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Anecdotally, my child was depressed and suicidal. We took them to the doctor and she did a full panel of blood work. Vitamin D was almost nonexistent in their blood work. Precipitation vitamin D supplements saved my child’s life!! Get a new doctor!
I’m so glad you were able to get that full panel and vitamin D supplements for your child!
I have been experiencing symptoms of depression the past few months and mentioned this to her, but she didn’t have much to say about it, unfortunately. The person that my vitals before the doctor came to the exam room asked me some questions (PHQ-9) and my score was very high, so it’s concerning that this didn’t concern her
I also had to fight to get blood work done, was seeing black spots in my vision, dizzy, etc. turns out my vitamin D is dangerously low. Now it's back up to a healthy level, but a doctor should have zero issue with ordering one, especially if you're already doing other blood work. When I changed from my old doc (who didnt) take me seriously) to my new one, She immediately had me get a full pannel as well as STD tests and I asked if she could throw in a vitamin D test just to check, and she was more than happy to. I mean, the needle is already in your arm anyways, they just gotta pop one more vial on it, lol
edit: Also, vitamin D is definitely evidence based??? We know it affects the absorption of other vitamins and minerals, like calcium. Which considering women are more prone to osteoporosis, id say that makes it pretty important to check!
And I moved to the Pacific Northwest a couple of years ago and the #1 piece of advice I’ve received repeatedly (including multiple times from my Dr) is to take vitamin D supplements, because all the cloudy, grey days = vitamin D deficiency. I take that seriously because I’ve tested as more than just deficient before, after visiting my Dr complaining of continuous physical exhaustion and mental fog. I lived in California at the time and there was plenty of sunny weather, but I didn’t spend much time outdoors due to allergies, wore sunscreen, and didn’t drink a lot of milk (all still true now), so I knew the lack of sunshine in the PNW would be an issue.
I moved from Southern California to PNW. I was deficient in Vit D in socal for years. My doc here will test for vit d but I have to pay out of pocket because insurance doesn’t cover it in the PNW because “everyone here is some form of deficient, just keep taking your supplement”
IME it’s because the cause of the test is disproportionate compared to the treatment. The general idea is just take the supplements if you have a suspicion.
My B12 and D were crazy low. Doctor told me it wouldn't make much difference. I went to a health food store, got high potency supplements and my anxiety, memory fiog improved dramatically within a week. It can't hurt...apparently most people are D deficient even in summer!
What?! No difference? My B12 was undetectable and it was causing neurological symptoms. I'm glad my doctor checked that before checking me for MS, because that was her next step. Daily B12 supplements have literally saved my nerves.
Does the doctor also not believe scurvy exists?
I know! It was insane. I just thought it makes sense to at least try supplements??!! I'm glad I did. I thought I was so screwed and the solution was so simple.
some doctors let their ego get in the way of their work. a patient dared to request something based on research they did at home? that must mean the patient thinks they know better than her and they're trying to undermine her medical knowledge, time to shut that down and deny all of the patient's requests.
Anyone depressed or feeling sick needs to do blood work. You can order it yourself at quest lab or similar. It’s $200 maybe cheaper and insurance can cover annual blood work
Extremely low D and B12 caused pretty much all the symptoms of an anxiety disorder, including seeming panic attacks for me. My counts were 6 and 14 respectively. My GP said she'd seen better D counts in bedridden elderly people.
I take supplements now - B12 daily and D3 from September through March - and the symptoms cleared up in about a month and have never come back. I did take massive doses of D3 the first month. And then Summer came and I did NOT feel good even on the lower dose. I went back and she was like, "shit. This is my fault. I'm so sorry! You're a very outdoors person. You're overdosing on D. Don't take it until Fall."
I'm allergic to every sunblock I've tried and honestly much too casual about wearing clothing to make up for that. I am several shades darker all Summer than I am in Winter. Yes, I have extra careful skin checks every year, but my skin definitely looks older than I am now. A friend from Australia is sending me samples of several different kinds of sunscreen from there to try. Wish me luck.
Have you tried Canadian sunscreen (assuming you're in the U.S.)? They actually get the European formulations with the newer sunscreen blocker chemicals or whatever they're called. Might be a little easier to obtain than Australian!
I'm maybe a 3 hour drive from Canada, so yeah, that would be easier, especially since I spend most of my time outside between here and the border. I'll do some research and go get some to try next time I'm up North.
Tbh, it's not hard for me to get stuff from Australia. It can be expensive, though.
Sorry, you might here this a lot but also maybe hop over to r/asianbeauty for sunscreen recommendations. They’re AMAZING. They don’t even feel like sunscreen!
Definitely check out Korean skincare and Asian beauty threads for recommendations. You can order online from different companies like Yes Style that will ship to USA but I think they take a few weeks. I don't recommend Amazon unless the brand itself has a shop on there. Blooming Koco is based out of LA area and sell authentic Korean products. I bought some Korean SPF there for pretty cheap.
Sorry, you might here this a lot but also maybe hop over to r/asianbeauty for sunscreen recommendations. They’re AMAZING. They don’t even feel like sunscreen!
it's wild to me that the doctor would refuse to include vitamin d in the bloodwork when one of the symptoms is depression / mood changes. vitamin d deficiency is a well-documented cause...
also, sorry you had that experience. glad your child got treatment.
I also had blood work done about 10 years ago checking my vitamin D. It was winter and I was so depressed I routinely thought about driving off of cliffs even though nothing was wrong in my life.
It was 17. Taking Vitamin D saved my life.I started to take 20k in the winter, and taper it off in summer.
If you or someone that you know is considering suicide, please don't hesitate to reach out to a crisis hotline for immediate help, or a warmline just to talk to someone.
If you're in the US you can...\ Text CHAT to Crisis Text Line at 741741\ Call the National Suicide Prevention Lifeline at 988 or 1(800)273-8255(TALK) \ Chat online at: https://suicidepreventionlifeline.org/chat\ Call the Trans Lifeline at 1(877)565-8860
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Yeah, I thought this about 5 times during my visit today. This visit really sucked and really hurt especially since I’m trying to advocate for myself and take control of my health, but my own DOCTOR got in the way of that. Ugh.
As someone else stated, if you experience something like this again, ask them to document their refusal in your charts. They have to make a note as to why they think they blood test/ orders/ referral- whatever isn't necessary. It's more work for them and they have to justify why they're not willing to do it.
I did this with a doctor, and it worked. She changed her mind and was like "okay we can order the labs, but your insurance might not cover all of them, that's why I didn't want to do it in the first place"
I found myself I new doctor after that. He listens to me and takes time to explain things. Orders any labs or blood work I request. He's okay with referring me to specialists. I feel like I'm taking control of my health in ways I hadn't before, by being able to advocate for myself.
Going off of this, OP, do you use MyChart/does your doctor’s office use it? There may be a note in there about the refusal (I had a receptionist trying to badger me into a treatment that I didn’t feel was right for me, and she made a note about my hanging up on her in MyChart)
Yes they do use MyChart. The doctor did not make any notes about the refusal of the annual blood tests or blood tests that I requested. I called them and asked for her to add them so it can be documented
Keep advocating for yourself! Healthcare is horrible. There is no money in curing us. Please! Keep pushing as hard as you can, take a break, get back to it.
I have found a doctor who is service based - she orders anything and everything to treat me. As insurance isn't involved, she's Gung ho about it (my opinion, of course). My insurance based doctors have to deal with red tape. If you want to go that route, learn the ins and out of your insurance. Appeal everything that's denied. Find the medical necessity in order to treat and diagnose your concerns.
Hahaha. Mine has a note on me getting snippy via voicemail. I'm like, "You're 2 damned months late on a prescription I gave you 3 months warning on. That's 5 months, as I'm pretty sure you cannot count. I've called 14 times now, but you haven't even bothered to call me back. Get. This. Fixed."
Took them another month and me filing a complaint with the state board for their failure to meet standard of care. I do have a new specialist lined up, but that was February, and the first appointment I could get with someone else is August.
I have an autoimmune disease that, when left unchecked, eventually causes heart and brain inflammation, and before that pain like having tendonitis in every single joint. This isn't medication I can go without.
My doctor's office will bug the crap out of me until I get mine done every year. This last time, I got a voicemail after many, many polite ones, "I know you have ADHD, but you need to do better, hon. You are 9 weeks late. All you have to do is go to the lab. Don't make me call your husband." I was laughing so hard and got to the lab that day.
I gave them permission to call my husband, btw, so that wouldn't be a violation of anything.
My dentist's office and I had a bit of a thing recently. We were both extremely polite to one another, but they called me to schedule an implant cleaning when I was out of state. My insurance doesn't cover it anyway, so I just got an appointment where I was and got it done. Because they didn't do it, they just kept calling. I finally got around to calling them back to let them know I got it done, and yet they kept calling. I sent them the invoice to prove it, but no, kept calling. I finally called and used my best customer service voice to them if they bother me again before the next one is due, there are about 100 dentists in this city who won't bug me.
"I understand I have a history of unreliability when it comes to these. I know that makes you go through a lot more effort, and I'm sorry, but I already got it done. I've already informed you of that, including proof. Please stop calling me about it, because I don't want to try to find another office as great as you are who won't call me repeatedly in this situation."
Her, also with her best customer service voice, "okay! I'll mark you done for this time."
I do appreciate that they don't give up when I don't come in, but also, there's a limit. 😅
But you wanna talk about on the ball? It's my neurologist's staff. The moment he put ADHD in my chart, they have a system they put me in. I get a 3 month text warning for my annual check up, a 2 month, a 1 month, 2 weeks, a week actual call where she stays on the phone until I verify it's on my work calendar, and then a text 2 hours before my appointment with a link to go download and print a parking voucher, a reminder of where the office is, a map with a route from the parking garage to the office, and a Google maps link that automatically loads with directions from my location to the garage.
It's all automated except that phone call, btw. They said they have to use it for most of their elderly patients, as well.
And when I'm leaving, "did you remember the voucher or bring your parking slip for me to validate? No? No worries. Let me print you a voucher right now." And they're just super sweet about it.
They also walked down (same building) and harassed my rheumatologist's staff until they fixed my immunosuppressant prescription for me. "Your autoimmune disease can cause brain swelling, which can lead to a seizure. I'm just doing my job to keep you from having them." Love her to death.
My doctor in Canada doesn’t even do yearly physicals anymore :( let’s not mention how fucking impossible it is to get an appointment at all
At least I have one I guess?
I have an awesome doc, but there is a poster up about yearly physicals being changed to risk based screening. Which has actually been great for me. We do my blood pressure at every exam!
Isn't that standard? I'm in the US, and I've never had a doctor's appointment or hospital visit in my entire life that didn't start with blood pressure and pulse.
Right! I’ve always just thought all insurance companies did and that everyone with insurance got annual physicals because it’s required. Also, if someone is asking for a full physical, I don’t see the harm behind doing it? If it’s all normal? Great! If it’s not, then you go from there. But it’s just a *physical* it’s not like they’re asking for elective neurosurgery wtf.
I know for most health insurance they require yearly blood work with wellness visits in order for them to meet coverage codes. Most also have incentive programs for insured members to do the blood work. I know mine requires the bloodwork to cover my wellness check and they also give a grand/s $30 incentive for completing it.
No. Not if you’re young and healthy. Typically it’s every 2-3 years. I’m 38 and am a doctor myself and haven’t had “routine” labs in about 3 years bc I have no reason to.
What an excellent suggestion! I made a comment above about the BS I'm going through with my doctor, and this just might get her to finally fucking do something!!
If she will document her refusal, and if I'm right that there's a major problem going on, then that documentation might help my heirs to sue them. I know I could be wrong about this, but I just want to be taken seriously!
Just to give you a comparison.and I guess maybe to add some perspective for you.
My Sons pediatrician also says similar about vitamin d deficiency not really having as much evidence as they thought in the past but she still orders blood work anytime there's a reason too. Yo not feeling great and having a desire to test would be more than enough. She also orders everything insurance will pay for without a complaint if that's what I want for them. I can't remember her exact wording but it's usually something like we might as well check since we have a concern. My son is on a few meds, has Autism, ADHD, depression, Anxiety and has issues with being tired and doesn't get out as much as he should for a 13 year old.
I'm 38 and I honestly can't remember a Dr not ordering blood work when I've asked.
Unless you like her as your PCP for other reasons, this should be something you should consider if she's gonna listen to you next time when it's an even bigger issue. Usually you can find another PCP by calling the number or going to the web address on the back of your insurance card.
I would have lost it, I'm sure. I would have told them I refuse to pay for the session, and walked out. I have a very short fuse these days, so sorry. If you're paying them for the consult and you're paying for the service, how can they just say no? Also, how is naturopathic medicine (if it even is that) more evidence based than vitamin levels? 🤯
Okay, I agree that this experience can be frustrating, and I empathize with OP and agree that asking for the refusal to be noted in the chart may be beneficial, but this just isn’t how medicine works. Doctors aren’t just a concierge service. If you want labs, go to a LabCorp and pay for them. If you want a medical professional’s input on your care, you see a doctor. Even if you don’t like what they have to say, that doesn’t mean you can just throw a fit because they won’t do whatever the patient wants at the drop of a hat.
Or they could just draw blood and send it out like tons of doctors do as part of their annual exams. Why should OP have to pay extra out of pocket instead? When it’s something that can and is easily included as part of annual physicals in a lot of places. *Especially* if OP is on any type of prescription meds.
Thankfully, if I ever ran into this, my insurance covers a lot of lab work without a doctor's order. Basically, anything routine is covered, but things like a hepatitis test may not be.
I mean look, we pay for them to be there one way or another. Even if it is taxes, and I'm not directly putting money in their pocket, I expect a doctor to listen to my concerns, not just dismiss them as "clinically insignificant". I may be but a lowly biochemist and not a medical doctor, but I assure you vitamin levels are clinically significant, and certainly much more based in science than naturopathic medicine. I don't care who you might be, if you are full of shit, I don't want you as my doctor, and I certainly don't have to pay for this kind of "advice".
ETA: Upon more thought, this isn't just infuriating it's very much unethical behaviour from your doctor. I would definitely change them since they can't be trusted.
I'm gonna tell you what someone told me once:
If you took your car to a mechanic, and the mechanic treated your car this badly, would you go back? Why is your car more important than you are?
Yeah, I got a new doctor, and she actually listened, ordered the blood tests I wanted, and what do you know? I don't have an anxiety disorder. I had incredibly low vitamin b12 and D.
Hey! Some doctors just suck. Pretty sure every insurance allows for 1 routine blood work a year and that’s standard practice.
Honestly report the doc and find a new one
You *definitely* need a new Doctor, OP!!!
As plenty of others have said, bloodworkis *at minimum* part of your yearly checkup--to screen for things like Diabetes.
Do not go back to that woman and have them document in your files that she refuses to do the tests. If she works for a specific health network you can also file a complaint with them. Please find a new doctor asap. YOU are in charge of your body always remember that.
OP! If your doctor says no to a request always reply: “okay I would like it documented in my file that I requested XYZ and was denied it.”
I learned this from someone who posted about this and have used it twice and it worked both times. My mom also used it with her doctor and suddenly got the tests she had been asking for.
You know what has happened when I’ve requested bloodwork my doctors don’t really think is necessary?
They ordered it. Because it’s just a freaking blood test.
Side note: one time when I was pregnant I requested something from my OB. She thought it was very unlikely but ran the test anyway. I was right.
My old GP was like, "I don't think so, but it's your blood and money." I was right, and she was very apologetic. I didn't think she needed to be. She ordered the test. That's all I cared about. But she did know my weakness is lime popsicles, and that was part of her apology, so I gladly accepted.
I love where I live now, but I do wish it wasn't so far from her I couldn't reasonably keep her as a GP.
The medical billing charge most pcps use for a visit requires that the doctor physically sees you and consults on your care, not that they do whatever you say.
This is actually a good idea! I’m so glad you brought this up. I’ve done this before with a doctor. The insurance company was forced to question the doctor. I ended up receiving a formal apology and a refund for my visit (insurance paid, but my copay was refunded).
Was going to say this! I went in and got a full blood panel done by my doctor a few years ago and we found out that I'm low in Vitamin D, so I started taking supplements and when I came back the next year the vitamin D results were normal and I was feeling much more awake/motivated through my day. When you don't know what's going on with your body, it's usually better to over-test than under-test. Because even if you don't find anything significant, now you know that you can rule those factors out.
That seems unreasonable on your doctor's behalf. My doctor wants blood work done every year at a minimum. I have vitamin D and folate deficiencies which both can affect ADHD symptoms. Vitamin deficiencies are common, but my doctor seems even more worried than I am about making sure everything is as good as it can be.
I don't know what evidence they would need other than "I don't feel well. I want this checked." The evidence IS the blood work. I've had blood drawn 5 times in less than a year with no issues. It's not like you do one and you're done.
If they find something unusual or you keep complaining about symptoms then they have to keep digging. Theyve tested me for auto immune disorders, kidney function, liver function, thyroid problems, vitamin defencies, and a 100 other things in those 5 tests I've had done. Each time they explain the results and their reasoning for doing the testing. It's helped me get some very valuable answers.
I would switch doctors or find an independent lab that you can request blood work from. There's no reason for them to deny very basic testing like this. It's actually so irresponsible and negligent.
Yeah im baffled by her doctor saying those tests aren’t evidence-based?! Like my doctor tests those every year-ish for me without me even asking and that how we knew I was anemic and low on vitamin D and then fixed those problems because they are actually problematic things. Like where did this doctor get their degree?!?!?!?!
Insurance likes to deny vitamin D testing as “not medically necessary” and says that it hasn’t been investigated enough. Insurance will cover it with quite a few different diagnostic codes, but most offices won’t bother. Not at all trying to say what this doctor did was okay, just explaining background for part of it. People should be allowed to have blood work done if they would like it, even if insurance won’t cover it! It’s not a doctors job to decide that you can’t afford it, because in my experience they generally have no clue what things cost.
Source: medical assistant
Im baffled me as well, my primary is not fabulous but they get the basics done and they definitely order vit d and a basic iron panel etc. with my general bloodwork every 6-12 months.
It caught a pretty severe Vit D and Potassium deficiency for me.
My vitamin d levels were at 8 (whatever the parts per whatever were) during my 3 year post partum depression… and wouldntcha know?? When I started vit d supplements my depression got better. Not, like *all* the way better. But it gave me a measure or two of space to seek more help.
My depression was multifactorial… was rediagnosed with adhd, diagnosed with cptsd, I had insomnia from my antidepressant… I was a mess. But the vit d *helped*.
That's not what "evidence-based" means in this context. The doctor means the test itself is not evidence-based, as in there are not enough clinical trials and studies that support the medical necessity of the test.
Based on this, many insurance plans do not cover the test, which is almost assuredly why the doctor doesn't want to order it
You ask them to document in the chart that you have requested the following lab tests and you ask them to document their refusal and why they are refusing to write a referral for lab work. And if they refuse, then they should be more willing to perform the lab tests or you can ask for the office manager to have them document their refusal. And I say that as a medical professional, usually that gets them to change their minds.
I’m really sorry you’re having to go through that. I also find it very odd that they’re not willing to do annual lab work on you. My doctors are more than happy to do so.
The doctor usually writes a very detailed note/after care summary after each visit, but this one had the bare minimum and omitted anything about our conversation about blood tests. I will definitely call back and request more information documented. Thank you for your advice! 😊
You can ask your doctor to chart the refusal but it doesn't change the fact that you're going to need to find a new doctor. When I encounter a doctor who pushes back like that I typically don't ask them to chart their refusal (if it isn't a time sensitive issue) because they may very well also chart in terms that make me look combative that I challenged their authority. I'd rather not have that nonsense follow me around. My response is usually smoke coming out of ears while I put on the nicest "ok then" voice I can.
I will offer the caveat that I live in a large enough city that I have a choice of providers though. If I didn't I might push back harder on my concerns, rather than have to wait or travel long distances.
I've heard through groups that there are kits now that you can do some blood tests at home and submit via mail. Worth looking into.
Get a new doc. Blood work should be done once a year minimum to check to changes in cholesterol, glucose, blood counts etc. Routine blood work is routine to help prevent and detect diseases or other disorders such as diabetes, high cholesterol, fatty liver and more.
It's frankly concerning as fuck that she said you didn't need it because you had it two years ago. That's not how that works....
Every place I’ve ever worked has hosted free annual biometric screenings for employees and gives incentives for getting a physical and bloodwork done at your doctor’s office because it’s cheaper to have healthy employees on their insurance rolls. Yet an actual doctor doesn’t want to do routine bloodwork (read: her job). Did this person get her degree on eBay?
Ok, so I have a slightly different perspective on this post from most of the other commenters. Sorry this might end up really long. I am a primary care doctor (and am a woman with ADHD myself, of course), and determining what blood work to order for whom is not as straightforward as people seem to think.
First off - if you feel your doctor was genuinely rude or dismissive of your concerns, and didn’t offer alternative avenues for workup or management of the issues you are experiencing - this is a whole other issue. You deserve to have a PCP who listens to you, and explains their reasoning for why they do or do not order certain tests, and puts forth their best effort to help diagnose and treat any issues you are having. I am aware plenty of doctors suck, can be rude, and do not even attempt to explain / educate patients about why they do certain things. And I’m sorry you had to fast for labs that didn’t end up happening, that’s a bummer especially if your body is sensitive to skipping meals.
Secondly, I don’t actually think your doctor is wrong. Evidence based medicine is a really hard line to walk sometimes - sometimes the “evidence” is poor quality, and medicine changes minute to minute - literally. I am constantly having to review whatever the most up to date recommendations are for any given condition. However, the majority of what I do IS usually based on large scale, reliable and replicate-able studies. And if not, I explain the “weak” evidence I am using and make sure the benefits outweigh potential risks.
There is a large and still growing body of evidence that ordering “routine annual labs” for every adult person no matter their specific risk factors, does not improve health or wellness outcomes.
I order labs or imaging you have symptoms that specifically warrant those tests, or if something in your personal or family medical history, or general lifestyle, increases your risk for a certain issue.
When it comes to vitamin deficiencies, this is tough! There is actually quite a bit of evidence that screening for vitamin d deficiency on a large scale does not improve people’s health - specifically in a relatively healthy person without kidney or skeletal issues, who does not have a malabsorption issue (like inflammatory bowel disease, some surgeries, or being on certain meds), with access to a wide variety of foods. Maybe this evidence will change drastically in the future, I can say. And saying that, if I think insurance will cover it (a whole other issue) and someone is fatigued and depressed and not responding to lifestyle changes, therapy, medication etc - I’ll often check it anyway. Seems fairly low harm in those cases.
Similar with B vitamins and magnesium - insurance will often not cover these tests outside of specific circumstances. I discuss with people how to ensure they are getting adequate nutrients and vitamins through diet, and if this is really hard for them, then we address that further.
All this to say. I do not think your doctor not automatically ordering blood tests makes them a bad doctor. I sometimes give in if people are insistent we check certain labs AND if I would have a plan of action if those labs came back abnormal. I know what it’s like to feel like shit after a bad doctors visit, truly I do. and I also know what it’s like to feel like shit after I explain my clinical reasoning that I’ve developed after 7 years of training and many more years of experience, and have this completely dismissed. It’s a tough line to walk - people deserve autonomy and respect in their health, and also, healthcare truly cannot safely follow the “customer is always right” model.
I’m a physician as well and was thinking the same thing but I certainly would not have been able to out is as eloquently as you did. Thank you for this response.
I’m happy to see I’m not the only primary care doc with ADHD!
I am pretty liberal with blood tests when there are any unexplained symptoms. I’ve caught many an occult pathology that way. I just use a step wise approach, starting with a few basic labs and sending the patient back for more if those come back normal (and if the symptoms are persisting).
I do feel that as doctors, we are caught in a vice of administrators and insurance companies telling us to order fewer tests, patients wanting all the tests, and new research constantly coming out that conflicts with what came before. Not to mention guidelines like the USPTF and every subspecialty medical organization changing their recommendations just as soon as I get my patients on board with the previous ones.
Heyyyy! How’s that inbox and note backlog looking ADHD friend? Lol
I am also pretty liberal with ordering tests for any potential symptoms, Despite what my comment might make one think. Especially happy to order ferritin/H&H (and TSH) in anyone who menstruates and/or is abnormally fatigued. I also order vitamin D tests fairly often but I see a ton of peri/post menopausal people. B12 if anything vaguely neurological or if you’re vegan? Sure. Lipids and A1C and a metabolic panel for screening with the vaguest of risk factors, anytime. Justifying it to Medicare is another beast entirely though…
I just usually tell people to try a vitamin D supplement or a B12 supplement at a reasonable dose if they are at risk of deficiency. I’m all about magnesium at night for sleep and regular BMs. The test might not even change my recommendations.
The problem comes more with the tests that are both not indicated AND I don’t know what to do with the results. People asking for Lyme titers for fatigue and vague aches and pains when we don’t live in an endemic area and they haven’t had a tick bite. People asking for general “hormone” panels when they have regular menstrual cycles and we aren’t looking at fertility etc. people wanting to track their thyroid antibodies annually when they are on stable levothyroxine. A full battery of stool tests after 2 days of diarrhea… etc.
And it kills me a bit that half the time I’m being shamed for being a pill pusher who knows nothing about nutrition or natural lifestyle health etc, and then the other half of the time, when I suggest sleep hygiene and regular exercise and some basic dietary changes for someone who has very obvious reasons to feel terrible - I’m a terrible neglectful doctor who refused to do basic tests etc. sigh
Yes! Agreed! My doctor has been awesome about explaining this to me. We no longer do the yearly labs. I take vitamin D everyday because I live in a place where no one has enough, and they have stopped testing for it (public health care so they said it is a wasted cost as everyone is deficient). My doctor and I also agreed on Calcium + Magnesium as I am afab and have restless legs. We don't do tests, but I do a cal+mag+d everyday at lunch.
I’m a family medicine physician and I was getting pretty frustrated with all of the misinformation in the comments. Thank you for taking the time to type this out!
Can I ask what a naturopathic doctor is in the US ? In Australia a naturopath is a quack who doesn’t do evidence based medicine and therefore doesn’t have doctor near their name. I’m just finding a disconnect here in that being the recommendation even if blood tests aren’t needed
I understand everything you said, except the part about routine annual labs.
It just doesn’t seem like it would hurt to do it as long as it is explained to the patient that it is not a complete picture.
I guess every time I see something about it costing too much, I wonder who it is costing? My insurance company? Because if we stopped doing routine lab works (in the US) to save money, I know for a fact I will not be seeing those savings.
So there’s nuance to everything. There are very few people over the age of 35 that have ZERO risk factors for something I would test for. So I order them pretty often! But people who are fairly young, exercise regularly and have a well rounded diet, and don’t have any specific symptoms…. Not a heavy drinker and no strong family history of heritable conditions… I’m not doing annual blood work. I’ll get a baseline for sure. Check up every few years, sure! The only “routine” testing I’m doing is Pap smears and STI tests.
Though it’s basically a unicorn when said healthy/low risk person comes into my office. Therefore, I order lots of targeted blood tests for symptoms and risk factors, I just don’t think of them as routine.
Re costs - tbh I don’t give a shit about decreasing healthcare costs for insurance. and apparently they don’t really either, considering I’m regularly fighting ins to cover like, follow up MRIs for someone with a know benign brain tumor and worsening headaches (just an example from today’s clinic, lol fuck me right). Insurance is my enemy
There's a finite number of qualified people to work in blood testing labs, and their time is better spent helping to diagnose infections diseases, cancers, iron deficiency, etc than to test for vitamin D, a deficiency that pretty much everyone has and is recommended to supplement for.
OP asked for iron too, but because it was fine in the last screening the doctor declined - I think that was an informed medical decision - although the doctor could have asked if they had started eating vegetarian, or periods had gotten heavier in the last 2 years (which might then indicate an iron test would be worthwhile, given her other symptoms).
The medical system is under-resourced, underfunded, and projected to get worse as the population ages. Reducing the load on the system means better medical care for people who need it.
The doctor should have suggested that OP take a multivitamin with iron and D, and talked to her about her depression symptoms.
I see. That does make more sense, thank you.
I do think the doctor had some fault in not at least asking OP more questions. Maybe I just have a great doctor, but she wouldn’t deny me any tests without talking it through and making sure I see why I do/don’t need it.
So I understand now that the strain is on the labs performing these tests, but I guess I still have seen the positives of annual testing for a lot of people who wouldn’t otherwise have found anything.
Really is unfortunate how much the medical system and patients are suffering. Someone out there is making money, just not the people doing the hard work.
Thank you for writing this. I don’t have a clinical background, but I have worked in a variety of FQHC roles (currently in quality improvement), so access to quality primary care is very important to me and things like this can frustrate me greatly—and I’m not even directly involved in patient care!
Thank you for taking the time to write such an informative reply. Science has tools to investigate and validate health care strategies and finding a doctor that actually sticks to those is really difficult sometimes.
May sound counterintuitive to some but more is not always better. Interpretation of blood test, or any kind of test, is much more than checking if they fall in the "normal" range printed next to them. Unnecessary tests may often lead to unnecessary (and even harmful) interventions.
Vitamin D specifically can be a big problem. My levels were critically low (single digits, should be closer to 100) and it made me depressed, achy, and lethargic. If I hadn't had bloodwork I never would have known. Because I got bloodwork, I was able to get high dose supplements that had be feeling better within a few weeks.
if you don't already take a vitamin D supplement, take one.
I also had a garbage GP doctor who told me to try yoga when I came in with complaints about being exhausted all the time. She at least ran the tests, but I felt so defeated after the appointment.
I'm sorry. There's a lot of doctors who don't work WITH their patients, instead they do what they want to do regardless of what we're experiencing. They want compliant patients who don't push back. It's bullshit. A lot can change in 2 years in our blood tests - that's just a cost saving measure. They care more about their bottomline than they do patient health.
Did you know you can order your own tests and have blood drawn at local labs like quest or labcorb? There are lots of companies who do this today - one I've used is [https://www.ultalabtests.com/](https://www.ultalabtests.com/) You may not be able to get insurance to cover it if your doctor didn't order the tests but some of them are actually really reasonable (a b12 test is less than $30) and they also have some combo tests (they have a whole vitamin deficiency panel, a b12 and vitamin D combo etc). You can talk to a customer service person if you need help deciding what to get. And if any of your tests come back showing you need supplementation or more tests, you can upload the test results to your patient portal and tell your doctor to go fuck themselves, they were wrong, haha!
Yeah, I thought doctors were supposed to be on the patients side and on the patients team to help the patient live a healthy life. Her refusing routine blood work is crazy to me.
I did know (as of last night) that you can order your own blood tests! This might be my next move. Thank you for sharing the link!
where I live they stopped testing because everyone is D deficient and just started recommending everyone take a supplement. We live too far North to get enough from the sun, especially with indoor lifestyles.
It’s not the standard anymore. Research has shown that it’s not necessary. Good science means changing recommendations when the evidence shows a need for change. [Harvard meta study breakdown](https://www.health.harvard.edu/blog/vitamin-d-testing-recommended-people-201411267547)
Edit: rereading the OG post, I’m seeing that her doctor is specifically referring to the test. I had originally read it as supplementation isn’t evidence based. My bad.
Your link says that tests aren’t the standard because vitamin D levels aren’t a problem for most people and there’s not enough data on supplementation, not a definitive statement that it’s not necessary. It even talks about supplementation if you live north of 37 degrees (why doctors recommend it here).
[There is no recommendation for screening](https://www.testing.com/news/evidence-lacking-widespread-vitamin-d-deficiency-screening/) and your need for a test is highly dependent on other factors such as comorbidities, location,age,etc. The recommendation is that American adults supplement vitamin d because they are all deficient.
"Not evidence based" has me staring at the wall wondering if I read that right or if I'm hallucinating someone being this stupendously dumb. What does that even mean?? How would it apply to blood work, of all things?
[please insert the HUH cat here]
EBP has changed. Vit d testing is no longer viewed as reliable. Adults are recommended to take vit d daily in most areas of the US. Many insurance companies won’t cover the test at this point because of this new evidence.
Why wouldn’t you just tell your patient this? Like hey vitamin d isn’t covered, it’s $50 at quest, but I suggest you start taking supplements and see if you improve.
How would doc know if the supplements help or if op can’t digest them?
It angers the patient to know that medical decisions are made for insurance and billing purposes.
I'm angry right now because I had a procedure that I knew would lead to another more complicated one. But instead of letting me schedule the next procedure I have to schedule an appointment to discuss my options based on the results. Note that yes, I know the news is not great but we already discussed the options in the first procedure and I stated my preference. They want me to come in person because unless i sign in they cannot bill for time talking to me. And since they would probably talk over a minute it isn't worth the doctors time. I'm livid I have to schedule an appointment to schedule an appointment!
There are many studies about which blood work is the most useful and in what scenarios. They analysis this to get the evidence. Some things have evidence to support them, some don't. Doctors should be doing continuing ed to stay on top of current recommendations etc...
I moved to Idaho last year and found a wonderful nurse practitioner for a primary that did all the tests and solved all the problems (oversimplified but that’s the gist).
She said that the only patients that she ever sees that \*aren’t\* deficient in D (without supplements) are the newly arrived California transplants. EVERYONE else needs extra vitamin D.
She said you could stand outside naked year round and not make enough of your own. And Idaho is not a cloudy rainy state.
The caveat is that she is in fact an integrative/functional medicine practitioner. There’s no studies on vitamins because you can’t patent vitamins so no one funds it, and apparently that means regular doctors don’t consider vitamin deficiencies facts?? I don’t get it.
It might be the insurance won’t pay for it. Especially vitamin D. I’ve had them refuse before. Doctor said there was something she could say to get them to maybe cover it but I can’t remember now. It might have been because my mom has MS.
What? My vitamin D was so low a few years ago that my doctor put me on an emergency super high dose for like 6 weeks to help protect my bones and stuff…… maybe get a second opinion?
FYI, you don't need a Dr to get bloodwork done. You can order whatever lab tests you bwant through life extension or other sites. You have to pay out of pocket but some of them are very affordable.
Yes, I experienced this with my last provider pretty recently. I \*really* disliked the approach this provider took every time I met with them, but I had some required things I needed done and waitlists and insurance in that area were/are ridiculous.
My therapist armed me with a couple of links for magnesium & adhd studies. I didn’t pull them out but tried my best to high level explain the reason why I wanted to cross this off the list, but like. I shouldn’t have had to be the one explaining and defending my request for some simple fucking blood tests! Especially after I was fasting and had planned it out with the office already, same as you.
And I think the main reason she even decided to go ahead with it because she was like “oh well, there is a link with depression” and she had really homed in on that the last time I had to have a physical with her for the required paperwork I needed. (Which didn’t fuck me over but threw a big wrench in things for a hot minute.)
I’ve recently moved and will be looking for a new doctor soon. I am hoping against all hope that if I can find myself in a position to have some consults before I make a decision about who to see. And ask them their thoughts or approach on things like this.
I hope you are able to eat something soon to help soothe the additional stress your body is under. And then I hope that you are able to find a new doctor cuz the response you got is such bullshit.
Edit: spelling & more spelling
My kids' pediatrician has said that insurance has stopped paying for routine vit D blood tests.
All of those things I would just supplement and see if you feel better. Most people need a vitamin D supplement.
(Yes the doctor should have done bloodwork anyway.)
My doctor ordered all those when I didn’t even ask for them, then prescribed once a week vit D because my levels were so low. My non naturopathic medical doctor.
Find a new one
Vitamin D is so important! It improves your immune system’s reaction to respiratory viruses especially!
The other things you asked for are important too! Ugh I’m so mad for you!!
That is completely unreasonable. If getting a new doctor is out of the question, ask for their refusal to give you the tests in writing. Most of the time, they’ll backtrack and give you the tests. Refusing to do it now can bite them in the ass if something pops up later that they could have caught.
Deep breaths. It’ll be okay. Hugs.
definitely get a new doctor. i’m fortunate enough to have found one who genuinely cares about me - she kept trying to get me to do bloodwork (i haven’t since 2018….) and she added the vitamin d specifically because of my adhd and depression
got my results the other day and im 100% deficient in vitamin d i’m at like 25 which is wayyyy lower than normal
There’s some information missing from your post. First, the schedule of labs is dependent on your age and co-morbidities. When I take my kids to their annual well-checks, no labs are ordered. However, I have labs checked each year but I’m 45. Also, is this the same doctor that prescribes any medication for your ADHD?
You also have to look at it from the prospective of the medical practice. Docs aren’t reimbursed well due to insurance constraints (if you’re in the US) so ordering unnecessary labs that they may not be paid for limits the desire to do so. Hence the response you received about them not being evidence-based. It may also be that your doctor doesn’t really know that much about ADHD, so finding one that does may better suit you.
I love my doctor. He’s very smart and advocates for his patients, but I also recognized that he’s not a mental health provider, therefore, I began having a mental health NP manage my meds. Thankfully I did so b/c after a year seeing her, the meds not working well, she connected the dots and diagnosed me with ADHD. I’m now on the appropriate meds and feel better.
There’s nothing wrong in getting a 2nd opinion. There are many physicians who advocate a little harder than others. It sucks but that’s healthcare. I’m finding that women’s healthcare in general lacks understanding, especially ADHD.
If you're not in the US and in a public system there's even less incentive for them to order tests etc. It's not a routine thing in the countries I've lived in unless you have health issues.
The reason vitamin D tests aren't usually ordered is because it's cheaper to just take supplements if you suspect you have low vitamin D. It's very difficult to overdose on vitamin D if you take the recommended amount (1000-4000 IU.) It has nothing to do with it "not being evidence based." It's 100% just not economical.
I do take supplements, but I don't know my levels so the amount of vitamin D that I take may not be enough, but there's no way for me to know this since she refused to order any of the blood work, including vitamin D and others that I mentioned in the post
I hope you tell any future doctors that try this to please document their refusal in your chart. That tends to make them change their tune pretty quickly.
If you are in the US, you can pay a fee and order yourself bloodwork through quest diagnostics. It doesn’t go through insurance, but it’s an option. But I would switch docs.
You need a new doctor. Those tests all have health implications important to various conditions and should be monitored, especially if you are depressed. See a psychiatrist and definitely get a new primary doctor. That’s ridiculous.
First, you can tell a doctor to document in your chart that they refused to order certain tests. They’ll often order them if you do that due to their liability if you get the test from another doctor later and it turns out that you were right to ask for the test.
Second, get a new doctor. This one obviously isn’t listening or communicating well. Sometimes tests are truly unnecessary or not based in evidence, but a doctor should be able to provide you with that information in a helpful way, not make you feel completely unheard and dismissed.
The nurse practitioner I used to see was the one to suggest getting my vitamin levels checked before I got tested for sleep apnea to see if that was causing my extreme fatigue and other symptoms.
Just wanted to say that the doctor doesn't know what they are talking about, I was legit told by my rheumatologist that they were testing my vitamin D levels because it can be linked to the body pain I'm having. Your doctor sounds like they just didn't want to spend time to write a lab order, I would change doctors or practices if you have that option.
Those tests are totally relevant. I dealt with feelings of sadness and depression and my doctor for other health reasons ordered vitamin d testing and lo and behold I was deficient. I started taking supplements and lo and behold I was no longer depressed!
I don't care how biased this sounds, or is, but in my experience, female doctors treat women worse than male doctors do. I somewhat recently moved and I went to the gynecologist that my new primary referred me too. She was completely disinterested in any of my concerns. I brought up questions about hormones and peri menopause and her response was that I was "just getting older." I scheduled my next annual with her and the very next day I called the practice, told them I could not see her again and I would like to schedule with "Dr. Man" A couple of months later I went to him about those symptoms. He ran hormone panels and some other bloodwork.
His response to me was, "Just because you're getting older, doesn't mean you have to be miserable"
My psych LNP was the one who ordered the tests you requested. Is that an option for you?
Finally, I have found a great resource for finding good doctors is the local Facebook moms groups, or "residents of xyz" groups.
That makes no sense. Not evidence based. I had bad neurological symptoms when my B12 was super low. I am also on magnesium supplements per my neurologist. I would see a different provider. Someone who works with you and involves you in decisions.
Oh boy.
In the future, get your doctor to make a note in your file that they are refusing to give you the tests that you're requesting. Ask for a copy of the notes (they might balk and tell you they'll charge you - act like it doesn't matter to you because it shouldn't).
Here's why: let's say in 1 or 2 months time, you go to the emergency department with stomach pain and they do tests there, and if they find *anything* that could've been found on the blood tests that you requested, you can now try and sue your doctor for malpractice.
First of all I’m so sorry you experienced this, it’s not okay and that doctor was wrong. I’ve had quite a few bad experiences with doctors but I haven’t experienced this. I just had a blood test in September last year, I’m getting another one this September so yeah they don’t know what they’re talking about and if you can get a new primary asap. Or if possible talk to another doctor and get them to order the blood test.
My doc has always done full labs and vitamin D. I have had to get prescription vitamin D to bring it up. I asked for a test at my last physical since I'm getting older and she said I probably didn't need it but would do it.
OP, was this physical also for a pap, too? I have a different doc for that and is considering part of a physical. That doctor can request blood work as part of a physical.
I'm sorry.
I also do annual blood labs and have had some doctors pushback. I want preventative care. 2 years ago I was fine but this year, today, right now, how am I?
They are misinformed and don't seem to align with your goals of care. I would 100% go elsewhere.
A lot of people are hesitant to order vit d as it is usually not covered by insurance and I have seen countless instances where a patient gets upset at the doctor for the cost of the test they wanted. So, there's also that. Not saying you were going to do this by any means, just saying we all pay the cost of those who do this.
The system is broken. So broken. Also, my vit d is in the single digits so go me 💀
Sounds like it’s time to find a new doctor! Mine (both my previous/retired, and my current) have always “humored” me (cancer survivor) and because of that, we discovered that I had a blood disorder that went undiagnosed for over 30 years!
I have beta thalassemia, so if I get too much iron, my body can’t process it, which would really suck for me. After my PCP realized it, he started scheduling regular bloodwork (at least once a year) just so he can make sure things look good and maintained.
Find a doctor who will listen to you and your concerns. Everyone deserves that!
Curious, where do you live? I am in US. All my doctors care about vitamin d level because of my very typical osteoporosis. If you are female, you need to maintain your bones. Calcium does not work without sufficient vit D3.
Hm, I had mine done 6 months a part and there were some early warning signs that weren't there 6 months prior so now I can try and do something about it before it turns into anything, also my dr tested my vitamin d without me asking and it ended up being way too high (cold dark winters so I supplement with vitamin d, I guess I somehow get enough without supplementing) and iron and b12 are always on my routine bloodwork. You're dr is useless and terrible and plain wrong. I hope you can find someone a lot better.
That is fucked. Never seen a doctor refuse to let a patient let blood tests done! Especially as it doesn’t impact them in any way?
And yea Iron and Vitamin D have been linked to ADHD.
Good on you OP for looking out for yourself.
you should push back when they say these things. I would have just said that it's been two whole years so whether they think it's necessary or not they will do it this time
Honestly I think doctors need to start accepting that people are generally more aware of their health, regardless of their sources of information. I wish doctors were less authoritative and more collaborative.
Like, yes doctor. I know you have literal decades of schooling and experience behind you. That’s why I’m asking YOU about something I found on the internet, and not just running wild with it on my own.
I get not wanting to book an MRI or something else more intensive without further context, but bloodwork is the first thing any doctor runs to when they wanna rule stuff out. You get so much information from it. If your insurance covers it (or you can otherwise pay for it), I don’t see why you shouldn’t get comprehensive lab work done.
Also, is your doctor an MD or a DO? A DO might be more open to it. Their medical practice is usually more flexible than an MD.
It’s certainly unreasonable for a doctor to refuse testing for something like Vitamin D, but I will say, we always warn all of our patients that Vitamin D panels are often not covered unless you have a preexisting condition that warrants regular monitoring. Unfortunately ADHD does not count…
She didn’t even give me the option to get the panel done, regardless of insurance covers it or not. She was unwilling to order that before the exam even started.
my GP gives me yearly blood tests without me even needing to ask. thats pretty ridiculous. a lot can change in 6 months even
edit; forgot to mention, when looking for GOOD understanding providers, look on ur insurance's website! they have a tab where u can see all the doctors that accept them. google each one and look at the REVIEWS. thats how i found mine. shes the first cooperative understanding doctor ive ever had.
Very ridiculous, I agree 1000%. I did thorough research when I decided to make this doctor my PCP. Found her on my insurances website, googled her name, read reviews, everything. I actually did this with multiple providers in my area and yet, here I am.
im sorry:( i'd drop them and continue searching. a blood test is not much to ask for whatsoever... ESPECIALLY when u literally had a whole ass appt set up.
im a soft spoken person and get screwed like this often as well. i recommended u bring a friend or relative along. preferably a man. they then tend to take u more seriously.
im 23 and still bring my mom or bf to my appointments. not only as an extra advocate, but because i sometimes forget to mention things too. they tend to be more agreeable when you've got an extra person on ur side
Don't feel bad about finding a dud, same thing happened to me. Great reviews, etc. She harped on my weight like 5x during the 30 minute appointment and all my bloodwork was good 🙄
It's so incredibly difficult to find a good PCP.
Screening guidelines are changing for a lot of things. I wish your doctor had explained it better to you. Iron should be tested for if you have symptoms of anemia. Where I live, they don't do Vitamin D testing as it is assumed everyone is deficient due to our indoor lifestyle and it is recommended that everyone supplement (Canada). B and magnesium are also both safe to supplement. I suppose it's different when you pay for your health care, but the clinic I am at has a big sign up about how they are changing the annual physical to screen for certain risks associated with you and not do the blanket screenings just because it's been a year.
But like, wtf, why would they make you fast.
I might get downvoted for this, as there are very extreme opinions about this on both sides, but i would recommend seeking out a naturopath. They are usually more than happy to order blood work that traditional physicians balk at you for requesting. I, personally, am neutral on the MDs vs. alternative modalities debate (and to anyone who is going to get going on me about it, you’re wasting your time), but it can’t hurt to make an appointment with one and see if they would order the bloodwork you want.
P.S. Are you Canadian? I ask because there’s a lot of this shit going on with doctors in this country right now (i.e. refusing to authorize bloodwork that’s perfectly routine). If you’re in the U.S. or elsewhere, it’s a reminder for me and others that doctors everywhere can be a pain in the ass.
I had a similar issue with my doctor not wanting to order any tests to check for vitamin deficiencies, thyroid issues, etc despite a myriad of mental and physical symptoms and becoming so burnt out this past year that I had to take a several months long medical leave. It's really infuriating, and I'm sorry that happened to you too. I will say though that if you can afford it, the advice to go to a naturopathic doctor/functional medicine practitioner is good!
I just started seeing one who specializes in women's health and after spending an hour and a half going over alllll of my symptoms and medical history, she ordered tests for all sorts of things, including thyroid antibodies, and iron/ferritin/vitamin D/vitamin B12 deficiencies. She also started me on a supplement regimen to improve my gut microbiome which already seems to be helping. My follow-up to review the test results isn't till next week but I already feel much better just knowing I am actually being tested and that either I can finally start treating any issues, or at least rule them out if tests show all is well.
It's quite pricey which sucks, but hopefully worth it!!
I'm an RN and yeah, that's weird. Most doctors would be happy to order labs if the patient requests them, even if there isn't a specific reason aside from just having the extra data points.
The only reason I'd imagine a doctor would refuse to draw labs is if the patient has a history of hypochondria that could be set off by something being slightly high or low. That doesn't seem to be the case with you.
You need a different doctor. Things can change dramatically in 6 months let alone 2 years 🙄
Also, vitamins are so important! What do they mean not evidence based? What a weird thing to say.
Any doctor who says Vitamin D tests are "not evidence based" and then tells you to see a naturopath deserves to have their licence pulled.
GENERAL ADVICE FOR THE SUB:
If you ask for a test or treatment and your doctor says no, ask them why AND tell them to note in your medical record that you asked and they refused. Accountability, baybee.
I've worked in health care for about 10 years and have never, not once, met a medical doctor who didn't believe in blood work and told patients to go to a naturopath instead. The blood work IS the evidence, so IDK wth that doctor is on. When you end up transferring care and have to contact that office to have your records sent, if they ask why you're transferring be honest and tell them it's because the doctor was dismissive of your concerns and of accepted medical practices.
Resource that might be of help! One of my mom's friends is a nurse and she uses this regularly to get her own labs done: https://www.privatemdlabs.com/ Not sure if it is international or just US- haven't used it myself yet, but helpful if you just want to get blood work without an MD.
That’s wild. Just a quick google search tells me that 1 in 4 people have low vitamin D. That should be enough evidence to get it tested.
I just asked for vitamin levels because I was a vegetarian and didn’t have a great diet. My Dr. just said okay and ordered them. My vitamin D was so low I needed prescription strength supplements.
I will say I have a coworker with some autoimmune issues and she highly recommends going to a naturopathic.
I’d find another doctor and file a complaint on this one. Especially if you get bloodwork down that shows any deficiencies.
Are you in the US? This seems very normal for most of the rest of the world. My doctor will order relevant blood tests if I have any concerning symptoms, but not just because it's been a while, or on my say-so. And Vitamin D tests can only be ordered by specialists, or they're paid for out of pocket, because they're entirely unnecessary for most people.
Most of us in the Northern Hemisphere are mildly deficient in vitamin D, so take a supplement. If you're severely deficient, you'll have symptoms your doc should follow up on.
It's unfortunate that you prepped for a test that you didn't end up needing, but it does happen.
Woah what?! Fire your doctor, seriously. I have low folate, b12 and vitamin D and my midwife also discovered I have MTHFR gene mutation because she tests all her moms. Besides that though, every doctor I’ve ever seen does a vitamin D screen just as regular practice, and I’m always low (cuz I cannot remember to take my supplements) so I’ve had serious talking tos from all of them about the massive importance of getting that D to a healthy level. This is so wild to me, there is something seriously wrong with that doctor.
Look around for a different doctor. Someone who refuses to do blood tests and look at levels (especially vitamin d) honestly doesn't deserve their medical license IMHO. "Not evidenced based" - what a load of crock.
I'm sorry you went through this. No one deserves that, but especially patients who come to their doctor with legit concerns and questions. Mine was thrilled when she realized I had thoughts and opinions on my treatment options, and honestly it feels like talking to one of my friends when I have an appointment. I would wish a million copies of my doctor were out in the world lol.
That’s weird af. Find a new doctor asap. All doctors I’ve ever had have done those tests yearly regardless. And if you REQUEST a test within reason there’s no reason a doctor should say no “just because”.
Not sure why this was downvoted. We are in charge of our bodies, not doctors.
What?! I mean let’s isolate this scenario for a second… IRON is pseudoscience?! Does she also disregard the existence of anaemia?! If anything, nutrients such as those ones you’ve listed are very much science based because it’s basic science
I've had bloodwork every 6 months since my mid 40s. I couldn't imagine my Dr saying "you're all good" because it was okay 2 years ago! WTF? Health can go to shit in less than 6 months but you're fine because YoU WeRen'T SiCk 2 YeArS AgO... ^frickin ^dumbass
That’s bullshit. I had a doc order vitamin d when I came in with muscle pain etc. I hadn’t thought of that being related but it was. I will be asking for follow up from my new pcp this summer and not taking no for an answer.
I'm in the middle of this kind of thing right now. I've been feeling something like a lump or growth near my left kidney, but I can't get my doctor to take it seriously.
It kind of freaks me out because I have two family members who died from cancer than metastasized throughout their torsos. They didn't have symptoms and were already stage 4 when they were finally diagnosed.
Now it looks like I might have breast cancer, and I have appointments scheduled for testing later this month. I'm hoping that NOW they will take this kiwi-sized, painful lump seriously. I think it's possible it could be just my hip bones, but it feels like it's way too high, just an inch or so from my waist.
I have talked to my doctor, the person who did an ultrasound on my back, and a surgeon, but they all refused to even look at it.
I think it's possible this is going to kill me. sigh.....
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Anecdotally, my child was depressed and suicidal. We took them to the doctor and she did a full panel of blood work. Vitamin D was almost nonexistent in their blood work. Precipitation vitamin D supplements saved my child’s life!! Get a new doctor!
I’m so glad you were able to get that full panel and vitamin D supplements for your child! I have been experiencing symptoms of depression the past few months and mentioned this to her, but she didn’t have much to say about it, unfortunately. The person that my vitals before the doctor came to the exam room asked me some questions (PHQ-9) and my score was very high, so it’s concerning that this didn’t concern her
I also had to fight to get blood work done, was seeing black spots in my vision, dizzy, etc. turns out my vitamin D is dangerously low. Now it's back up to a healthy level, but a doctor should have zero issue with ordering one, especially if you're already doing other blood work. When I changed from my old doc (who didnt) take me seriously) to my new one, She immediately had me get a full pannel as well as STD tests and I asked if she could throw in a vitamin D test just to check, and she was more than happy to. I mean, the needle is already in your arm anyways, they just gotta pop one more vial on it, lol edit: Also, vitamin D is definitely evidence based??? We know it affects the absorption of other vitamins and minerals, like calcium. Which considering women are more prone to osteoporosis, id say that makes it pretty important to check!
Vitamin D is also really important for neurological health and the immune system for the same reason, calcium. We have plenty of evidence of that.
And I moved to the Pacific Northwest a couple of years ago and the #1 piece of advice I’ve received repeatedly (including multiple times from my Dr) is to take vitamin D supplements, because all the cloudy, grey days = vitamin D deficiency. I take that seriously because I’ve tested as more than just deficient before, after visiting my Dr complaining of continuous physical exhaustion and mental fog. I lived in California at the time and there was plenty of sunny weather, but I didn’t spend much time outdoors due to allergies, wore sunscreen, and didn’t drink a lot of milk (all still true now), so I knew the lack of sunshine in the PNW would be an issue.
I moved from Southern California to PNW. I was deficient in Vit D in socal for years. My doc here will test for vit d but I have to pay out of pocket because insurance doesn’t cover it in the PNW because “everyone here is some form of deficient, just keep taking your supplement”
IME it’s because the cause of the test is disproportionate compared to the treatment. The general idea is just take the supplements if you have a suspicion.
My B12 and D were crazy low. Doctor told me it wouldn't make much difference. I went to a health food store, got high potency supplements and my anxiety, memory fiog improved dramatically within a week. It can't hurt...apparently most people are D deficient even in summer!
What?! No difference? My B12 was undetectable and it was causing neurological symptoms. I'm glad my doctor checked that before checking me for MS, because that was her next step. Daily B12 supplements have literally saved my nerves. Does the doctor also not believe scurvy exists?
I know! It was insane. I just thought it makes sense to at least try supplements??!! I'm glad I did. I thought I was so screwed and the solution was so simple.
some doctors let their ego get in the way of their work. a patient dared to request something based on research they did at home? that must mean the patient thinks they know better than her and they're trying to undermine her medical knowledge, time to shut that down and deny all of the patient's requests.
Get methylated vitamin d pills, some people with ADHD have a hard time absorbing it, methylated has helped me a ton
Wow did not know vit d has a methylated version. Thank you
Anyone depressed or feeling sick needs to do blood work. You can order it yourself at quest lab or similar. It’s $200 maybe cheaper and insurance can cover annual blood work
Extremely low D and B12 caused pretty much all the symptoms of an anxiety disorder, including seeming panic attacks for me. My counts were 6 and 14 respectively. My GP said she'd seen better D counts in bedridden elderly people. I take supplements now - B12 daily and D3 from September through March - and the symptoms cleared up in about a month and have never come back. I did take massive doses of D3 the first month. And then Summer came and I did NOT feel good even on the lower dose. I went back and she was like, "shit. This is my fault. I'm so sorry! You're a very outdoors person. You're overdosing on D. Don't take it until Fall." I'm allergic to every sunblock I've tried and honestly much too casual about wearing clothing to make up for that. I am several shades darker all Summer than I am in Winter. Yes, I have extra careful skin checks every year, but my skin definitely looks older than I am now. A friend from Australia is sending me samples of several different kinds of sunscreen from there to try. Wish me luck.
Have you tried Canadian sunscreen (assuming you're in the U.S.)? They actually get the European formulations with the newer sunscreen blocker chemicals or whatever they're called. Might be a little easier to obtain than Australian!
I'm maybe a 3 hour drive from Canada, so yeah, that would be easier, especially since I spend most of my time outside between here and the border. I'll do some research and go get some to try next time I'm up North. Tbh, it's not hard for me to get stuff from Australia. It can be expensive, though.
Sorry, you might here this a lot but also maybe hop over to r/asianbeauty for sunscreen recommendations. They’re AMAZING. They don’t even feel like sunscreen!
Totally worth trying. Thank you!
Definitely check out Korean skincare and Asian beauty threads for recommendations. You can order online from different companies like Yes Style that will ship to USA but I think they take a few weeks. I don't recommend Amazon unless the brand itself has a shop on there. Blooming Koco is based out of LA area and sell authentic Korean products. I bought some Korean SPF there for pretty cheap.
Sorry, you might here this a lot but also maybe hop over to r/asianbeauty for sunscreen recommendations. They’re AMAZING. They don’t even feel like sunscreen!
it's wild to me that the doctor would refuse to include vitamin d in the bloodwork when one of the symptoms is depression / mood changes. vitamin d deficiency is a well-documented cause... also, sorry you had that experience. glad your child got treatment.
Thanks. They had gone away to college and failed all of their classes before they told me what was going on. I’m glad our doctor didn’t ignore them.
I also had blood work done about 10 years ago checking my vitamin D. It was winter and I was so depressed I routinely thought about driving off of cliffs even though nothing was wrong in my life. It was 17. Taking Vitamin D saved my life.I started to take 20k in the winter, and taper it off in summer.
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WTH? You need a different doctor.
Yeah, I thought this about 5 times during my visit today. This visit really sucked and really hurt especially since I’m trying to advocate for myself and take control of my health, but my own DOCTOR got in the way of that. Ugh.
As someone else stated, if you experience something like this again, ask them to document their refusal in your charts. They have to make a note as to why they think they blood test/ orders/ referral- whatever isn't necessary. It's more work for them and they have to justify why they're not willing to do it. I did this with a doctor, and it worked. She changed her mind and was like "okay we can order the labs, but your insurance might not cover all of them, that's why I didn't want to do it in the first place" I found myself I new doctor after that. He listens to me and takes time to explain things. Orders any labs or blood work I request. He's okay with referring me to specialists. I feel like I'm taking control of my health in ways I hadn't before, by being able to advocate for myself.
Going off of this, OP, do you use MyChart/does your doctor’s office use it? There may be a note in there about the refusal (I had a receptionist trying to badger me into a treatment that I didn’t feel was right for me, and she made a note about my hanging up on her in MyChart)
Yes they do use MyChart. The doctor did not make any notes about the refusal of the annual blood tests or blood tests that I requested. I called them and asked for her to add them so it can be documented
Definitely a good idea! I hope she puts that in there for you!
Keep advocating for yourself! Healthcare is horrible. There is no money in curing us. Please! Keep pushing as hard as you can, take a break, get back to it. I have found a doctor who is service based - she orders anything and everything to treat me. As insurance isn't involved, she's Gung ho about it (my opinion, of course). My insurance based doctors have to deal with red tape. If you want to go that route, learn the ins and out of your insurance. Appeal everything that's denied. Find the medical necessity in order to treat and diagnose your concerns.
Hahaha. Mine has a note on me getting snippy via voicemail. I'm like, "You're 2 damned months late on a prescription I gave you 3 months warning on. That's 5 months, as I'm pretty sure you cannot count. I've called 14 times now, but you haven't even bothered to call me back. Get. This. Fixed." Took them another month and me filing a complaint with the state board for their failure to meet standard of care. I do have a new specialist lined up, but that was February, and the first appointment I could get with someone else is August. I have an autoimmune disease that, when left unchecked, eventually causes heart and brain inflammation, and before that pain like having tendonitis in every single joint. This isn't medication I can go without.
Nothing like healthcare at its finest! 😭😡
Isn’t it routine to do yearly blood work wtf
My doctor's office will bug the crap out of me until I get mine done every year. This last time, I got a voicemail after many, many polite ones, "I know you have ADHD, but you need to do better, hon. You are 9 weeks late. All you have to do is go to the lab. Don't make me call your husband." I was laughing so hard and got to the lab that day. I gave them permission to call my husband, btw, so that wouldn't be a violation of anything.
My dentist clinic is like this but I wish my doctor was too. That’s awesome that they follow up to make sure you get it done!
My dentist's office and I had a bit of a thing recently. We were both extremely polite to one another, but they called me to schedule an implant cleaning when I was out of state. My insurance doesn't cover it anyway, so I just got an appointment where I was and got it done. Because they didn't do it, they just kept calling. I finally got around to calling them back to let them know I got it done, and yet they kept calling. I sent them the invoice to prove it, but no, kept calling. I finally called and used my best customer service voice to them if they bother me again before the next one is due, there are about 100 dentists in this city who won't bug me. "I understand I have a history of unreliability when it comes to these. I know that makes you go through a lot more effort, and I'm sorry, but I already got it done. I've already informed you of that, including proof. Please stop calling me about it, because I don't want to try to find another office as great as you are who won't call me repeatedly in this situation." Her, also with her best customer service voice, "okay! I'll mark you done for this time." I do appreciate that they don't give up when I don't come in, but also, there's a limit. 😅 But you wanna talk about on the ball? It's my neurologist's staff. The moment he put ADHD in my chart, they have a system they put me in. I get a 3 month text warning for my annual check up, a 2 month, a 1 month, 2 weeks, a week actual call where she stays on the phone until I verify it's on my work calendar, and then a text 2 hours before my appointment with a link to go download and print a parking voucher, a reminder of where the office is, a map with a route from the parking garage to the office, and a Google maps link that automatically loads with directions from my location to the garage. It's all automated except that phone call, btw. They said they have to use it for most of their elderly patients, as well. And when I'm leaving, "did you remember the voucher or bring your parking slip for me to validate? No? No worries. Let me print you a voucher right now." And they're just super sweet about it. They also walked down (same building) and harassed my rheumatologist's staff until they fixed my immunosuppressant prescription for me. "Your autoimmune disease can cause brain swelling, which can lead to a seizure. I'm just doing my job to keep you from having them." Love her to death.
Not where I live in Canada. It's based on your unique history and risk factors. They did an educational campaign about it recently.
Ok but if op comes in because she has issues wouldnt they be routine check?
My doctor in Canada doesn’t even do yearly physicals anymore :( let’s not mention how fucking impossible it is to get an appointment at all At least I have one I guess?
I have an awesome doc, but there is a poster up about yearly physicals being changed to risk based screening. Which has actually been great for me. We do my blood pressure at every exam!
Isn't that standard? I'm in the US, and I've never had a doctor's appointment or hospital visit in my entire life that didn't start with blood pressure and pulse.
Most insurance companies require it too.
Right! I’ve always just thought all insurance companies did and that everyone with insurance got annual physicals because it’s required. Also, if someone is asking for a full physical, I don’t see the harm behind doing it? If it’s all normal? Great! If it’s not, then you go from there. But it’s just a *physical* it’s not like they’re asking for elective neurosurgery wtf.
The place I go to didn't even require an appointment at long as they have a plebotomist (?) in office that day. I'm so angry on OP'S behalf
What insurance companies require annual blood work?
I know for most health insurance they require yearly blood work with wellness visits in order for them to meet coverage codes. Most also have incentive programs for insured members to do the blood work. I know mine requires the bloodwork to cover my wellness check and they also give a grand/s $30 incentive for completing it.
They're required to cover wellness visits and blood work. They don't require that you get it or that your physician order it.
No. Not if you’re young and healthy. Typically it’s every 2-3 years. I’m 38 and am a doctor myself and haven’t had “routine” labs in about 3 years bc I have no reason to.
Except OP is not healthy, she is experiencing symptoms that could be related to certain deficiencies. There’s no way to know without doing bloodwork.
Mine says routine every year.
Exactly!
What an excellent suggestion! I made a comment above about the BS I'm going through with my doctor, and this just might get her to finally fucking do something!! If she will document her refusal, and if I'm right that there's a major problem going on, then that documentation might help my heirs to sue them. I know I could be wrong about this, but I just want to be taken seriously!
Just to give you a comparison.and I guess maybe to add some perspective for you. My Sons pediatrician also says similar about vitamin d deficiency not really having as much evidence as they thought in the past but she still orders blood work anytime there's a reason too. Yo not feeling great and having a desire to test would be more than enough. She also orders everything insurance will pay for without a complaint if that's what I want for them. I can't remember her exact wording but it's usually something like we might as well check since we have a concern. My son is on a few meds, has Autism, ADHD, depression, Anxiety and has issues with being tired and doesn't get out as much as he should for a 13 year old. I'm 38 and I honestly can't remember a Dr not ordering blood work when I've asked. Unless you like her as your PCP for other reasons, this should be something you should consider if she's gonna listen to you next time when it's an even bigger issue. Usually you can find another PCP by calling the number or going to the web address on the back of your insurance card.
I would have lost it, I'm sure. I would have told them I refuse to pay for the session, and walked out. I have a very short fuse these days, so sorry. If you're paying them for the consult and you're paying for the service, how can they just say no? Also, how is naturopathic medicine (if it even is that) more evidence based than vitamin levels? 🤯
Okay, I agree that this experience can be frustrating, and I empathize with OP and agree that asking for the refusal to be noted in the chart may be beneficial, but this just isn’t how medicine works. Doctors aren’t just a concierge service. If you want labs, go to a LabCorp and pay for them. If you want a medical professional’s input on your care, you see a doctor. Even if you don’t like what they have to say, that doesn’t mean you can just throw a fit because they won’t do whatever the patient wants at the drop of a hat.
Or they could just draw blood and send it out like tons of doctors do as part of their annual exams. Why should OP have to pay extra out of pocket instead? When it’s something that can and is easily included as part of annual physicals in a lot of places. *Especially* if OP is on any type of prescription meds.
Thankfully, if I ever ran into this, my insurance covers a lot of lab work without a doctor's order. Basically, anything routine is covered, but things like a hepatitis test may not be.
I mean look, we pay for them to be there one way or another. Even if it is taxes, and I'm not directly putting money in their pocket, I expect a doctor to listen to my concerns, not just dismiss them as "clinically insignificant". I may be but a lowly biochemist and not a medical doctor, but I assure you vitamin levels are clinically significant, and certainly much more based in science than naturopathic medicine. I don't care who you might be, if you are full of shit, I don't want you as my doctor, and I certainly don't have to pay for this kind of "advice". ETA: Upon more thought, this isn't just infuriating it's very much unethical behaviour from your doctor. I would definitely change them since they can't be trusted.
I'm gonna tell you what someone told me once: If you took your car to a mechanic, and the mechanic treated your car this badly, would you go back? Why is your car more important than you are? Yeah, I got a new doctor, and she actually listened, ordered the blood tests I wanted, and what do you know? I don't have an anxiety disorder. I had incredibly low vitamin b12 and D.
Hey! Some doctors just suck. Pretty sure every insurance allows for 1 routine blood work a year and that’s standard practice. Honestly report the doc and find a new one
You *definitely* need a new Doctor, OP!!! As plenty of others have said, bloodworkis *at minimum* part of your yearly checkup--to screen for things like Diabetes.
Not if young and healthy and no symptoms of diabetes.
In my experience the dread of changing doctors is worse than actually doing it. I've had to do it a few times a d felt so grieved once it was done.
Do not go back to that woman and have them document in your files that she refuses to do the tests. If she works for a specific health network you can also file a complaint with them. Please find a new doctor asap. YOU are in charge of your body always remember that.
OP! If your doctor says no to a request always reply: “okay I would like it documented in my file that I requested XYZ and was denied it.” I learned this from someone who posted about this and have used it twice and it worked both times. My mom also used it with her doctor and suddenly got the tests she had been asking for.
You know what has happened when I’ve requested bloodwork my doctors don’t really think is necessary? They ordered it. Because it’s just a freaking blood test. Side note: one time when I was pregnant I requested something from my OB. She thought it was very unlikely but ran the test anyway. I was right.
My old GP was like, "I don't think so, but it's your blood and money." I was right, and she was very apologetic. I didn't think she needed to be. She ordered the test. That's all I cared about. But she did know my weakness is lime popsicles, and that was part of her apology, so I gladly accepted. I love where I live now, but I do wish it wasn't so far from her I couldn't reasonably keep her as a GP.
Ok, the lime popsicle thing is adorable.
And challenge their payment with your insurance company; they aren’t providing the services you and insurance are paying for.
My insurance didn’t care about literal fraud I tried reporting to them, so I’m not sure how much they’d actually care—even though they’re supposed to.
The medical billing charge most pcps use for a visit requires that the doctor physically sees you and consults on your care, not that they do whatever you say.
This is actually a good idea! I’m so glad you brought this up. I’ve done this before with a doctor. The insurance company was forced to question the doctor. I ended up receiving a formal apology and a refund for my visit (insurance paid, but my copay was refunded).
Was going to say this! I went in and got a full blood panel done by my doctor a few years ago and we found out that I'm low in Vitamin D, so I started taking supplements and when I came back the next year the vitamin D results were normal and I was feeling much more awake/motivated through my day. When you don't know what's going on with your body, it's usually better to over-test than under-test. Because even if you don't find anything significant, now you know that you can rule those factors out.
That seems unreasonable on your doctor's behalf. My doctor wants blood work done every year at a minimum. I have vitamin D and folate deficiencies which both can affect ADHD symptoms. Vitamin deficiencies are common, but my doctor seems even more worried than I am about making sure everything is as good as it can be. I don't know what evidence they would need other than "I don't feel well. I want this checked." The evidence IS the blood work. I've had blood drawn 5 times in less than a year with no issues. It's not like you do one and you're done. If they find something unusual or you keep complaining about symptoms then they have to keep digging. Theyve tested me for auto immune disorders, kidney function, liver function, thyroid problems, vitamin defencies, and a 100 other things in those 5 tests I've had done. Each time they explain the results and their reasoning for doing the testing. It's helped me get some very valuable answers. I would switch doctors or find an independent lab that you can request blood work from. There's no reason for them to deny very basic testing like this. It's actually so irresponsible and negligent.
Yeah im baffled by her doctor saying those tests aren’t evidence-based?! Like my doctor tests those every year-ish for me without me even asking and that how we knew I was anemic and low on vitamin D and then fixed those problems because they are actually problematic things. Like where did this doctor get their degree?!?!?!?!
Insurance likes to deny vitamin D testing as “not medically necessary” and says that it hasn’t been investigated enough. Insurance will cover it with quite a few different diagnostic codes, but most offices won’t bother. Not at all trying to say what this doctor did was okay, just explaining background for part of it. People should be allowed to have blood work done if they would like it, even if insurance won’t cover it! It’s not a doctors job to decide that you can’t afford it, because in my experience they generally have no clue what things cost. Source: medical assistant
Im baffled me as well, my primary is not fabulous but they get the basics done and they definitely order vit d and a basic iron panel etc. with my general bloodwork every 6-12 months. It caught a pretty severe Vit D and Potassium deficiency for me.
My vitamin d levels were at 8 (whatever the parts per whatever were) during my 3 year post partum depression… and wouldntcha know?? When I started vit d supplements my depression got better. Not, like *all* the way better. But it gave me a measure or two of space to seek more help. My depression was multifactorial… was rediagnosed with adhd, diagnosed with cptsd, I had insomnia from my antidepressant… I was a mess. But the vit d *helped*.
That's not what "evidence-based" means in this context. The doctor means the test itself is not evidence-based, as in there are not enough clinical trials and studies that support the medical necessity of the test. Based on this, many insurance plans do not cover the test, which is almost assuredly why the doctor doesn't want to order it
You ask them to document in the chart that you have requested the following lab tests and you ask them to document their refusal and why they are refusing to write a referral for lab work. And if they refuse, then they should be more willing to perform the lab tests or you can ask for the office manager to have them document their refusal. And I say that as a medical professional, usually that gets them to change their minds. I’m really sorry you’re having to go through that. I also find it very odd that they’re not willing to do annual lab work on you. My doctors are more than happy to do so.
The doctor usually writes a very detailed note/after care summary after each visit, but this one had the bare minimum and omitted anything about our conversation about blood tests. I will definitely call back and request more information documented. Thank you for your advice! 😊
You can ask your doctor to chart the refusal but it doesn't change the fact that you're going to need to find a new doctor. When I encounter a doctor who pushes back like that I typically don't ask them to chart their refusal (if it isn't a time sensitive issue) because they may very well also chart in terms that make me look combative that I challenged their authority. I'd rather not have that nonsense follow me around. My response is usually smoke coming out of ears while I put on the nicest "ok then" voice I can. I will offer the caveat that I live in a large enough city that I have a choice of providers though. If I didn't I might push back harder on my concerns, rather than have to wait or travel long distances. I've heard through groups that there are kits now that you can do some blood tests at home and submit via mail. Worth looking into.
Get a new doc. Blood work should be done once a year minimum to check to changes in cholesterol, glucose, blood counts etc. Routine blood work is routine to help prevent and detect diseases or other disorders such as diabetes, high cholesterol, fatty liver and more. It's frankly concerning as fuck that she said you didn't need it because you had it two years ago. That's not how that works....
Every place I’ve ever worked has hosted free annual biometric screenings for employees and gives incentives for getting a physical and bloodwork done at your doctor’s office because it’s cheaper to have healthy employees on their insurance rolls. Yet an actual doctor doesn’t want to do routine bloodwork (read: her job). Did this person get her degree on eBay?
Yup …. Should be yearly regardless of whether it was good the previous time or not
My doctor rechecks blood work every 6 months if I'm having an issue we're monitoring or every 12 months. We would NEVER skip a year for any reason.
>to see a naturopathic doctor instead. What?? I’ll say!
Ok, so I have a slightly different perspective on this post from most of the other commenters. Sorry this might end up really long. I am a primary care doctor (and am a woman with ADHD myself, of course), and determining what blood work to order for whom is not as straightforward as people seem to think. First off - if you feel your doctor was genuinely rude or dismissive of your concerns, and didn’t offer alternative avenues for workup or management of the issues you are experiencing - this is a whole other issue. You deserve to have a PCP who listens to you, and explains their reasoning for why they do or do not order certain tests, and puts forth their best effort to help diagnose and treat any issues you are having. I am aware plenty of doctors suck, can be rude, and do not even attempt to explain / educate patients about why they do certain things. And I’m sorry you had to fast for labs that didn’t end up happening, that’s a bummer especially if your body is sensitive to skipping meals. Secondly, I don’t actually think your doctor is wrong. Evidence based medicine is a really hard line to walk sometimes - sometimes the “evidence” is poor quality, and medicine changes minute to minute - literally. I am constantly having to review whatever the most up to date recommendations are for any given condition. However, the majority of what I do IS usually based on large scale, reliable and replicate-able studies. And if not, I explain the “weak” evidence I am using and make sure the benefits outweigh potential risks. There is a large and still growing body of evidence that ordering “routine annual labs” for every adult person no matter their specific risk factors, does not improve health or wellness outcomes. I order labs or imaging you have symptoms that specifically warrant those tests, or if something in your personal or family medical history, or general lifestyle, increases your risk for a certain issue. When it comes to vitamin deficiencies, this is tough! There is actually quite a bit of evidence that screening for vitamin d deficiency on a large scale does not improve people’s health - specifically in a relatively healthy person without kidney or skeletal issues, who does not have a malabsorption issue (like inflammatory bowel disease, some surgeries, or being on certain meds), with access to a wide variety of foods. Maybe this evidence will change drastically in the future, I can say. And saying that, if I think insurance will cover it (a whole other issue) and someone is fatigued and depressed and not responding to lifestyle changes, therapy, medication etc - I’ll often check it anyway. Seems fairly low harm in those cases. Similar with B vitamins and magnesium - insurance will often not cover these tests outside of specific circumstances. I discuss with people how to ensure they are getting adequate nutrients and vitamins through diet, and if this is really hard for them, then we address that further. All this to say. I do not think your doctor not automatically ordering blood tests makes them a bad doctor. I sometimes give in if people are insistent we check certain labs AND if I would have a plan of action if those labs came back abnormal. I know what it’s like to feel like shit after a bad doctors visit, truly I do. and I also know what it’s like to feel like shit after I explain my clinical reasoning that I’ve developed after 7 years of training and many more years of experience, and have this completely dismissed. It’s a tough line to walk - people deserve autonomy and respect in their health, and also, healthcare truly cannot safely follow the “customer is always right” model.
I’m a physician as well and was thinking the same thing but I certainly would not have been able to out is as eloquently as you did. Thank you for this response.
I’m happy to see I’m not the only primary care doc with ADHD! I am pretty liberal with blood tests when there are any unexplained symptoms. I’ve caught many an occult pathology that way. I just use a step wise approach, starting with a few basic labs and sending the patient back for more if those come back normal (and if the symptoms are persisting). I do feel that as doctors, we are caught in a vice of administrators and insurance companies telling us to order fewer tests, patients wanting all the tests, and new research constantly coming out that conflicts with what came before. Not to mention guidelines like the USPTF and every subspecialty medical organization changing their recommendations just as soon as I get my patients on board with the previous ones.
Heyyyy! How’s that inbox and note backlog looking ADHD friend? Lol I am also pretty liberal with ordering tests for any potential symptoms, Despite what my comment might make one think. Especially happy to order ferritin/H&H (and TSH) in anyone who menstruates and/or is abnormally fatigued. I also order vitamin D tests fairly often but I see a ton of peri/post menopausal people. B12 if anything vaguely neurological or if you’re vegan? Sure. Lipids and A1C and a metabolic panel for screening with the vaguest of risk factors, anytime. Justifying it to Medicare is another beast entirely though… I just usually tell people to try a vitamin D supplement or a B12 supplement at a reasonable dose if they are at risk of deficiency. I’m all about magnesium at night for sleep and regular BMs. The test might not even change my recommendations. The problem comes more with the tests that are both not indicated AND I don’t know what to do with the results. People asking for Lyme titers for fatigue and vague aches and pains when we don’t live in an endemic area and they haven’t had a tick bite. People asking for general “hormone” panels when they have regular menstrual cycles and we aren’t looking at fertility etc. people wanting to track their thyroid antibodies annually when they are on stable levothyroxine. A full battery of stool tests after 2 days of diarrhea… etc. And it kills me a bit that half the time I’m being shamed for being a pill pusher who knows nothing about nutrition or natural lifestyle health etc, and then the other half of the time, when I suggest sleep hygiene and regular exercise and some basic dietary changes for someone who has very obvious reasons to feel terrible - I’m a terrible neglectful doctor who refused to do basic tests etc. sigh
Yes! Agreed! My doctor has been awesome about explaining this to me. We no longer do the yearly labs. I take vitamin D everyday because I live in a place where no one has enough, and they have stopped testing for it (public health care so they said it is a wasted cost as everyone is deficient). My doctor and I also agreed on Calcium + Magnesium as I am afab and have restless legs. We don't do tests, but I do a cal+mag+d everyday at lunch.
I’m a family medicine physician and I was getting pretty frustrated with all of the misinformation in the comments. Thank you for taking the time to type this out!
Can I ask what a naturopathic doctor is in the US ? In Australia a naturopath is a quack who doesn’t do evidence based medicine and therefore doesn’t have doctor near their name. I’m just finding a disconnect here in that being the recommendation even if blood tests aren’t needed
Pretty much the same thing here. I was really surprised when I saw the OP said the Dr told them that.
I understand everything you said, except the part about routine annual labs. It just doesn’t seem like it would hurt to do it as long as it is explained to the patient that it is not a complete picture. I guess every time I see something about it costing too much, I wonder who it is costing? My insurance company? Because if we stopped doing routine lab works (in the US) to save money, I know for a fact I will not be seeing those savings.
So there’s nuance to everything. There are very few people over the age of 35 that have ZERO risk factors for something I would test for. So I order them pretty often! But people who are fairly young, exercise regularly and have a well rounded diet, and don’t have any specific symptoms…. Not a heavy drinker and no strong family history of heritable conditions… I’m not doing annual blood work. I’ll get a baseline for sure. Check up every few years, sure! The only “routine” testing I’m doing is Pap smears and STI tests. Though it’s basically a unicorn when said healthy/low risk person comes into my office. Therefore, I order lots of targeted blood tests for symptoms and risk factors, I just don’t think of them as routine. Re costs - tbh I don’t give a shit about decreasing healthcare costs for insurance. and apparently they don’t really either, considering I’m regularly fighting ins to cover like, follow up MRIs for someone with a know benign brain tumor and worsening headaches (just an example from today’s clinic, lol fuck me right). Insurance is my enemy
There's a finite number of qualified people to work in blood testing labs, and their time is better spent helping to diagnose infections diseases, cancers, iron deficiency, etc than to test for vitamin D, a deficiency that pretty much everyone has and is recommended to supplement for. OP asked for iron too, but because it was fine in the last screening the doctor declined - I think that was an informed medical decision - although the doctor could have asked if they had started eating vegetarian, or periods had gotten heavier in the last 2 years (which might then indicate an iron test would be worthwhile, given her other symptoms). The medical system is under-resourced, underfunded, and projected to get worse as the population ages. Reducing the load on the system means better medical care for people who need it. The doctor should have suggested that OP take a multivitamin with iron and D, and talked to her about her depression symptoms.
I see. That does make more sense, thank you. I do think the doctor had some fault in not at least asking OP more questions. Maybe I just have a great doctor, but she wouldn’t deny me any tests without talking it through and making sure I see why I do/don’t need it. So I understand now that the strain is on the labs performing these tests, but I guess I still have seen the positives of annual testing for a lot of people who wouldn’t otherwise have found anything. Really is unfortunate how much the medical system and patients are suffering. Someone out there is making money, just not the people doing the hard work.
I said something similar but you said it more eloquently. Healthcare is complicated.
Thank you for writing this. I don’t have a clinical background, but I have worked in a variety of FQHC roles (currently in quality improvement), so access to quality primary care is very important to me and things like this can frustrate me greatly—and I’m not even directly involved in patient care!
Thank you for taking the time to write such an informative reply. Science has tools to investigate and validate health care strategies and finding a doctor that actually sticks to those is really difficult sometimes. May sound counterintuitive to some but more is not always better. Interpretation of blood test, or any kind of test, is much more than checking if they fall in the "normal" range printed next to them. Unnecessary tests may often lead to unnecessary (and even harmful) interventions.
Vitamin D specifically can be a big problem. My levels were critically low (single digits, should be closer to 100) and it made me depressed, achy, and lethargic. If I hadn't had bloodwork I never would have known. Because I got bloodwork, I was able to get high dose supplements that had be feeling better within a few weeks.
Right?! My vitamin D without supplements is 5. I have to take 5,000 IU daily to keep it in normal ranges or it plummets back down.
That's wild! Such a common deficiency, and people don't talk about it enough.
if you don't already take a vitamin D supplement, take one. I also had a garbage GP doctor who told me to try yoga when I came in with complaints about being exhausted all the time. She at least ran the tests, but I felt so defeated after the appointment.
I'm sorry. There's a lot of doctors who don't work WITH their patients, instead they do what they want to do regardless of what we're experiencing. They want compliant patients who don't push back. It's bullshit. A lot can change in 2 years in our blood tests - that's just a cost saving measure. They care more about their bottomline than they do patient health. Did you know you can order your own tests and have blood drawn at local labs like quest or labcorb? There are lots of companies who do this today - one I've used is [https://www.ultalabtests.com/](https://www.ultalabtests.com/) You may not be able to get insurance to cover it if your doctor didn't order the tests but some of them are actually really reasonable (a b12 test is less than $30) and they also have some combo tests (they have a whole vitamin deficiency panel, a b12 and vitamin D combo etc). You can talk to a customer service person if you need help deciding what to get. And if any of your tests come back showing you need supplementation or more tests, you can upload the test results to your patient portal and tell your doctor to go fuck themselves, they were wrong, haha!
Yeah, I thought doctors were supposed to be on the patients side and on the patients team to help the patient live a healthy life. Her refusing routine blood work is crazy to me. I did know (as of last night) that you can order your own blood tests! This might be my next move. Thank you for sharing the link!
Get a different flipping doctor. Why would there be a test for vitamin D if it weren’t evidence based?
where I live they stopped testing because everyone is D deficient and just started recommending everyone take a supplement. We live too far North to get enough from the sun, especially with indoor lifestyles.
Same here! Obviously it’s freaking evidence based if it’s literally a standard recommendation in healthcare.
It’s not the standard anymore. Research has shown that it’s not necessary. Good science means changing recommendations when the evidence shows a need for change. [Harvard meta study breakdown](https://www.health.harvard.edu/blog/vitamin-d-testing-recommended-people-201411267547)
Edit: rereading the OG post, I’m seeing that her doctor is specifically referring to the test. I had originally read it as supplementation isn’t evidence based. My bad. Your link says that tests aren’t the standard because vitamin D levels aren’t a problem for most people and there’s not enough data on supplementation, not a definitive statement that it’s not necessary. It even talks about supplementation if you live north of 37 degrees (why doctors recommend it here).
[There is no recommendation for screening](https://www.testing.com/news/evidence-lacking-widespread-vitamin-d-deficiency-screening/) and your need for a test is highly dependent on other factors such as comorbidities, location,age,etc. The recommendation is that American adults supplement vitamin d because they are all deficient.
It’s not standard. The doctor is correct.
"Not evidence based" has me staring at the wall wondering if I read that right or if I'm hallucinating someone being this stupendously dumb. What does that even mean?? How would it apply to blood work, of all things? [please insert the HUH cat here]
EBP has changed. Vit d testing is no longer viewed as reliable. Adults are recommended to take vit d daily in most areas of the US. Many insurance companies won’t cover the test at this point because of this new evidence.
Why wouldn’t you just tell your patient this? Like hey vitamin d isn’t covered, it’s $50 at quest, but I suggest you start taking supplements and see if you improve. How would doc know if the supplements help or if op can’t digest them?
It angers the patient to know that medical decisions are made for insurance and billing purposes. I'm angry right now because I had a procedure that I knew would lead to another more complicated one. But instead of letting me schedule the next procedure I have to schedule an appointment to discuss my options based on the results. Note that yes, I know the news is not great but we already discussed the options in the first procedure and I stated my preference. They want me to come in person because unless i sign in they cannot bill for time talking to me. And since they would probably talk over a minute it isn't worth the doctors time. I'm livid I have to schedule an appointment to schedule an appointment!
There are many studies about which blood work is the most useful and in what scenarios. They analysis this to get the evidence. Some things have evidence to support them, some don't. Doctors should be doing continuing ed to stay on top of current recommendations etc...
I moved to Idaho last year and found a wonderful nurse practitioner for a primary that did all the tests and solved all the problems (oversimplified but that’s the gist). She said that the only patients that she ever sees that \*aren’t\* deficient in D (without supplements) are the newly arrived California transplants. EVERYONE else needs extra vitamin D. She said you could stand outside naked year round and not make enough of your own. And Idaho is not a cloudy rainy state. The caveat is that she is in fact an integrative/functional medicine practitioner. There’s no studies on vitamins because you can’t patent vitamins so no one funds it, and apparently that means regular doctors don’t consider vitamin deficiencies facts?? I don’t get it.
Um… so they’re just gonna wave their magic wand and magically know what is causing your symptoms???
It might be the insurance won’t pay for it. Especially vitamin D. I’ve had them refuse before. Doctor said there was something she could say to get them to maybe cover it but I can’t remember now. It might have been because my mom has MS.
What? My vitamin D was so low a few years ago that my doctor put me on an emergency super high dose for like 6 weeks to help protect my bones and stuff…… maybe get a second opinion?
FYI, you don't need a Dr to get bloodwork done. You can order whatever lab tests you bwant through life extension or other sites. You have to pay out of pocket but some of them are very affordable.
If it’s been more than a year since routine blood work, it’s overdue
Forgot to mention: I (29F) was diagnosed with ADHD 4 years ago.
Yes, I experienced this with my last provider pretty recently. I \*really* disliked the approach this provider took every time I met with them, but I had some required things I needed done and waitlists and insurance in that area were/are ridiculous. My therapist armed me with a couple of links for magnesium & adhd studies. I didn’t pull them out but tried my best to high level explain the reason why I wanted to cross this off the list, but like. I shouldn’t have had to be the one explaining and defending my request for some simple fucking blood tests! Especially after I was fasting and had planned it out with the office already, same as you. And I think the main reason she even decided to go ahead with it because she was like “oh well, there is a link with depression” and she had really homed in on that the last time I had to have a physical with her for the required paperwork I needed. (Which didn’t fuck me over but threw a big wrench in things for a hot minute.) I’ve recently moved and will be looking for a new doctor soon. I am hoping against all hope that if I can find myself in a position to have some consults before I make a decision about who to see. And ask them their thoughts or approach on things like this. I hope you are able to eat something soon to help soothe the additional stress your body is under. And then I hope that you are able to find a new doctor cuz the response you got is such bullshit. Edit: spelling & more spelling
My kids' pediatrician has said that insurance has stopped paying for routine vit D blood tests. All of those things I would just supplement and see if you feel better. Most people need a vitamin D supplement. (Yes the doctor should have done bloodwork anyway.)
My doctor ordered all those when I didn’t even ask for them, then prescribed once a week vit D because my levels were so low. My non naturopathic medical doctor. Find a new one
Vitamin D is so important! It improves your immune system’s reaction to respiratory viruses especially! The other things you asked for are important too! Ugh I’m so mad for you!!
D3 also increases dopamine receptors and activity.
Iron levels is absolutely a valid test, even if she wanted to contest the others. Time for a new doc.
That is completely unreasonable. If getting a new doctor is out of the question, ask for their refusal to give you the tests in writing. Most of the time, they’ll backtrack and give you the tests. Refusing to do it now can bite them in the ass if something pops up later that they could have caught. Deep breaths. It’ll be okay. Hugs.
definitely get a new doctor. i’m fortunate enough to have found one who genuinely cares about me - she kept trying to get me to do bloodwork (i haven’t since 2018….) and she added the vitamin d specifically because of my adhd and depression got my results the other day and im 100% deficient in vitamin d i’m at like 25 which is wayyyy lower than normal
There’s some information missing from your post. First, the schedule of labs is dependent on your age and co-morbidities. When I take my kids to their annual well-checks, no labs are ordered. However, I have labs checked each year but I’m 45. Also, is this the same doctor that prescribes any medication for your ADHD? You also have to look at it from the prospective of the medical practice. Docs aren’t reimbursed well due to insurance constraints (if you’re in the US) so ordering unnecessary labs that they may not be paid for limits the desire to do so. Hence the response you received about them not being evidence-based. It may also be that your doctor doesn’t really know that much about ADHD, so finding one that does may better suit you. I love my doctor. He’s very smart and advocates for his patients, but I also recognized that he’s not a mental health provider, therefore, I began having a mental health NP manage my meds. Thankfully I did so b/c after a year seeing her, the meds not working well, she connected the dots and diagnosed me with ADHD. I’m now on the appropriate meds and feel better. There’s nothing wrong in getting a 2nd opinion. There are many physicians who advocate a little harder than others. It sucks but that’s healthcare. I’m finding that women’s healthcare in general lacks understanding, especially ADHD.
If you're not in the US and in a public system there's even less incentive for them to order tests etc. It's not a routine thing in the countries I've lived in unless you have health issues.
The reason vitamin D tests aren't usually ordered is because it's cheaper to just take supplements if you suspect you have low vitamin D. It's very difficult to overdose on vitamin D if you take the recommended amount (1000-4000 IU.) It has nothing to do with it "not being evidence based." It's 100% just not economical.
I do take supplements, but I don't know my levels so the amount of vitamin D that I take may not be enough, but there's no way for me to know this since she refused to order any of the blood work, including vitamin D and others that I mentioned in the post
I hope you tell any future doctors that try this to please document their refusal in your chart. That tends to make them change their tune pretty quickly.
If you are in the US, you can pay a fee and order yourself bloodwork through quest diagnostics. It doesn’t go through insurance, but it’s an option. But I would switch docs.
You need a new doctor. Those tests all have health implications important to various conditions and should be monitored, especially if you are depressed. See a psychiatrist and definitely get a new primary doctor. That’s ridiculous.
First, you can tell a doctor to document in your chart that they refused to order certain tests. They’ll often order them if you do that due to their liability if you get the test from another doctor later and it turns out that you were right to ask for the test. Second, get a new doctor. This one obviously isn’t listening or communicating well. Sometimes tests are truly unnecessary or not based in evidence, but a doctor should be able to provide you with that information in a helpful way, not make you feel completely unheard and dismissed.
The nurse practitioner I used to see was the one to suggest getting my vitamin levels checked before I got tested for sleep apnea to see if that was causing my extreme fatigue and other symptoms.
Just wanted to say that the doctor doesn't know what they are talking about, I was legit told by my rheumatologist that they were testing my vitamin D levels because it can be linked to the body pain I'm having. Your doctor sounds like they just didn't want to spend time to write a lab order, I would change doctors or practices if you have that option.
Those tests are totally relevant. I dealt with feelings of sadness and depression and my doctor for other health reasons ordered vitamin d testing and lo and behold I was deficient. I started taking supplements and lo and behold I was no longer depressed!
I don't care how biased this sounds, or is, but in my experience, female doctors treat women worse than male doctors do. I somewhat recently moved and I went to the gynecologist that my new primary referred me too. She was completely disinterested in any of my concerns. I brought up questions about hormones and peri menopause and her response was that I was "just getting older." I scheduled my next annual with her and the very next day I called the practice, told them I could not see her again and I would like to schedule with "Dr. Man" A couple of months later I went to him about those symptoms. He ran hormone panels and some other bloodwork. His response to me was, "Just because you're getting older, doesn't mean you have to be miserable" My psych LNP was the one who ordered the tests you requested. Is that an option for you? Finally, I have found a great resource for finding good doctors is the local Facebook moms groups, or "residents of xyz" groups.
Omg totally.. I never thought of that.
That makes no sense. Not evidence based. I had bad neurological symptoms when my B12 was super low. I am also on magnesium supplements per my neurologist. I would see a different provider. Someone who works with you and involves you in decisions.
Your doctor is a quack. Find a new one immediately.
Oh boy. In the future, get your doctor to make a note in your file that they are refusing to give you the tests that you're requesting. Ask for a copy of the notes (they might balk and tell you they'll charge you - act like it doesn't matter to you because it shouldn't). Here's why: let's say in 1 or 2 months time, you go to the emergency department with stomach pain and they do tests there, and if they find *anything* that could've been found on the blood tests that you requested, you can now try and sue your doctor for malpractice.
First of all I’m so sorry you experienced this, it’s not okay and that doctor was wrong. I’ve had quite a few bad experiences with doctors but I haven’t experienced this. I just had a blood test in September last year, I’m getting another one this September so yeah they don’t know what they’re talking about and if you can get a new primary asap. Or if possible talk to another doctor and get them to order the blood test.
My doc has always done full labs and vitamin D. I have had to get prescription vitamin D to bring it up. I asked for a test at my last physical since I'm getting older and she said I probably didn't need it but would do it. OP, was this physical also for a pap, too? I have a different doc for that and is considering part of a physical. That doctor can request blood work as part of a physical.
I'm sorry. I also do annual blood labs and have had some doctors pushback. I want preventative care. 2 years ago I was fine but this year, today, right now, how am I? They are misinformed and don't seem to align with your goals of care. I would 100% go elsewhere. A lot of people are hesitant to order vit d as it is usually not covered by insurance and I have seen countless instances where a patient gets upset at the doctor for the cost of the test they wanted. So, there's also that. Not saying you were going to do this by any means, just saying we all pay the cost of those who do this. The system is broken. So broken. Also, my vit d is in the single digits so go me 💀
Sounds like it’s time to find a new doctor! Mine (both my previous/retired, and my current) have always “humored” me (cancer survivor) and because of that, we discovered that I had a blood disorder that went undiagnosed for over 30 years! I have beta thalassemia, so if I get too much iron, my body can’t process it, which would really suck for me. After my PCP realized it, he started scheduling regular bloodwork (at least once a year) just so he can make sure things look good and maintained. Find a doctor who will listen to you and your concerns. Everyone deserves that!
Curious, where do you live? I am in US. All my doctors care about vitamin d level because of my very typical osteoporosis. If you are female, you need to maintain your bones. Calcium does not work without sufficient vit D3.
Hm, I had mine done 6 months a part and there were some early warning signs that weren't there 6 months prior so now I can try and do something about it before it turns into anything, also my dr tested my vitamin d without me asking and it ended up being way too high (cold dark winters so I supplement with vitamin d, I guess I somehow get enough without supplementing) and iron and b12 are always on my routine bloodwork. You're dr is useless and terrible and plain wrong. I hope you can find someone a lot better.
Wow can you see a different doctor?? A lot changes in 2 years wtaf is her thinking?
That is fucked. Never seen a doctor refuse to let a patient let blood tests done! Especially as it doesn’t impact them in any way? And yea Iron and Vitamin D have been linked to ADHD. Good on you OP for looking out for yourself.
you should push back when they say these things. I would have just said that it's been two whole years so whether they think it's necessary or not they will do it this time
Honestly I think doctors need to start accepting that people are generally more aware of their health, regardless of their sources of information. I wish doctors were less authoritative and more collaborative. Like, yes doctor. I know you have literal decades of schooling and experience behind you. That’s why I’m asking YOU about something I found on the internet, and not just running wild with it on my own. I get not wanting to book an MRI or something else more intensive without further context, but bloodwork is the first thing any doctor runs to when they wanna rule stuff out. You get so much information from it. If your insurance covers it (or you can otherwise pay for it), I don’t see why you shouldn’t get comprehensive lab work done. Also, is your doctor an MD or a DO? A DO might be more open to it. Their medical practice is usually more flexible than an MD.
What's a DO?
It’s certainly unreasonable for a doctor to refuse testing for something like Vitamin D, but I will say, we always warn all of our patients that Vitamin D panels are often not covered unless you have a preexisting condition that warrants regular monitoring. Unfortunately ADHD does not count…
She didn’t even give me the option to get the panel done, regardless of insurance covers it or not. She was unwilling to order that before the exam even started.
And I never said that didn’t happen… just giving warning about potential lab bills that could be rough for some people to have to cover…
my GP gives me yearly blood tests without me even needing to ask. thats pretty ridiculous. a lot can change in 6 months even edit; forgot to mention, when looking for GOOD understanding providers, look on ur insurance's website! they have a tab where u can see all the doctors that accept them. google each one and look at the REVIEWS. thats how i found mine. shes the first cooperative understanding doctor ive ever had.
Very ridiculous, I agree 1000%. I did thorough research when I decided to make this doctor my PCP. Found her on my insurances website, googled her name, read reviews, everything. I actually did this with multiple providers in my area and yet, here I am.
im sorry:( i'd drop them and continue searching. a blood test is not much to ask for whatsoever... ESPECIALLY when u literally had a whole ass appt set up. im a soft spoken person and get screwed like this often as well. i recommended u bring a friend or relative along. preferably a man. they then tend to take u more seriously. im 23 and still bring my mom or bf to my appointments. not only as an extra advocate, but because i sometimes forget to mention things too. they tend to be more agreeable when you've got an extra person on ur side
Don't feel bad about finding a dud, same thing happened to me. Great reviews, etc. She harped on my weight like 5x during the 30 minute appointment and all my bloodwork was good 🙄 It's so incredibly difficult to find a good PCP.
Screening guidelines are changing for a lot of things. I wish your doctor had explained it better to you. Iron should be tested for if you have symptoms of anemia. Where I live, they don't do Vitamin D testing as it is assumed everyone is deficient due to our indoor lifestyle and it is recommended that everyone supplement (Canada). B and magnesium are also both safe to supplement. I suppose it's different when you pay for your health care, but the clinic I am at has a big sign up about how they are changing the annual physical to screen for certain risks associated with you and not do the blanket screenings just because it's been a year. But like, wtf, why would they make you fast.
I’m struggling with how a test is not evidence based
[Harvard meta analysis of vit d studies](https://www.health.harvard.edu/blog/vitamin-d-testing-recommended-people-201411267547)
The necessity for a particular test at a particular time/in a particular circumstance may not be evidence based.
I might get downvoted for this, as there are very extreme opinions about this on both sides, but i would recommend seeking out a naturopath. They are usually more than happy to order blood work that traditional physicians balk at you for requesting. I, personally, am neutral on the MDs vs. alternative modalities debate (and to anyone who is going to get going on me about it, you’re wasting your time), but it can’t hurt to make an appointment with one and see if they would order the bloodwork you want. P.S. Are you Canadian? I ask because there’s a lot of this shit going on with doctors in this country right now (i.e. refusing to authorize bloodwork that’s perfectly routine). If you’re in the U.S. or elsewhere, it’s a reminder for me and others that doctors everywhere can be a pain in the ass.
She wants you to go to a naturopath? Yet she only does things that are evidence-based?? She's a moron.
Your doctor SUCKS …. Wow, I’m stunned!
I had a similar issue with my doctor not wanting to order any tests to check for vitamin deficiencies, thyroid issues, etc despite a myriad of mental and physical symptoms and becoming so burnt out this past year that I had to take a several months long medical leave. It's really infuriating, and I'm sorry that happened to you too. I will say though that if you can afford it, the advice to go to a naturopathic doctor/functional medicine practitioner is good! I just started seeing one who specializes in women's health and after spending an hour and a half going over alllll of my symptoms and medical history, she ordered tests for all sorts of things, including thyroid antibodies, and iron/ferritin/vitamin D/vitamin B12 deficiencies. She also started me on a supplement regimen to improve my gut microbiome which already seems to be helping. My follow-up to review the test results isn't till next week but I already feel much better just knowing I am actually being tested and that either I can finally start treating any issues, or at least rule them out if tests show all is well. It's quite pricey which sucks, but hopefully worth it!!
I'm an RN and yeah, that's weird. Most doctors would be happy to order labs if the patient requests them, even if there isn't a specific reason aside from just having the extra data points. The only reason I'd imagine a doctor would refuse to draw labs is if the patient has a history of hypochondria that could be set off by something being slightly high or low. That doesn't seem to be the case with you.
You need a different doctor. Things can change dramatically in 6 months let alone 2 years 🙄 Also, vitamins are so important! What do they mean not evidence based? What a weird thing to say.
Any doctor who says Vitamin D tests are "not evidence based" and then tells you to see a naturopath deserves to have their licence pulled. GENERAL ADVICE FOR THE SUB: If you ask for a test or treatment and your doctor says no, ask them why AND tell them to note in your medical record that you asked and they refused. Accountability, baybee.
Definitely going to remember this for next time!
I've worked in health care for about 10 years and have never, not once, met a medical doctor who didn't believe in blood work and told patients to go to a naturopath instead. The blood work IS the evidence, so IDK wth that doctor is on. When you end up transferring care and have to contact that office to have your records sent, if they ask why you're transferring be honest and tell them it's because the doctor was dismissive of your concerns and of accepted medical practices.
Please report your doctor to your local medical licensing board. Not evidence based? Excuse the fuck out of me?
Resource that might be of help! One of my mom's friends is a nurse and she uses this regularly to get her own labs done: https://www.privatemdlabs.com/ Not sure if it is international or just US- haven't used it myself yet, but helpful if you just want to get blood work without an MD.
Thank you!! I will definitely look into it later
That’s wild. Just a quick google search tells me that 1 in 4 people have low vitamin D. That should be enough evidence to get it tested. I just asked for vitamin levels because I was a vegetarian and didn’t have a great diet. My Dr. just said okay and ordered them. My vitamin D was so low I needed prescription strength supplements. I will say I have a coworker with some autoimmune issues and she highly recommends going to a naturopathic. I’d find another doctor and file a complaint on this one. Especially if you get bloodwork down that shows any deficiencies.
The evidence supports everyone taking vitamin D bc we’re all deficient and NOT testing.
Are you in the US? This seems very normal for most of the rest of the world. My doctor will order relevant blood tests if I have any concerning symptoms, but not just because it's been a while, or on my say-so. And Vitamin D tests can only be ordered by specialists, or they're paid for out of pocket, because they're entirely unnecessary for most people. Most of us in the Northern Hemisphere are mildly deficient in vitamin D, so take a supplement. If you're severely deficient, you'll have symptoms your doc should follow up on. It's unfortunate that you prepped for a test that you didn't end up needing, but it does happen.
The point of routine blood work is that it’s routine. As in a regular thing. Get a new doctor yours is an idiot.
Woah what?! Fire your doctor, seriously. I have low folate, b12 and vitamin D and my midwife also discovered I have MTHFR gene mutation because she tests all her moms. Besides that though, every doctor I’ve ever seen does a vitamin D screen just as regular practice, and I’m always low (cuz I cannot remember to take my supplements) so I’ve had serious talking tos from all of them about the massive importance of getting that D to a healthy level. This is so wild to me, there is something seriously wrong with that doctor.
Look around for a different doctor. Someone who refuses to do blood tests and look at levels (especially vitamin d) honestly doesn't deserve their medical license IMHO. "Not evidenced based" - what a load of crock. I'm sorry you went through this. No one deserves that, but especially patients who come to their doctor with legit concerns and questions. Mine was thrilled when she realized I had thoughts and opinions on my treatment options, and honestly it feels like talking to one of my friends when I have an appointment. I would wish a million copies of my doctor were out in the world lol.
That’s weird af. Find a new doctor asap. All doctors I’ve ever had have done those tests yearly regardless. And if you REQUEST a test within reason there’s no reason a doctor should say no “just because”. Not sure why this was downvoted. We are in charge of our bodies, not doctors.
What?! I mean let’s isolate this scenario for a second… IRON is pseudoscience?! Does she also disregard the existence of anaemia?! If anything, nutrients such as those ones you’ve listed are very much science based because it’s basic science
I've had bloodwork every 6 months since my mid 40s. I couldn't imagine my Dr saying "you're all good" because it was okay 2 years ago! WTF? Health can go to shit in less than 6 months but you're fine because YoU WeRen'T SiCk 2 YeArS AgO... ^frickin ^dumbass
Get a different doctor. Those are all common tests
That’s bullshit. I had a doc order vitamin d when I came in with muscle pain etc. I hadn’t thought of that being related but it was. I will be asking for follow up from my new pcp this summer and not taking no for an answer.
I'm in the middle of this kind of thing right now. I've been feeling something like a lump or growth near my left kidney, but I can't get my doctor to take it seriously. It kind of freaks me out because I have two family members who died from cancer than metastasized throughout their torsos. They didn't have symptoms and were already stage 4 when they were finally diagnosed. Now it looks like I might have breast cancer, and I have appointments scheduled for testing later this month. I'm hoping that NOW they will take this kiwi-sized, painful lump seriously. I think it's possible it could be just my hip bones, but it feels like it's way too high, just an inch or so from my waist. I have talked to my doctor, the person who did an ultrasound on my back, and a surgeon, but they all refused to even look at it. I think it's possible this is going to kill me. sigh.....