Urine Microalbumin

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Dr. Ebbert is professor of medicine and a general internist at the Mayo Clinic in Rochester, Minn.  Yes, theeee Mayo Clinic. He wrote a recent opinion piece in Internal Medicine News that you may find intriguing.  You see, he has been following yearly urinary microalbumin in his patients with diabetes even though they are already on an ACE inhibitor or an angiotensin receptor blocker. Why?  Because he was “supposed” to even though he didn’t know what to do with the results.  Why is he like every other doctor?  Because like lemmings, we have believed in these stupid quality indicators, which, by the way, are unproven but “somewhere along the line, an annual microalbumin has been incorporated into performance measures and clinical algorithms”   As Dr. Ebbert points out, the American College of Physicians just published a clinical guideline on the “Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease” (Ann. Intern. Med. 2013 Oct. 22 [doi:10.7326/0003-4819-159-12-201312170-00726]) and it “recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II–receptor blocker.”

Dr. Ebbert ended his piece by asking,” How long it will take for clinical practice to catch up and remove this as a performance measure remains to be seen.”

I bet years!

This is one more reason metrics, quality indicators and pay-for-performance is WRONG for medicine.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Urine Microalbumin

  1. kurt
    December 26, 2013 at 5:04 pm

    I like that guy! If they spill protein the nephro isn’t going to get too yanked unless it’s 1000mg. 500mg? You’re O.K. Cripes they’ll just decide whether they want to do a kidney biopsy or not. If on the ACE/ARB already and spilling, “Turf ’em Daniel.”

    How about pneumovax? If one is so decrepit that a run of the mill strep can kill’em, if
    they’ve had the pneumovax, plenty of other more vicious bugs are going to give ’em the dirt nap.

    Only one case in 28 years I’ve seen pneumovax help. A person with marginal zone lymphoma got strep pneumonia “alot” in spite of a single pneumovax shot. I started giving him one shot every three months for a year, every 4 months for a year, twice a year and then once a year thereafter. When I started that, he never had a strep pneumonia again. It’s called teasing an amnestic response from an impaired immune system. The guy was in pretty good shape otherwise but the strep pneumo would knock him down every few months.

  2. ken kayser
    December 26, 2013 at 10:36 am

    Obamacare has provisions to reduce this type of thing. It is estimated the 1/3 of all tests and diagnostic procedures are “unnecessary”. Depends on you definition of unnecessary, by my definition it is over 2/3.

    • Doug Farrago
      December 26, 2013 at 10:40 am

      How can they reduce this if they are using them as a way to bonus doctors with pay-for-perfomance indicators?

      • Sir Lance-a-Lot
        December 26, 2013 at 10:52 am

        On the nose, Doug.

        And make sure you put the word “bonus” n quotation marks, since all they are dong is giving back money they stole in the first place.

  3. carpenter
    December 26, 2013 at 10:02 am

    This is just like the ACE levels used for certain autoimmune disorders. Ask a physician what it means and they tell you it doesn’t really tell them anything, but everyone uses it as an index of inflammation.

  4. Sir-Lance-a-Lot
    December 21, 2013 at 9:49 am

    Like they said in residency: “Don’t do the test if the results won’t change your treatment.”

    I do as few tests as possible, and I feel good about that.

    What the hell am I supposed to do about an isolated trace blood, or an elevated CRP or ESR anyway?!?

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