There are two versions of “the conversation” we have with men: One is for teenage boys, and it is about wet dreams, sexually transmitted disease, unwanted pregnancy and at one point also about testicular self-examinations. Those have now been edited out of the script, which makes sense to me since I have seen only three cases of that in forty years of practice, all but a couple of them diligently preaching that particular gospel.
The other one is with men of the age I now am, explaining, a few years ago, the benefits of blood tests (and, remember the rubber glove exam?) for prostate cancer screening and more lately the confusing intricacies of PSA blood tests.
For several years I’ve been spending a lot of time during physicals and wellness visits talking about the pros and cons of prostate cancer screening. I tell people you have to treat maybe 36 patients with prostate cancer to save one life. I tell patients that a recent long term study of men with early prostate cancer showed that ten years into it, only half of them had needed to do anything about the cancer. Still, many people want to be screened, and I just encourage them not to panic if the result is abnormal.
A few weeks ago, I got my first rejection of a Medicare PSA test for cancer screening purposes (ICD-10 diagnosis Z12.5, screening for prostate cancer).
My first, primitive, reaction was “here I have to spend all this time soft-pedaling the news that PSA testing, which men (and doctors) were brainwashed into performing, is a general waste of time” and Medicare simply stops paying for it overnight without even telling me to save my breath.
Medicare will now only pay for PSA testing if you have the dribbles or something like that, not for screening for prostate cancer. On my iPhone, I get notifications of all kinds of stupid things that don’t bother me a whole lot. Why couldn’t somebody tell me that Medicare no longer covers PSA for screening?
Hans Duvefelt, also known as “A Country Doctor,” is a family physician who blogs at A Country Doctor Writes:.
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