Saturday, January 12, 2008

Growing old is hard on doctors, too

When I was in medical school, which was half a century ago, life expectancy was less than it is now, but a lot more than half a century before that. We had Social Security, although many people never made it to 65, so the system was flush. Congress used the surplus for a piggy bank.

I had a patient who retired from Ford in 1965. When he was filling out the forms they told him that the average retiree got two checks. Despite this gloomy prediction, he lived another 25 years. This is the kind of thing that drives corporate planners crazy. Congress heard about such people and began to think about putting some of the money back.

We did not study geriatrics — the care of the elderly —because there weren’t enough of them to worry about. I suppose we learned some things by watching our grandparents, but I certainly never asked mine any medical questions. How could I ask the woman who taught me to ride a tricycle if she had any trouble with her bowels?

As a person gets older, it’s natural to wonder which symptoms are normal and which indicate something ominous. If no one at the barber shop or beauty parlor knows the answer, we tend to ask the doctor. “Doctor,” we say, “is it normal to (fill in your complaint) every night?” If your doctor is 25 years younger than you, he might not know the answer. Even if your doctor is your age, he might be some kind of health nut, exercising all the time and taking vitamins, while thinking that something entirely normal is actually a portent of doom. That leads to unnecessary tests and worry, neither of which is covered by your insurance.

If your doctor is a good bit older and wears that “I’ve got to retire soon” expression all the time, he probably has a lot of symptoms that he hopes are normal, but he has no one to ask, either. He is sure that the younger doctors don’t know anything, and he doesn’t want the older doctors to suspect there is something wrong with him. This is not a good situation.

“Doctor,” you might say to him, “I only sleep four hours a night. Is that normal?”

“Oh, sure,” he says, wondering why he only sleeps three hours a night. He is envious of you but doesn’t say anything. He decides to advance his retirement another three months. He makes a note of this, but you think the note is about your problems, and you are pleased at his keen interest.

“Doctor,” you say again, “my memory is going to pot. Is that normal?”

“Well,” he replies, checking your name on the chart, “what was that again?”
“Doctor, I’m thinking of getting a hearing aid. What’s the right kind?”

“It’s 3:15,” he answers, checking his watch. You, having already forgotten the question, check your watch, too, and are pleased that it agrees with your doctor’s. It’s a Timex and only cost $29.95, but it keeps good time and tells you the day and the date, which you otherwise wouldn’t know.

It’s easy to see how you could waste a whole appointment and not learn a thing. It’s important to understand that if the doctor checks his watch during your appointment, and then holds it up to his ear, he is probably distracted by his own concerns, and you should find another doctor. You are not getting your co-pay’s worth.

If you are old enough to have buried half your friends, you could go to a geriatrics specialist, but it won’t do any good. He learned geriatrics from books, and books about old people are written by young doctors who don’t know anything about old people. It’s like writing about Antarctica after living in Florida all your life. You have to go there, first. The critical fact is that young doctors are the only ones with enough energy to write the books.

I don’t want to paint an entirely negative picture, and I do have some helpful suggestions:

If it hurts, and it didn’t hurt before, go to your doctor. Give him two tries, and it you’re no better, forget about it.

If it doesn’t hurt, but it doesn’t function normally, toss a coin. Heads or tails, go to your doctor. If it lands on edge, forget about it. If you think your pills are all messed up, take them to Amanda, the counter lady at my Publix pharmacy. Even if she can’t straighten them out, she’s always very pleasant and you’ll enjoy meeting her, which might be more than I can say for your doctor.

If you are really stumped for an answer and have no hope of getting one, spend your time reminding your congressman to keep his hands off the Social Security trust fund. At his age, he needs all the reminding he can get.

By John R. Agnew,a retired Fort Myers physician. He can be reached through mstephens@news-press.com.

Source: http://www.news-press.com/apps/pbcs.dll/article?AID=/20080111/OPINION/80110062/1015

Forget yourself for others, and others will never forget you.

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