Because I try to be aware of the latest, best practices for whatever I’m having addressed, I often encounter doctors reluctant to do imaging that could shed some light on whatever’s going on. Most of the time, it’s because the guidelines themselves are against imaging unless certain conditions are met.
For instance, you could have 250 LDL, 1000 CAC score, implying the widowmaker is one flight of stairs from clogging just enough to kill you, and the guidelines advise not doing an angiogram to check how blocked it is, which could reveal the need for an urgent bypass since it’s 95% blocked, unless you’re having symptoms. Never mind that the first symptom could be death.
In my mind, if there’s a 1% chance of finding a problem, I struggled to understand the rationale behind this “better not look” approach.. Ok, limiting “radiation exposure”, that makes sense. Except it applies to non or very low radiation imaging too. So that’s not the root of the guideline driven anti-imaging philosophy.
Cost to benefit ratio? Of course that’s always a factor, though when it comes to my health, if there’s any chance of a benefit from testing, I don’t give a crap about saving the insurance company money. Improve your balance sheet with some other sucker, not me. But even offering to self pay often doesn’t overcome the reluctance and insistence in following guidelines.
I finally discovered the primary reason guidelines avoid imaging unless all the factors put together meet some threshold is the harm of potentially *unnecessary procedures* resulting from seeing something in the imaging.
After giving that a lot of thought, I concluded that for a patient actively involved in their own care, it’s MUCH better to have all the information possible, then if something is discovered, make the decision as to whether it’s worth treating with some procedure or not.
There’s just no way I can see having less information is preferable to having more. At least not for a proactive, engaged patient with a couple of functioning brain cells who won’t panic, demanding surgery without weighing the risk to reward. I don’t need to be “saved from myself” by “not knowing”.
There’s no harm in seeing what’s up with your liver. It’s painless and radiation free. I’d see it as an opportunity to get a free diagnostic and be armed with more insight about your body so you can make better decisions going forward.