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Wednesday, 04 December 2013

Journal Entry: Plugged Back in to the Medical World

At my annual vision checkup a couple of weeks ago, Dr. O said my cataracts have advanced far enough for removal and an appointment was made with a surgical specialist.

That's where I spent the greater part of Tuesday – a visit scheduled for an hour to begin at 9:30AM, and I didn't arrive home until nearly 2:30PM.

No one had told me that cataract surgery is not allowed without a physical examination from a primary care doctor. I don't have a primary care doctor. Well, I didn't when I left the house in the morning; I do now.

I was mildly panicked when the assistant in the surgeon's office explained “no physical, no surgery.”

I've never spent much time with doctors and when, now and then, I lecture myself about finding one, none I researched who met my criteria was taking new patients.

(I always wonder if that means not taking new patients or not take new Medicare patients because they always ask what kind of insurance I have before answering no.)

An assistant at the surgeon's office (they specialize only in eye surgery) said that I'm not alone in lacking a physician and they often send such patients as me to one of several doctors in a group practice at the building next door. She gave me the name and pointed the way.

The desk assistant said there were no appointments until mid-February. I shrugged, decided I should think this through some more anyway and turned to leave - already resigned to living with the cataracts for longer than I had intended.

She called me back. Would I mind seeing a different doctor who would be free in 45 minutes? Since I knew nothing about the one whose name I had, I couldn't figure what difference it would make in my life and clearly the assistant – let's call her Jane – was going out of her way to see if she could help me.

We filled those 45 minutes with the de rigeur medical forms – Jane asked questions, I answered, she typed. Just as we reached the end, the doctor's assistant was ready to see me.

It was clear they were accustomed to the occasional cataract patient needing an exam before surgery. It's not a full-blown physical – just some general background, height, weight, blood pressure, heart rate, EKG, some blood work.

About exactly as much as I can tolerate or have patience for.

By the time it was finished, I'd spent four-and-a-half hours with doctors and their sidekicks who take notes, run the tests and stick you with needles.

The second biggest reason I am grateful for my lifelong remarkably good health is that I don't spend much time being poked, prodded and hooked up to various machines – yesterday was the longest in years and half of it was wait time I filled with my Kindle.

The exam went well or, rather, met my standard for going well which is: over and done with quickly. I like the medical assistant. I like the doctor and we decided he'd be my primary care physician. But they never let you off that easy.

Once you're plugged into the medical establishment, it's hard to escape. There are now in my near future, in addition to the cataract surgery, a mammogram, a gynecological exam and Medicare wellness visit.

Supposedly this is all good. Everyone says you're supposed to do these things regularly. I'm not so sure that's true, at least not for everyone. Not for me.

But there is some relief now in having a name to write down in the “primary care physician” box when it turns up now and then on a form and knowing there is someone who has a record of relatively recent test results.

Later, at home, I wondered if I should not have done this so quickly, if I should not have researched some more doctors – you know, check credentials, get the best.

I have never known anyone – not a single person in my entire life – who did not tell me, when talking about a medical procedure of some sort, that his/her doctor/surgeon/specialist was the “best in his field.” Whatever that means.

My new Dr. J may or may not be the best in his field. I wouldn't know how to judge that. But he's smart, thoughtful, personable, asks good questions and he's old enough to be well experienced.

Jane and the other two assistants I spent time with have all worked together for several years with Dr. J. It is obvious each one likes her job, is skilled and eager to help.

If I have reluctantly rejoined the medical establishment – which is apparently so - those are important credentials to me.

At The Elder Storytelling Place today, Janet Thompson: Riding the Rails on the Old D&RG

Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post


Mazal tov. Welcome to the club of peeps with primary care physicians. Grateful that your entrance was smooth, short, and "routine" versus all that we know, fear, imagine, hear, read. The suddenness of the requirement for a primary care person, and the immediacy of Dr. J's availability might be great gifts... no time to ponder, research, compare, etc. I'd prefer saving those due diligence hours/days/weeks to learning about the surgeon.

Let's see, Ronni - you are three years younger than me and you are having cataract surgery 3.5 years later. We must be on schedule! I did not know that you needed a primary care physician and I am amazed that you would be asked to see a gyn at "our age". I don't know how any of us unsophisticates in health care can possibly judge a physician - other than, do the personalities work together.
Good luck in your surgery and may you find it as life-transforming as I found mine.

Well, it sounds like you're off to a good start, if reluctantly. But, like insurance, the time to get a primary care physician is before you need to.

I am amazed that you have gone w/o annual mammo & pap tests.

I would not be alive today if during what I thought was a routine pap exam, my ob gyn found cancer subsequently treated by surgery, chemo & radiation.

Please do get on the horse and do so!!!!!!!!!


Consider yourself lucky that your doctor was chosen for you and you didn't have to go through a lot of aggravation to find one.

It's all a matter of luck, anyway. My BIL and I use to go to the track together and he would spend hours deciding which horse to bet on. He checked their parentage, running in the mud records, how often he won or lost to the other horses in the race, who was the jockey, how much does he weigh,etc.

Then the daily double would finally come up and he would bet on the horse he had researched and I would bet my house number and most of the time I won!

So, that's basically what you did, Ronni. You bet your house number on this doctor and you will probably win.,.

Welcome to our world. You are going to love the colors of your new world, and the mammogram/paps are a bonus leading to better health. Both my mother and Grandma wouldn't have lived as long as they did without the mammogram.

I stopped having mammograms and pap smears when I turned 80 with my doctor's blessing. It may be foolish to do so, but if I haven't had cancer (other than skin cancer) by this time I figure the odds of getting it now are very low.

I am not recommended stopping the tests, but merely stating my own case.

I agree that if you like the primary care physician and he asks the right questions you have a good one. Most of them refer you to a specialist anyhow if something looks wrong with your tests.

Good for you taking care of yourself. Life is so much better if you have good health. Every other thing is just frosting on the cake.

I have been "connected" to the medical world now for many years. I have a primary, an allergist, a cardiologist, and did have an ear, nose and throat specialist, but fired him due to, what I believe, were over zealous marketing efforts. I have had a few shoulder dislocations, back surgery, and nasal surgery, but everything else is preventative. I'd not trade my "staff" of doctors for the world and would encourage all seniors to stay on top or ahead of health issues. Good luck to all.

Sounds like you found a good doc who meets the most important criteria - he's good for you.

After a recent move, I chose a primary care physician based on friends' recommendations. She was awful because she and her staff were patronizing to the old folks and even bullying to her patients.

I went online and found one whose credentials were great, hospital affiliation perfect for me, etc. Found patients who liked him. Perfect, right?

The first time I saw him, he took a call on his cell phone while I was with him! arrggghhh..... He said it was important, he had to take it. In the old days, if such an urgent call came a staff member would at least apologize for interrupting and he would step out to take the call. I told him he I was very surprised and didn't appreciate him taking the call. He apologized, agreed he should not have answered, and I hope we can move forward on good terms.

Otherwise, I do like him, and I only need him so far for the annual appointment and referrals.

I think you've done well.

I had cataract surgery in February, 2013. Choosing a surgeon was easy because my husband had had the surgery several years before, and I nursed him through it.

It's interesting that cataracts requiring surgery occur earlier in pilots because of their exposure to higher amounts of UV light. I wonder whether miners and others with much less UV exposure would take longer to develop cataracts.

I rarely go to Drs. But I do have a primary care person just for the records. You can change them at a drop of the hat. Just via a phone call. It's no big deal. Though of course, harder to find a good one. One who is simpatico. So far, I have not cared for any of mine. But I am hard to please and they are necessary for just such a situation as you describe. Suki

Being a doctor's daughter, I've never been unplugged from the medical community. With primary care, I insist on someone I feel comfortable and confident with. And I've no patience with a doctor who can't book appointments and, barring emergencies, stay on schedule.

With a specialist or surgeon, I do a lot of homework checking credentials, experience, etc. A surgeon should have performed the procedure hundreds if not thousands of times -- and recently. Especially with eyes, since they only come two to a customer.

Cataract surgery, which I had about two years ago, is pretty routine and will make a huge difference in your vision. You'll wonder why you waited so long!

Like you, Ronni, I approached medics reluctantly if at all for a long time. Waking up one night almost unable to breath followed by some hospital time for repairs got my attention. Regular trips to my wife's GP followed. Last year, he walked me through the Medicare Wellness Exam hoops, and it was a good experience. The system can work, and I hope it does for you.

The book -----

Rethinking Aging (Growing Old and Living Well in an Overtreated Society)

by Nortin M. Hadler, M.D.

He discusses the value or non value of screenings --- most interesting read.

I'm with you about avoiding too much medicalization and excess screening. An interesting read is Seeking Sickness: Medical Screening and the Misguided Hunt for Disease by Alan Cassels. He makes the point that the promoters of screening overpromise on its benefits and downplay its harms. (Oh and by the way, I'm married to a doctor, so I've had almost 30 years of hearing first hand what medicine can and cannot fix.)

I had this procedure done last May. Went perfectly.
I was not quite ready for it
but because of being on computer a lot and also
Sjogrens dry eyes it was recommended.
I did not realize they are an implant and was given a special little card to show in case of a procedure that wants to know if I have any implants in my body :)
I rarely use glasses at this time. Only for super super small print.

Forgot to add
I have not had mamo/or pap smears since age 75 and now 79.
4 children, all my body parts and never any problem.
It is so nice to not have this done - will if I notice a problem.

Ronni, people in the big gap between the end of their last real job with health care benefits and the start of Medicare often bought "private insurance."

As has recently been widely publicized, these were terrible policies but they were the only option.

As has NOT been publicized, people with this insurance could probably find providers who would do all those screenings. BUT if anything suspicious was found, you didn't dare treat it, because the insurance company would cancel you in a flash and you'd be bankrupt, assuming your doctors would even continue to help you.

Illegal now, and it's about time. Those were the "good old days" of private insurance that some claim to be so nostalgic for.

As a result, I was last screened for anything about 1995. Obamacare and then Medicare will help a LOT.

Most countries don't do paps after 70 and up here in Canada we don't do routine mammograms after 75. You actually are very much overtested in the U.S.. At 70+ and no symptoms I wouldn't be getting a pap test either. If you were in a monogamous relationship I wouldn't be getting any after menopause. The dormancy rate for HPV is at most 20 years.

You seem to spend all your health care dollars on senior citizens and ignore the quality of life of anybody under 65.

Oh Ronni, all I can tell you is that I have become an expert dishcloth knitter as I wait in doctor's offices.
It's frightening to know how messed up things can get before you know it. I am living proof.

Many advances in healthcare are helpful; cataract surgery being one of those, blood pressure meds, etc. I've had the most wonderful, smart, attentive woman PA (physician's assistant) for the last 15 years, and I just got a letter saying she's going to retire. Best non-doctor I've ever dealt with so I'm pouting. But I'll provide my next doctor with an advance directive on the first visit and make sure they understand why I'm not going to show up for mammo's and colonoscopies after 70. Something is going to take all of us out, and when medicine starts trying to prevent that - that last journey can really get ugly.

My husband worked for a highly-rated HMO for 20 years and retired as one of the last group of employees to qualify for what is truly a "platinum" retiree medical plan. We are limited to doctors who are employed by the HMO, but to date we have no complaints--none at all.

We're both basically healthy and haven't had to spend a whole lot of time with doctors, thank goodness. However, we've both had cataract surgery on one eye and will need it on the other eye in the next year or two.

The surgery was totally problem-free for me--and, yes, I had to have a brief physical pre-op. Doing eye drops for 4 weeks prior to surgery was a nuisance, but two days afterwards, I could see very clearly out of the corrected eye. I'm a big fan of cataract surgery.

However, I'm no fan of medical tests for the sake of testing, so I have no problem that our HMO recommends stopping routine mammograms and colonoscopies after age 75. They cite evidence that the risks can outweigh the potential benefits except in high-risk situations, or if there is a suspected problem.

I've been lucky enough to have had Kaiser (one of the best HMOs in the country) for the last ten years through my partner's work. They make you pick a primary doc. First one I had was great; sympathetic and seemed to remember who I am. She moved up in the world and passed me to another. We are not so sympatico, but I have no doubt she's a good doc. I could switch to another, but she's plenty okay and we're getting to know each other. When I need a specialist, she passes me to one of their in-house ones.

There are lots of stories out there about people who had trouble getting their Kaiser specialists to deal with their complex problems. I suppose that is true. Kaiser thrives on keeping its members healthy and on dealing with obvious conditions for which there are standard remedies. If you have unusual problems, I can imagine Kaiser would be hard to push to care for them. But if you are reasonably healthy, Kaiser is great.

Oh, and I can usually get an appointment within a day or two if I need one and simple prescription orders by email or phone without a doctor visit.

I feel your pain! And I think you've done the right thing. You can still research, you know, and change doctors if you want. But meanwhile -- you're covered. Good!

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