Elective Surgery on an 81 Year-Old: If Medicare Pays, How Wrong Could It Be?

With one hand supporting my left thigh, the orthopedic surgeon gently flexes my knee. “Yep, a torn ACL,” he says, referring to a small ligament that many an NBA player has had surgically repaired, not always successfully.

“Are you sure?”

“This test is the gold standard,” he says, though his “test” seems as primitive as the way my internist prowls for hernias (hand beside my balls, asking me to turn my head and cough).

For a second opinion, I see a doctor at The Hospital for Special Surgery, the one who comes up first on my internet search. This is, I’m guessing, because, as his profile says, he’s been featured in GQ.  His office has so many officious assistants that you’re never put on hold or have to leave a voicemail, though you do have to wait well beyond your appointment time to be examined.

He refuses to use the x-rays I brought, insisting on ones done by his office that cost me over $500. Impeccably dressed, lots of quiet, attentive, orthopedic doctor-wannabees trailing behind him, he performs the gold standard test, then says that my ACL must be surgically repaired, the only question being whether the replacement ligament should from a cadaver, or be cut from an overly plump one of my own.

Asked about alternative treatments, he looks at me like I want to drive cross-country on a couple of flat tires.

“Do you always repair them?  I mean, I’m not having any problems walking.  And how’s the rehab?” I ask, remembering the months I spent rehabbing a tennis-induced, shoulder injury.

“Always,” says the man who insists on payment up front, not sullying himself with insurance.

“Just did an 81 year-old.  Man wants to keep skiing, stay perfect.”

“An operation like this at 81?  So he can ski?  And Medicare paid for it?” I say so incredulously that he rolls his eyes, obviously angry or offended or both.

“So what do you want to do?” he asks impatiently.

“I’d like alternatives.  I hear that in Europe don’t even do this surgery.”

“Down the hall.  Room 233. They’ll give you a brace,” he says, his entourage parting so he can lead them out the door. “And here.” He hands me a prescription for physical therapy.

It’s almost six years later.  I hike extensively, dog scooter with my very energetic, rescued Malamute, garden (including building stone walls) on a hillside, and otherwise am as active as always, all without surgery.  Yes, I wear a knee brace when I play tennis, one I got on the internet that’s the exact same as what the officious Special Surgery Hospital doctor’s office offered to sell me, but at one-quarter the price.  And yes, I went through 3 months of physical therapy, strengthening the muscles surrounding the offending knee. But no surgery, rehab or complications.

Slalom-ready, at least until 81.

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