed endeavour. No doctors get paid to do stuff
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  they don't get paid to think so the specialties that have
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  gadgets, that's cool. Primary care, not so much.
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  So you need to be aware of all this, the influences, the forces
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  that mold recommendations. If you don't know where they
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  emanate from, it's hard to appreciate how you can direct
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  your own care and what's important for you.
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  Remember, you don't have health insurance.
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  You have sick insurance. Nobody got health going to a
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  hospital, an emergency room, a subspecialty clinic.
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  You got intervention of sickness.
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  Going to your primary care doctor should be a wonderful
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  health enhancing anti aging experience.
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  It's not if you go to your doctor and you're not
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  chronically ill and you say, you know, I just want to know what
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  to do to stay vital. So I don't age like normal
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  people. It's not their specialty.
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  Now, it's a little bit of a sidebar, but my advocacy is find
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  a primary care Doctor Who does not take insurance.
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  They have more freedom, more liberty, more time.
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  They are direct doctors, and in the near future, they're going
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  to be doctors trained in the doctor Pedaruti protocol for
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  prostate cancer. They'll have broader skill and
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  experience. But let's get to the topic.
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  Don't let anybody put a finger up your butt, men, unless you
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  happen to prefer that. The idea here is that it does
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  not help make any diagnostic assessment.
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  It is a time honored tradition. Listen, I've done it thousands
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  of times. I stopped doing it about 12
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  years ago. The research does not support
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  its value. A study published in 2018, the
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  Annals of Family Practice, looked at a multitude of
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  studies, over 9000 men concluding that the digital
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  rectal exam to evaluate prostate health had no value.
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  None. And I can tell you from my own
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  experience, you're kind of feeling something, but you're
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  not really sure. And it wasn't for lack of
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  experience or effort. My fingers are plenty long
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  enough, my skill is plenty sharp enough.
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  My sense of touch is rather exquisite.
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  It's simply you can't feel much and it doesn't matter.
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  We have PS as we have imaging. It is uncomfortable,
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  unnecessary, but commonly done to a certain extent.
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  The doctor does not want to be accused of being inadequate, of
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  being not detailed enough, so they may be thinking you're
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  expecting it. You can help your doctor by
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  expressing your desire. Say listen, I do not want to
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  have a rectal exam. I understand it's often part of
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  the process, but I prefer not to get that unless it is of
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  critical essential nature, which it's not.
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  This will let your doctor put in the chart.
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  Patient declines rectal exam. That'll give the doctor the
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  coverage he or she needs, so that when the records are
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  audited, they don't look like they're being lazy.
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  After all, it's a function of focused quality.
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  I'd rather spend the time talking to my patient.
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  That's more valuable. So no digital rectal exams
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  unless you're in an emergency room.
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  You just got in a car wreck? Different story.
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  But as far as a screening exam? Useless, uncomfortable,
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  unnecessary. Stop it.
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  All right. What else fits that category?
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  Time honored tradition. I don't know if they still do
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  these, but an EKG as a screening tool?
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  Useless. It does not help predict heart
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  disease. It does not help determine risk.
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  It has no value. It's different if you're having
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  cardiac symptoms. It's different if you're on
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  drugs that affect the conduction of the heart.
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  That's different. I'm talking about as a screening
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  tool, no value. And I'll put in that category
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  all these watches. Some people are toting around
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  checking out the heart, what the rhythm is doing.
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  The heart normally has irregular rhythm.
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  The heart normally will have little blips of tachycardia,
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  doublets, PVCS, short runs of a fib even.
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  None of it is clinically significant.
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  The heart does that. So when you have these watches,
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  really it's a recipe for over focus and anxiety.
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  If they can sell you a gadget that you think will make you
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  healthier or track your health, holy cow, it's a bonanza.
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  By and large, these gadgets have no real value.
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  How do you know if you're sleeping well?
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  Does your watch tell you? Yeah.
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  How about how do you feel the next day?
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  How about how your energy is during the day?
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  I maintain if you have good energy, you slept well.
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  Period. And by the way, everybody wakes
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  up. Nobody sleeps through the night.
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  Not normal. So if you're waking up, that's
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  not a pathologic event. Anyhow, I don't want to get too
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  tangential here. We're talking about stuff you
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  can do and shouldn't do. Here's another thing you should
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  not do. Pap smears are over.
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  They're done. No longer does a woman need to
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  get a pap smear. Why?
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  Because they now have at home testing.
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  How great is that? It was approved in January of
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  2026. It's a home swab.
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  The kit comes with a swab. A woman simply swabs
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  intravaginally, sends it to the lab.
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  Done. Instead of looking for cellular
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  change, they're looking for the president's presence of human
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  papilloma virus, HPV, certain species of that virus, certain
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  subtypes of it correlate with a risk or the presence even of
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  cervical cancer. If it's positive, it can trigger
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  further assessment. If it's negative, you're good to
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  go. This is fantastic.
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  No longer do you have to go to the doctor's office.
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  I believe there are many GYN doctors that are going to be
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  resistant to this point of change.
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  I mean, after all, it eliminates a significant source of office
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  visits and revenue. Many GYN doctors have several P
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  as and others cranking out pap smears.
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  They just they just lost a job. In essence, you do this at home.
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  It's as good as going to the. It's better than going to the
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  doctor's office because it's convenient, less expensive, non
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  intrusive. Human papilloma virus by the
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  way, is common. We all have it.
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  There are about 100 different strains.
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  Therefore, it begs the question, why does it cause cancer in some
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  women and not in others? It's also been associated with
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  oropharyngeal cancer in some. The variables are simply the
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  volume of the virus, but perhaps more importantly, the status of
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  your immune system. We all live with viruses in US
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  every day. The reason that they don't take
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  over is because our immune system keeping the lid on it.
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  So take care of your immune system.
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  It's a daily endeavor. This is part of anti aging.
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  This is part of health maintenance.
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  The absence of disease, the absence of illness.
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  There are things that can support immune function.
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  They are too broad for me to go into in the moment.
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  Perhaps I'll podcast on that. But you know the basics, folks.
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  Got to sleep, you got to eat right, Three meals a day, avoid
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  junk, do not overdo alcohol. And please please can we stop
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  already with the cannabis is good for my health BS Cannabis
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  is harmful. If you want to get high, I'm OK
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  with that, at least it has a purpose.
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  But the notion that it's health maintenance, I don't think so.
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  So take care of your immune system, avoid crap food, don't
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  drink sugary drinks. Terrible for you.
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  A little bit of physical activity, a little bit of
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  sunshine. Keep your immune system pumping.
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  All right, so at pap smears are done, EKG done, rectal exams
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  over. You know what else is a waste of
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  your time and exposure? Bone density testing.
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  It is a stupid test. Here's what I know 100%.
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  Your bones will thin absent some external force to preserve them
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  100%. This is what happens to human
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  beings. Homo sapiens doing a bone
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  density to see where your bones are.
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  It's it's the equivalent of taking a block of ice and put it
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  on the driveway in July and taking a photo of it every hour
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  to see what happens. You know the outcome.
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  And this is a particularly relevant to thin white women.
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  You guys have the thinnest of bones and they will get thinner.
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  You don't need an imaging study to tell you what you already
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  know. Take action.
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  The other thing this bone density, it's remember it is
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  radiographic so it's it's ionizing radiation.
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  I'll be at a small amount but better to have none.
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  I know some folks are advocating this in the anti aging
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  community. It's a body analysis tool.
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  Nonsense. You can do it without the
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  exposure. Much better to do one of those
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  body analyzers. They've come a long way.
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  Quite accurate. Well, how will you know how
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  healthier bones are? The bone density study is
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  useless not only because, well, we know the outcome, but also it
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  doesn't tell us the quality of bone, it just tells you the
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  picture of it. It leads to sometimes a
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  recommendation for bisphosphonates.
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  These are drugs that help to make your bone density study
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  look prettier. Notice how I word that it does
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  nothing for the health of your bone.
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  These drugs are horrible, should never be used, the increased
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  risk of esophageal complications.
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  The type of bone they stimulate is suboptimal, chalky, prone to
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  fracture quality is not there, evidence of benefit not there.
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  You want to keep your bones strong, lift weights, resistance
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  exercise, and you got to be on hormones, people, no hormone.
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  The bones are going to be vulnerable.
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  Why would you not replace what's missing to maintain your best
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  health? It is just eminently logical.
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  And now the FDA is starting to catch up.
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  Here they are 20 years later. They remove the black box
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  warning for estrogen, progesterone, testosterone
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  regarding breast cancer. It's gone.
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  They remove the black box warning for heart disease.
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  The problem for you ladies is many doctors, nurse
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  practitioners are not knowledgeable or skilled enough
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  to give you testosterone and that's super critical.
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  So no more bone density testing, yes to your strength training,
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  yes to controlling percent body fat, and yes to hormonal
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  support. Hey, there's a reason why nobody
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  recommended a bone density study when you were 30.
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  It's because they knew your bones were fine.
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  Hormones are good, muscle mass is good.
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  I love body analysis equipment. I've had it in my office for
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  many years. If the muscles are growing, if
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  the muscles are are strong, good volume, the bones are good too.
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  It's called wolf's law. It's a connection between muscle
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  and bone. Muscle and bone are connected.
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  As the muscles get stimulated and grow, the bone gets
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  stronger. So no bone density testing, no
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  pap smears, no Ek GS, no rectal exams.
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  And here's the big one. Think twice before getting
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  mammogram. I want to say don't get them,
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  but it needs to be nuanced. Here's what never happens.
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  An honest discussion about risks, benefits, and the
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  worthiness of the study. Here's how it normally goes.
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  Hey, you have to get your mammogram.
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  You're due for a mammogram. Get the mammogram.
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  The mammogram was abnormal as we got to do a cone study.
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  Look at it more closely. Look at those shadows.
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  Oh my goodness, you poor women. You're getting tortured with
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  this stuff. It's an uncomfortable exam.
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  It's not been shown to correlate with decreasing risk of death
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  from from breast cancer and it's radiation exposure.
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  You've got a cancer prone organ, the breast, and you're
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  irradiating it with a cancer causing ionizing radiation.
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  Does nobody see the problem here?
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  You know, and now they're advocating it for younger and
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  younger ages. Holy cow.
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  Let's think a little and let's look at some of the studies.
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  I got them right here. Annals of Internal Medicine 2017
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  out of Denmark, looking at mammogram results, they found no
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  reduction in advanced breast cancer when they instituted
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  universal mammograms. Now think about that.
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  If the mammogram is intended to catch breast cancer early,
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  shouldn't there have been a reduction in advanced in
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  advanced breast cancer? There should have been.
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  There wasn't. In addition, it was a 48.3% rate
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  of overdiagnosis, 48.3% needle biopsy.
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  Oh it came back normal. Elliptical biopsy, lumpectomies.
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  The horror show goes on. But it's not just Denmark.
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  Look at Canada. British Medical Journal 2000 and
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  1490 Thousand women 90,000. Half of them got routine
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  mammograms, the other half did not.
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  They did annual breast exam by their doctor I presume some did
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  self breast exam. That's not known.
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  But what they found after 15 years is that the rate of death
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  from breast cancer was the same in both groups.
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  Mammogram. No mammogram, no difference in
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  death from breast cancer. Now I get it folks.
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  Breast cancer is terrifying. Mammograms give you a false
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  sense of comfort. There are tons of women who had
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  a normal mammogram to end up with breast cancer.
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  On top of that, the studies don't show value regarding
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  preventing death from breast cancer.
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  That's the bottom line. It's not chasing shadows.
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  What they concluded that, and this is a quote from the study.
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  The rationale for getting mammograms should be urgently
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  reassessed. That's medical gentle speak for.
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  Knock it off already. All right, I'm not done yet.
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  I'm down on mammograms. Sweden, 2000.
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  Lancet. Looking at the mammogram
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  results, the rate of false positives, the harm done, it's
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  not just a function of its lack of value regarding preventing
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  death, it is actually proactive and it's harm to women.
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  Conclusion. Mammograms are quote,
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  unjustified and quote why are we still doing them?
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  Why are we still doing them? It's a paradigm of perpetual
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  indoctrination on the part of your doctors.
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  Hey, listen, if your doctor invested in a women's breast
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  Health Center is a powerful financial incentive to keep
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  mammograms alive, to make you believe it's essential, you must
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  get it done. It's insurance reimbursed.
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  Go get it done. Multibillion dollar treadmill in
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  China. Another study compared mammogram
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  to ultrasound. Guess what?
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  The ultrasound 1 hands down. More accurate, more sensitive,
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  less harm, less false positives. Why then, do we do an ultrasound
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  after the mammogram? If the mammogram is
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  questionable, doesn't that imply the ultrasound's a better test?
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  Why don't we just do that out of the gate?
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  That'd be less harmful at least. Here's why.
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  X-rays were discovered first. As such, the equipment to look
• 19:00
  at the breast evolved was invented sooner than the
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  ultrasound developed. Thus we started mammograms and
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  then a multibillion dollar industry built up around it.
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  The mammogram equipment, the breast health centers, bringing
• 19:18
  the people in, right? You're not going to bust up this
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  gravy train anytime real soon, folks, unless you you put the
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  brakes on it. You know, Doctor, I've given
• 19:31
  been given its thought. I would.
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  I, I don't want to have a mammogram.
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  Oh, my God. But you, you know, you have to
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  have a mammogram. How do you know if I have breast
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  cancer or not? Yeah, Doc, I'm.
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  I'm willing to take that risk. Knowing what you now know, there
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  is no risk. The risk of having breast cancer
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  universal. The value of the mammogram
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  dubious at best. You're better off being
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  proactive, being proactive and making your body an unpleasant
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  place for cancer to live. Percent body fat control, right?
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  Modest exercise. Certain supplements have value
• 20:08
  make your body unpleasant for cancer.
• 20:10
  Vitamin D Get your vitamin D level above 50.
• 20:14
  Conventional medicine will not support that objective, but the
• 20:18
  evidence has value supporting its merit above 50.
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  Let's go back to the mammogram. And you know what to do about
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  it. You could say if you choose to
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  listen, it's not wrong to get a mammogram.
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  I appreciate the fact that for some women, it's Peace of Mind
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  and for some women, they have unique history, they have unique
• 20:39
  genetics. It may be worthy of of the
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  study. So it's an individual choice.
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  That's the emphasis, folks. Choice information reflection,
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  not A1 lane highway of dogma, of imposition, of a doctor's value
• 20:57
  trumping your own. That's just wrong.
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  So how to weigh it? You can tell the doctor, you
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  know, doc, let's skip the mammogram.
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  But I'm OK with doing an ultrasound.
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  Oh, but you have to get the mammogram first for insurance to
• 21:11
  pay for the ultrasound. OK, pay for it.
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  It's not that expensive. Find out the price, few 100
• 21:17
  bucks. Shop around.
• 21:20
  Do not let insurance be your driving force here.
• 21:23
  Do not cheap out on your health folks.
• 21:25
  I know you have insurance. I know you.
• 21:27
  I know you're paying sick money for it.
• 21:29
  That's a whole other conversation.
• 21:31
  The mere fact that you're getting screwed on your health
• 21:33
  insurance doesn't mean that you should rely upon it to do a
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  study. That doesn't make sense.
• 21:38
  Case in point, my wife went to get my son X-rayed and they were
• 21:43
  giving her a hassle at the front desk about the insurance, the
• 21:45
  insurance, the insurance. She said listen, how much does
• 21:47
  the X-ray cost? They said it's $45.00, said
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  screw it, I'm paying for it $45.00.
• 21:52
  Another example, go to the pharmacy, wife's picking up an
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  antibiotic, puts it through the insurance $25 copay.
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  She said how much if I just pay for it $5.00.
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  So a lot of things that we perceive to be exorbitantly
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  expensive are not if you shop them around.
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  So the ultrasound totally reasonable.
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  Now individualize this advice. If a woman is AC cup or less,
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  not a lot of tissue where lumps can hide.
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  Self breast exam has more value. Mammogram has less value.
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  If you've had an implant, a breast augmentation surgery,
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  mammogram is diminished in their value because it can cause harm.
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  The breast tissue is usually easy to examine.
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  That implant makes a nice platform for self exam.
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  If you feel a lump, take an action.
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  Do this every month. Consider the ultrasound.
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  If you're a large woman, D cup, double D cup.
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  You weigh. You're overweight, you have a
• 22:50
  lot of body mass. In that case, more worthwhile
• 22:55
  pursuing imaging because it's harder to examine.
• 22:58
  It's harder to see things. This is what I'm talking about.
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  Reflective decision making. I don't like dogma I don't like.
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  Knee jerks. I don't like being imposed upon
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  by stuff you have to do. But you know what happens?
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  Everybody's busy. You're swooping along in your
• 23:16
  life. You finally get in to see the
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  doctor and bang, bang, bang. Things seem to happen with
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  force. They seem to happen with
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  urgency. They seem to happen without
• 23:27
  conversation. And we defer because we're
• 23:31
  polite. We defer because we don't like
• 23:34
  conflict. We defer because, well, they are
• 23:36
  the expert. Be prepared in your brain for a
• 23:41
  conversation. Be prepared to pause the train.
• 23:46
  Most doctors are super busy. The thing that they often care
• 23:49
  about, or at least it's on their mind when they enter the room.
• 23:54
  How do I get out of this room? How can I quickly come to the
• 23:59
  conclusion, deliver to the patient what they want and get
• 24:02
  to my next patient? Because I'm 1/2 an hour behind
• 24:04
  and if I don't see 30 people today, I'm going to have a
• 24:07
  problem. I'm not going to hit my quota.
• 24:11
  So you get to slow the process down, pause, think, ask
• 24:15
  questions. And by the way, this is a
• 24:17
  universal piece of advice. Any time an imaging study, a
• 24:21
  procedure, or anything is advised or recommended, it's a
• 24:25
  fair question. Doctor.
• 24:28
  What will you do with the result?
• 24:30
  How will it affect your treatment decision?
• 24:34
  They should know that before the study is ordered.
• 24:37
  If they say well we have to wait and see what the study shows,
• 24:41
  that's not an honest answer. They know what they're going to
• 24:44
  do. They know how they're going to
• 24:45
  act. They should at least share with
• 24:48
  you those thoughts and those options.
• 24:51
  My knee hurts, doc. Oh, let's get an X-ray.
• 24:54
  How will the picture affect your treatment of me?
• 24:57
  Fair question. Knee pain, often times
• 25:01
  arthritis, synovitis, you could treat it without the picture,
• 25:06
  but the picture is highly renumerated.
• 25:10
  When I was urgent care, I was working at a walk in early in my
• 25:14
  career and the owner approached me, said, you know, Steve, I
• 25:18
  noticed you don't order many sinus X-rays.
• 25:21
  I said, yeah, they're, they're of no value.
• 25:23
  They've been proven not to be helpful in determining how to
• 25:27
  treat a sinus infection. They can't discriminate
• 25:29
  bacterial from viral from allergy.
• 25:32
  They all look the same. True fact, he said.
• 25:35
  Yeah, But Steve, you know, if you don't order those X-rays,
• 25:38
  it's hard for us to pay for the equipment and for the
• 25:40
  technologists to run it. And when somebody comes in who
• 25:43
  really needs an X-ray, the equipment won't be there for
• 25:46
  them. It's a true story.
• 25:49
  I was a bit dumbstruck. I didn't last very long there.
• 25:52
  But you see their real life considerations affecting these
• 25:56
  decisions. They don't all have to do with
• 25:59
  your health. Sometimes it's the doctors being
• 26:03
  audited. You know, Doctor Pederuti, your
• 26:06
  mammogram rate is below your peers.
• 26:09
  You know, everybody else is at 70%, You're at 40.
• 26:13
  This folks, is what computers have done to healthcare, right?
• 26:19
  Were you under the fantasy that it was going to somehow help
• 26:23
  doctors to better assess how you're doing?
• 26:26
  Nonsense. It is now enabled somebody 3
• 26:30
  states away to look into the charts and pressure the doctor's
• 26:34
  decision making. So get the to an independent
• 26:38
  doctor. I'm of the opinion that primary
• 26:40
  care doctors should be separated from the healthcare system,
• 26:43
  become complete free agents so they can advocate for your
• 26:47
  health without fear of negative feedback.
• 26:50
  Family doctors have become gatekeepers in many settings.
• 26:54
  They don't endeavor to actually treat.
• 26:56
  That's not good for the system. What's good for the system is
• 27:00
  generating referrals, generating studies, generating labs,
• 27:03
  generating imaging, generating stuff.
• 27:06
  Thinking ain't no ain't no profit in thinking unless you're
• 27:12
  the one doing the thinking. Remember, it's your body, it's
• 27:15
  your health. You have access to information.
• 27:18
  You have this fabulous podcast, you have the Internet, you can
• 27:22
  AI stuff. Hey, I don't knock it.
• 27:25
  It's a good starting point. Just don't believe it.
• 27:29
  AI is polluted with misinformation and it's going to
• 27:33
  get worse. There's too much junk, but it's
• 27:36
  not a bad, it's not a bad starting point.
• 27:39
  Just don't lean heavily out of it.
• 27:41
  And oh, by the way, if you're following a body hacker without
• 27:45
  expertise, without a degree in medicine, nurse practitioner,
• 27:51
  there's a lot of self-proclaimed experts trying to guide you
• 27:55
  along a path of nonsense peptides and supplements and it
• 28:00
  all looks smashing. You notice something I've
• 28:02
  noticed about them? They're all about 28 years old.
• 28:05
  You know I have AI have a bias. You know, if you're going to
• 28:09
  really do anti aging medicine, you better be at least above 60.
• 28:13
  Anyhow, we digress. Well team, it's a real pleasure.
• 28:16
  Thanks for hanging with me for a little bit.
• 28:18
  Remember, think before you do ask questions.
• 28:23
  It's your right, it's your body. You don't have to be socially
• 28:28
  acceptable in the doctor's office as much as you need to be
• 28:31
  politely affirmative. All right, until next time,
• 28:36
  we're wishing you guys 120 youthful, healthy and vital
• 28:40
  years. We never need to age before we
• 28:43
  die. Think about that.
• 28:45
  All right, Bye now.