Routine screening tests

Hai Ho, M.D.

Most expensive part of medical practice?

Your Pen

Case

55-year-old male comes to you for a routine physical examination. He is a nonsmoker who takes no medications and has no signs of acute or chronic disease, and he has not seen a doctor in years. What blood work should you order for this patients?

Complete metabolic panel?

$212

Basic metabolic panel

$175

CBC?

$36.40

Urinalysis?

$23.80 Microscopic Examination

$30.80Total

$54.60

Cost of FCC welcoming package?

Chemistry $212

CBC $36.40

Urinalysis $54.80

Total $303.20

Cost of ER welcoming package?

Chemistry $212

CBC $36.40

Urinalysis $54.80

Total CK $86

CK-MB $86

PT $49

PTT $61.60

Total $585.80

Pap smear after hysterectomy

Recommended screening tests

The disease must have high prevalence in the population tested

Favorable outcome when the disease is detected early

High sensitivity and specificity Not too expensive

Fasting plasma glucose – adults?

Age ≥ 45, and if normal q3 years

Fasting plasma glucose - adults Younger or more frequently

Obese >120% of ideal body weight or BMI ≥ 27 kg/m2

First-degree relative with diabetes High-risk ethnicity – African American, Latino, Native

American, Asian-American, Pacific Islander Delivered a baby weighed > 9 lbs. or history of GDM Hypertension HDL ≤ 45 mg/dl and/or TG ≥ 250 mg/dl Glucose intolerance on previous testing Associated insulin resistance – hypertension,

hyperlipidemia, PCOS

Fasting plasma glucose - children Overweight

BMI > 85 percentile for age and sex Weight for height > 85 percentile >120% of ideal body weight for heightPLUS:

Any two of the following Family history of type 2 diabetes in first or second

degree relative Ethnicity – Native American, African-American, Latino,

Asian-American, Pacific Islander Associated insulin resistance – hypertension,

hyperlipidemia, PCOS Every 2 years

Lipid panel

Lipid panel Total cholesterol, LDL, HDL, TG Cost: $95

Age ≥ 20 Every 5 years Metabolic syndrome – diabetes

mellitus, hypertension

Chlamydia

AAFP: Annually all sexually active female age ≤ 25 and other women at increased risk for chlamydia

Molina or IEHP: Annually all female age 16-26, identified as sexually active

Fecal occult blood testing

Annually for adults age ≥ 50