Seniors - Age-Wise: The right side of the grass

It is not too far fetched to say our generation and those before us grew up with unquestioning respect for doctors and lawyers. The doctor says, and so I comply. In the old days, the modus operandi was no questions, no second-guessing, and very few second opinions. Today we live in a more skeptical world with more knowledgeable patients who have access to a lot of the same information that doctors do. We are paying much more for health care, undergoing more delicate procedures and we want all the information we can get. Patients today also want to have the time to discuss their particular medical status with the doctor.

Several weeks ago I was having breakfast with a group of friends when one of them began describing several recent encounters with professionals in the medical world. “I felt dismissed, put out to pasture, insignificant,” she lamented. “First it was the eye doctor who several months ago told me to prepare for cataract surgery before the year was out. Suddenly he was asking, ‘Why do you want to bother with cataract surgery at your age?’” (My friend is 78 years old, an active woman who plays golf, gardens and does a number of handicrafts.)

Her next dismissive experience was during an annual physical. “My blood pressure was taken, heart listened to. I was weighed and my height measured. No blood tests, no discussion about any recurrence of past health issues and no medications. Dismissed!”

“Girls,” she said, “that wasn’t the end of it. I went to my dentist for my annual cleaning. When the hygienist finished, the dentist came in and peeked into my mouth.” Our friend sighed and went on. “Good job,” the dentist said, “nice and clean.” And left. No X-rays, no probing, no questions. “Just slam, bam, thank you ma’am, “ she said.

“I thought I was still standing on the right side of the grass, but these guys gave me pause to question whether or not I might have one foot on the other side!”

Of course everyone jumped in to assure her that was not the case and shared similar experiences. My personal favorite is about going to a specialist for the first time and being seen by a physician’s assistant, then being dismissed. “Oh no,” says I, “there’s no way that I have a first appointment with a specialist and then not be seen by him.” I held my ground and waited to have my time with the doctor. When it was over, I gave the doctor my take on the situation. I never saw the physician’s assistant in that office again.

Often we hear that doctors have less and less time to spend with patients because of reporting responsibilities. It’s like calling for help from the police station and being told that all officers are filling out paperwork on the last incident and can’t respond. How can a doctor adequately assess the patient’s situation without adequately assessing the patient? Why did the doctor ask a key question (have you had a bone density test?) only when the patient suffering his second broken ankle was in the hall on his way home?

Why is so little time given to patients, when patients are the doctor’s business? Is it possibly a matter of dismissing patients of a certain age because of age? We hope not. Is it because the patient is a hypochondriac? Does it have anything to do with health insurance? Or last but not least, does it have anything to do with how a doctor is reimbursed?

Recently, there have been a number of newspaper articles and books written about the issue of doctor-patient relationships, and why doctors do or don’t spend time with patients. For those of us who are 65 and older, it is possible that age has something to do with how much time a doctor spends with us. At 65 your primary health insurer is Medicare. Medicare pays doctors for specific services. Fees are calculated to reimburse the doctor for the amount of time expended and the skill employed, along with payment for overhead or “practice expense” such as X-ray machines, CT scanners, rent and salaries.

Expensive services that involve special equipment and testing generate higher fees. This “practice expense” continues to be factored into the fee even after the equipment is paid for. A recent article in The New York Times concludes, “…the doctor-patient visit, which involves no expensive equipment, offers no significant profit opportunity. So the best way for a doctor to make money in his practice is not to spend time with patients but to use equipment as much as possible. That means moving the maximum number of patients through the practice, and spending the minimum amount of time with each one.”

Whether this is true is not the issue. Nor can the medical profession use the excuse that long years of training develop distance from patients. Or that doctors are working in a broken system. The issue is this: both the patient and the doctor have a responsibility to make every visit productive and successful. Having a medical degree does not give one the right to be rude or dismissive, no matter who the patient is. As for the patient, medicine has for a very long time now been demystified. All questions are good questions if they are yours. So ask away.

Be prepared before your visit to the doctor’s office. Write your questions down. Make a list of your symptoms and any medications you are taking. Take your health insurance cards and give yourself time to fill out forms before you see the doctor.

Speak up, ask questions about diagnosis, tests and medications. Be candid with the doctor and give him/her all the information needed. If you know you might be intimidated, take someone with you. Whatever you do, do not be dismissed until you are totally satisfied.

A recent book you might want to seek out is “You: The Smart Patient” by Lindsay Mergens.