"Well man" clinics

[Thornyone]

I get invited by my GP practice to attend for an older man's MOT, where someone has now managed twice to put the wind up me, and I don't feel inclined to go again. I just wondered if others had had similar experiences? The reason I ask here is that I'm likely to be asking men who are fitter than the average. My experiences are:

1) First MOT a few years back, an ECG was done and the nurse said it was abnormal. I thought I was pretty fit (cycling then about 70-100 miles and swimming 3km a week, both things I've done for over 30 years, though I swam more before I got into cycling). I thought I had about a week to live and felt quite anxious. Fortunately my GP also works part-time as an expert in heart arrhythmia at Glenfield Hospital, one of the top places. When I got to see him after an anxious week, it turns out that I have sinus arrhythmia which from what I've read is common in children and something adults tend to have if they get a reasonable bit of aerobic exercise.

2) Recently, at my second MOT, height, weight, waist and BP were measured and a blood test done. My BP was (white coat syndrome) high and my other measurements indicated a somewhat high BMI. I'm now retired and am able to cycle 120-200 miles a week and still swim regularly, and I think I've got a reasonable figure for an old git of 62. I've always been of quite a muscular build, though somewhat vertically-challenged. Self-measuring BP at home, my readings were fine. When I returned for my test results, I was asked by the practice pharmacist (who was doing the clinic, rather than a GP) if I knew why I'd been called back. I said that it was probably because my cholesterol was now high and he wanted to prescribe statins? After looking at the BP readings I'd brought and looking rather perplexed as he hurriedly typed into his computer, he told me that my BP was fine (which I knew) and my cholesterol was fine, with a good proportion of the good sort. The only issue was that my BMI was "a bit on the high side". No meds needed.

Now what worries me is that the factors which they use to calculate risk for cardiovascular disease include age and BMI and I am concerned that BMI is a pretty crude measure. I honestly wonder if I can be bothered to attend another "let's put the wind up him" session! Any thoughts or similar expeiences?

[pjclinch]

I imagine you'll get the invitations automatically as being Over A Certain Age. I'd suggest you share your concerns with your GP who will have a much better idea of your health as an individual, and can give you the best answer here.

I suspect it's quite possibly the case that this initiative is targeted at average people who tend to be relatively inactive. Given your activity levels clearly paint you as not average, a general session aimed at others quite possibly isn't telling you much useful. But ask your GP rather than the Interweb.

Pete.

[Psamathe]

When I got my invite last year I was inclined to decline the invitation as I was very aware of the pressures primary healthcare is under and I felt fit and healthy. I reflected and then thought that we expect primary healthcare to keep us fit and if they request me to attend such a clinic then I should follow their advice/request (no point in handing experts responsibility and then ignoring their requests).

After the appointment I felt guilty about having wasted Primary Healthcare time/resources - it was a complete waste of time and if I get another "invite" when I feel like I do generally then I wont be bothering.

However, from an NHS resources perspective I can appreciate that for some they can be important and thus the difficulty comes in identifying those who would benefit from those for whom it is a waste of time (mainly a waste of NHS time/resource). I would be interested to see any analysis of those for whom the clinic was useful and whether they had seen their GP anyway over e.g. the last year. i.e. could people who rarely see their GP for health reasons be excluded or would there then be a massive outcry should somebody omitted then suffer a serious impact that could have been detected at such a clinic?

Maybe a questionnaire for people to complete and score themselves (e.g. "Do you take more than <xx> hours of exercise per week? Is your BMI over <xx>, etc.) and if score above a threshold then recommend the clinic.

Ian

[Vorpal]

BMI is not a measure. It's frankly silly. It cannot distinguish between muscle and fat (muscle weighs more), and it cannot distinguich between body types or builds.

I'm sturdily built for a woman. I used to play football & one of my colleagues remarked I looked more like a rugby player. I'm also muscular from years of doing various sports. My BMI has always been 'on the high side'. I used to have regualr medicals with the 'wellness' department at my work. Every year they noted that my BMI was on the high side and asked if I wanted advice about 'diet and lifestyle'. I got tired of it, and once told the nurse that I'd like her to ride her bike with me when I rode from home to work (28 miles), and when we got to work, she could tell me if I needed 'diet and lifestyle' advice.

Our measurment of and concepts about 'overweight' are based in cultural perceptions, research done during rationing after WWII, and many assumptions. There is little research to support the concepts about poor health outcomes associated with being slightly or moderately overweight.

There's a fair amount of more recent research that shows that people who are slightly overweight, live longer than those that have BMIs in the 'normal' range. And those who are moderately overweight, but not obese have outcomes no worse tha those in the 'normal' range. http://www.independent.co.uk/life-style ... 58229.html

Also, there is research that shows being fit is more important than weight. http://www.nytimes.com/2012/09/18/healt ... eight.html

[Psamathe]

BMI is not a measure. It's frankly silly. It cannot distinguish between muscle and fat (muscle weighs more), and it cannot distinguich between body types or builds......

Is there a better easy way to for people to be alerted that they might have a weight issue.

Occasionally I accidentally have a GP vs public program on (where they drag people in to check their health) and it's a real surprise how many who are clearly overweight/obese are shocked when told (by the GP celebrity "expert") that they need to lose weight.

I'm not supporting BMI but as a measure easy for people to take (my bathroom scales tell me my BMI every time I use them) and it might alert some. I'd guess many of those who have a high BMI due to muscle will be aware of the BMI limitations in their case so the worst that happens is they have to explain their build to some medic every now and again.

I can appreciate that it is probably over-used (e.g. by medical insurance companies selecting their clients) but I'd expect most GPs/nurses to be able to see/check if a high BMI is caused to lots of muscle or lots of fat. I imagine it depends on how much we are prepared to spend double checking everything e.g. even for people with too much fat the risk/impact depends on where that fat is but can we give all these people MRI scans?

I do think a simple to use measure is needed and being simple it is bound to have shortcomings and I'm very open to a better alternative if such a thing exists.

Ian

[Thornyone]

Interesting replies. BMI really does seem to be a pretty useless thing in many ways. I think it would be very useful if there were a questionnaire taking account of exercise as psamathe suggests. The only questions seem to be whether one smokes and how much one drinks (which in my case immediately labels me as an alcoholic, I shouldn't wonder ) But as far as exercise is concerned, it isn't taken account of at all, and a reasonably active person isn't filtered from a complete couch potato.

[Thornyone]

As far as a simple measure is concerned, I've heard that a "waist circumference half your height" rule is not bad, and in fact I never weigh myself, but I do use "belt holes" as a guide. I find it a good guide, because as soon as my exercise level drops (such as when I had a bad reaction to dental penicillin earlier this year and was confined to barracks for a month), I tend to gain weight easily, but the belt test reveals this and easily tells me when I'm back in shape again.

[kwackers]

At least you managed to get an appointment.

They've sent me a few but every time I ring up there are no available appointments left in the 'current' session.

[Vorpal]

Occasionally I accidentally have a GP vs public program on (where they drag people in to check their health) and it's a real surprise how many who are clearly overweight/obese are shocked when told (by the GP celebrity "expert") that they need to lose weight.

What if some of those people didn't really need to lose weight? Obesity is a different matter. That is associated with a number of preventable health issues. But overweight? By whose estimation? Maybe they just need to get their minimum recommended exercise each week. Admittedly, they are likely to lose weight if they do that.

What if there is something fundamentally wrong with how we perceive these things culturally?

[Thornyone]

I can get an appointment for something like this that I don’t feel I need. Often pretty difficult to get an appointment at my GP for something I consider more pressing. I think that the difference is that the GP clearly isn’t involved in the face-to-face part of most of the well man clinics

[bigjim]

I attended one of these clinics about 12 years ago. I was then called in by my GP who told me I had failed my MOT because my PSA levels were 16 and it was almost certainly cancer. I then had to wait a month, over Xmas as well, worrying myself stupid, before I got to see a consultant. He examined me [finger test] then told me to go away, but have another blood test. Second reading was 0.75. Nothing wrong. I've just had an email this morning to ask me to attend another as I am subject to 20% CVT risk. Don't know where they get that from? Run, swim, ride up to 100miles in a day and lift weights 3 times a week.
By the way there is an alternative BMI test. Google it. Gives a more accurate result.

[Si]

I got called for one. When I got there they said they were running two hours late and that they could contact me to rebook if I wanted...never heard from them again.

Recently I had a blood test for something else. Next day I got a call from receptionist: "please come into the surgery right away as your blood is borderline!!!". "borderline what?" I asked, slightly alarmed. "I don't know" she said, "it's just borderline so you'd better come in ASAP". So I turned up the next day, nurse (who knows I ride a bike a lot) looked at my file and said it was a waste of tie me coming in.....it was just that my cholesterol was borderline....if I had happened to be an overweight coach potato...the fact that I exercise everyday means that it is fine apparently. Yep, they are good at putting the wind up you!

[Psamathe]

Occasionally I accidentally have a GP vs public program on (where they drag people in to check their health) and it's a real surprise how many who are clearly overweight/obese are shocked when told (by the GP celebrity "expert") that they need to lose weight.

What if some of those people didn't really need to lose weight? Obesity is a different matter. That is associated with a number of preventable health issues. But overweight? By whose estimation? Maybe they just need to get their minimum recommended exercise each week. Admittedly, they are likely to lose weight if they do that.

What if there is something fundamentally wrong with how we perceive these things culturally?

Not having had the individuals from the program in front of me and not being an expert/medical I guess I'd go with the assessment of the GP was was doing the "you need to lose weight". So "By whose estimation?" in the example would be by the estimation of the GP saying it.

From what I've read (and I claim no expertise), generally medical people associate overweight/obese with a number of health issues so I have the impression they tend to prefer people to be in their "normal" ranges.

Culturally it can be a very different matter - I understood there are some cultures where obese is culturally acceptable and those cultures suffer the health issues and shortened lifespan issues.

I would have expected that the medical advice on weight is based on current interpretations of research (which is and always will be a "moving target"). So I'd expect the current medical advice is a sort of "best efforts" move to improve things as much as possible. I'm sure things would be better if we all had an MRI scan on the NHS each year but things have to be practical so I'm guessing BMI is being interpreted as "greatest good, greatest numbers" i.e. does not apply to everybody, requires some common sense and interpretation and is used with caution.

By analogy, PSA tests are highly suspect but that does not mean we should complete discard them, just that the results need to be treated appropriately.

Ian

[Psamathe]

.....I've just had an email this morning to ask me to attend another as I am subject to 20% CVT risk. Don't know where they get that from? Run, swim, ride up to 100miles in a day and lift weights 3 times a week.
....

When I had my test I was surprised at the low consideration for exercise. I was asked if I did some trivial level of exercise (can't remember what that was but you'd have to be glued to the TV 24/7 and have somebody fetch your donuts to be that lethargic). I exceeded their exercise question massively but that was not a consideration, it was only above or below their set very very low bar. I'd expected it would have been rated at least into a number of bands but not so.

Ian

[ianrobo]

funny just saw this as tomorrow I go for a comprehensive check up through the scheme at work. So this includes all the usual stuff plus a fitness one as at 45 time to get fully checked.

be interesting given my diet what they say about cholorestrol ha ha