Someone Should Be Looking at Your Arteries

Don't guess ... make sure your doctor is looking under the hood at your engine.

By Dr. Joseph Ferguson
MEDICAL COLUMNIST

Photo by Robina Weermeijer on Unsplash

Editor’s Note: This column by a local medical professional offers insights and advice on medical topics. The opinions or views expressed in these columns are not intended to treat or diagnose; nor are they meant to replace the treatment and care that you may be receiving from a licensed professional physician or mental health professional.

Let’s say you go to your mechanic and you tell her that you are about to drive across the country and you want to make sure your car is OK and, in particular, you want to make sure your engine is OK.

So now let’s imagine that your mechanic tells you the following:

“I could look at your engine and I could definitively tell you whether your engine is OK. But I’m not going to do that because it turns out that I’m really good at making educated guesses. I’m not going to look at your engine, but I’m going to use all kinds of important pieces of information and I’m going to make a very, very educated guess about how your engine is doing. I’m going to look at the make and model of the car, the mileage, the history of problems the car has had, you know, relevant stuff like that. And then I’m going to tell you everything you need to know about your engine without ever actually laying eyes on it.”

So then you say, “That all sounds really great, but I still just want you to take a quick look at the engine.”

The mechanic gives you a look of surprise and says, “Did you listen to a word I just said? I told you that I’m really good at making educated guesses and I’m not going to be looking at your engine. What part of that did you not understand?”

So that scenario seems absurd, but it very likely is almost exactly what’s going to happen when you request that your primary care doctor do the appropriate screening in order to find out if there is anything going on with your arteries that needs to be addressed.

The supposed experts in medicine believe that their methods of making educated guesses are so tremendous that it is not necessary to look and see whether their guesses are correct. I am truly not exaggerating here.

Almost every one of the doctors of whom I am aware actually believes that their educated guesses are so great that they do not find it necessary to actually take a look.

Of course I am interested in a patient’s family history and their other risk factors like blood sugar, blood pressure and cholesterol numbers. Of course I am interested in a patient’s risk for problems with blockages in their arteries. But I am the only physician I know who is laser-focused on doing the screening that will allow me to find out whether a patient actually HAS blockages in their arteries.

Here are four non-invasive screening tests that would allow us to look at your arteries: duplex ultrasound of the carotid arteries of the neck, CT calcium score to assess the coronary arteries of the heart, duplex ultrasound of the abdominal aorta, measurement of blood pressure in all four limbs to detect a blockage of blood flow to the arms or legs.

Trust me, patients of mine over 40 years old, unless they have had some inciting event: when I inherit them from other physicians, the vast majority have never been screened with a single one of those four assessments.

How could that even be possible?

The answer is very simple. Most doctors are trying to juggle a multitude of different priorities, including a requirement that they see four patients per hour, and they practice according to expert opinion. The experts who make the recommendations are so overwhelmingly impressed by their ability to make educated guesses that they really believe that there is no need to actually take a look.

I recommend that you tell your physician that educated guesses don’t cut it for you and you want to be screened with at least one, and maybe all four, of the tests, so you can find out what’s actually going on in your arteries. I don’t have high hopes that you will get a useful response.

Joseph Ferguson, MD, is a graduate of The John’s Hopkins School of Medicine. He founded Fredericksburg Primary Care 20 years ago and he has operated that clinic ever since. His office is accepting new patients at: 540.374.8140.

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