Medicare Wellness
When I moved here almost four years ago, I found a primary physician in one of the larger medical groups in San Diego (actually affiliated with the top university here). When we started together I was just 65, so I was on Medicare. I know how this works and I knew that after one look at me and my size (I have been characterized medically as morbidly obese forever, since a BMI of 40 or carrying weight in excess of 80 extra pounds gets you that ticket), the physician would want to do lots of entry point testing to figure out all the things that were most likely to kill me and ruin her patient survival statistics (I admit that is a tad cynical). This physician decided in all her 100-pound wisdom that she should see me every three months to make sure she got things right for me and that I didn’t die too quickly. Funny thing was that retirement seemed to agree with me and every time she saw me I got lighter and lighter for the first year. That, and some fiddling each visit with my high blood pressure medications also brought my blood pressure down into the proper zone. As the first few years went on, she was having a harder and harder time finding anything wrong with me so she knocked me down to every four months visits and then eventually semiannual visits. Apparently, contrary to popular medical wisdom, I was healthy…more or less.
Superstitious people tell me not to say anything like that because I wil jinx my situation and suddenly come up with some awful and debilitating condition, just for being presumptuous with Mother Nature. I filled out the Medicare Wellness questionnaire, intended to screen us older folks for progressive “frog boiling” conditions that creep up on us too slowly to otherwise recognize. It’s a real eye opener to read through the questions and realize all the things that can go wrong with you and how they might manifest themselves. I certainly don’t want any of that to happen to me even though I am sure that I will not slide by completely unscathed from the process of aging.
I am coming on five years since I started seeing this doctor and I am glad to say that she finally seems to get me fairly well. I visited her today for my semiannual check-up, something I think is pretty standard in terms of frequency. In fact, Google tells me that a seventy-year-olds should see the doctor twice a year where a sixty-year-old should go to the doctor every 1-3 years. Apparently Medicare expects you to go to the doctor at least annually and thus prescribes us all an annual wellness visit, which was what they called my scheduled visit today. This is what it entailed:
– Weight check – I’ve stopped losing retirement weight, but will likely start losing old-age weight soon enough…or at least I promise myself that I will.
– Height check – Yep, I keep on shrinking, or more accurately, compacting and have lost over an inch in my overall stature in the past 25 years. I am not terribly bothered by that but I no longer am usually the tallest person in the room or in any photograph.
– Blood Pressure check – The first one on the left arm is always high and then the nurse says she will check it again at the end and voila, the right arm gives them the exact reading I told them to expect and its a tad high on systolic and on the money on diastolic (which I have always been told is more important). The doctor will likely fiddle some more with my daily meds and we will keep that fantasy going for another six months.
– ENT check – Ears and mouth all good. Dentist visit last week confirmed that both teeth and gums are good to go for another six months. Nose, which is always a bit dry out here, gets regularly ignored in the equation.
– Pulmonary check – deep breaths both back and front show nothing but free and clear.
– Skin check (hence the no-shirt exam) – it seems that rubbing her hand across my forearm and asking if I use sunblock is all that is needed. My answer that I don’t use sunblock is ignored as is the mole on my upper back. All good since my demonologist skin checks are far more invasive, which is why I don’t go unless my GP tells me to.
– Ankle check for edema – this is the one area where I wish I could get some improvement for my right ankle and she again tells me its fine and I might want to wear compression socks if it bothers me. No big deal she says.
– She asks if I’m seeing any specialists (presumably so she doesn’t get blindsided by something big) and I say no, so she lets me go except to tell me that I need to get blood drawn.
I tell her on the way out that my BP ended up where I said it would be and she sends me on my way to the lab where the efficient technician goes into the exact vein I tell him to use and takes my sample in 90 seconds. And, I am free to go.
Wait a minute! I’m turning seventy between now and when I next see her in six months. Isn’t that the age that the Bible tells us we are all allotted on this earth? Isn’t this game going into overtime for all the good reasons? Did I put on clean underwear for nothing? Where is the rubber glove and the “turn your head and cough” program? As much as I am glad I got what I wished for, which is the most non-invasive physical exam I could imagine, it does make me wonder. Were we just being abused unnecessarily by our doctors as we grew up, or has Medicare and national budgetary concerns put us in a place of don’t-ask-don’t-tell just like the military was for years vis-a-vis LGBTQ issues? I can convince myself that in the same way the demographic longevity numbers have imbedded in them the notion that once you get to a certain age, your survival bodes ever better for extended longevity, maybe I have gotten past the danger zones and am just free to coast into home plate at my own speed from here. As much as I would like to think that, every so often I hear about a 78-year-old having a heart attack or cancer suddenly showing up in someone with no cancer history and their dying in a matter of months.
But I also think that when you get to a certain age and your obligations are mostly behind you, the medical profession should take a more casual approach to your health risk management. Who among us does not think that the centenarian who smokes like a chimney and drinks like a fish deserves to continue to do so if he/she so chooses? I know I am forever getting Kim to agree that giving Betty doggie treats and table scraps is the least we can do for a pup at her advanced stage of life. At some point heroic efforts to manage medical risks just don’t seem as necessary or appropriate even though the kids and grandkids do like having you around to give them nice Christmas gifts or fun vacations. Is that selfish of me? Some would say it is, but as an economist, I take the maximizing utility approach to life. That means to me that you need to ask me where my optimal utility is best achieved. There may be a day when I want a finger up my ass to keep me going for a few more days so I can say goodbye, but right now I am happy to waltz through my annual Medicare Wellness exam as I have. Like Woody Allen said, life is divided into the horrible and the miserable and so long as you are not confronted with anything horrible, be happy in your misery.