I’m a reluctant user of the medical system. An annual physical. One dermatological scan per year. A colonoscopy every ten. And that’s it. The rest I avoid like the plague. I wait for things to run their course and go away. Only when my girlfriend or one of my daughters threatens me will I make a doctor’s appointment. And even then, most of the time, just scheduling the appointment makes the symptoms disappear. Not so, it seems, with people like my father.
It’s no secret that boomers, and post-boomers like him, especially those reaching the Medicare age, overuse the medical system. Yet most of the worry seems to be over how to expand the system to meet their expanding demands, with reducing overuse seemingly ignored. My father, for example, with the exception of some reduced faculties, at 93 is almost as healthy as I am. Yet literally any time I speak with him, he’s got some new, totally minor ache or pain that he’s now embarking on extensive analysis and reatment of. It always follows the same path, from internist, to specialist, to second opinion, to surgeon, to second opinion surgeon, etc. That nothing’s ever cancer, or even anything, seems to disappoint him. It’s like he needs the attention, or to relieve the boredom. I often want to ask if the magazines in the waiting rooms have any influence on the doctors he picks, and whether he schedules his appointments to coincide with the arrival of new issues.
He did, though, recently reveal something that even I might call in a doctor on. While visiting him and his wife in their retirement community beside some New Jersey Turnpike exit, he says that once in a while he gets dizzy and just falls down, the new bruise on his head being a result. His symptoms cannot be explained by any of his squadron of Medicare-paid doctors, nor the massive panoply of tests they’ve ordered. The twenty or so pill bottles on the kitchen counter, however, all for this demonstrably healthy man, suggest that maybe he’s just ingesting too many chemicals.
His last visit, he says, was to another gerontologist. “A top guy at Mt. Sinai who bills $450 for a consultation. Can you believe it,” my father says proudly. “Medicare sent me a copy of the bill. You want to see?” he asks, leaning forward on the “his” of their “his and hers” TV-fronting barcaloungers, his foot rest conveniently retracting as he extends his legs and stands.
“Dad, did the guy have your records?”
“What records?”
“You never saw him before, right? So how did he know about what all your other doctors did? All your test results? All the pills you take?”
“He asked me.”
“He asked a 93 year-old man who takes about 20 different pills a day and who has dizziness problems to explain all his tests and pills?”
“Yea,” my father says, irritated, I think, that I’m questioning what a “top doctor” does. My father just seems honored to have had Medicare billed on his behalf by this guy.
“And what did you say?”
“I tried to remember the pills. Oh, and I told him what happens when I drive.”
“Which is?”
“Well, sometimes when I’m driving, I see huge trees. Right in the middle of the road.”
“And what did the doctor say?”
“He asked me what I did.”
“And you said?”
“I told him I drive right through them,” my father says proudly, as if he’d just courageously faced down a psychological fear, though it seems to me that driving through trees your mind places in the roadway is more like irrationally ignoring a mental defect that makes you an extremely dangerous driver.
“Did he talk about whether you should be driving?”
“No.”
“Did he ask to get your other records, or give you any ideas?
“No,” my father says, walking towards a table piled high with papers. “You want to see his bill? Medicare paid him $450. You know how tops you have to be to get that?”
So a “top guy at Mt. Sinai” thinks it’s okay to rely on a dizzy old man to remember all his medications, and to let him leave, though he’s having hallucinations while driving, without discussing with him or his family whether he should retire his car keys. Fact is, barely a year later, my father ran a red light, rear-ending a stopped garbage truck so hard that he knocked the driver unconscious and a passerby had to jump into the cab and hit the brakes to stop the now moving truck.
And the medical system’s role in all this?