Thursday, June 18, 2009

Medicare initial physical: My take used to be "never go to the doctor" (you know what happened to Letterman)


When I went to renew my prescription of the “chemical angioplasty” drug atenolol (which is so cheap anyway) this time the doctor’s office said, nothing doing. It seems that when you turn 65, not only does Medicare pay for one complete introductory physical, it is almost mandatory. Until 2004, however, Medicare had not paid for “routine physicals”.

I found a link describing what the physical comprises. About.com has a similar link here. AARP has an explanation here (your Part B coverage has to begin after Jan. 1, 2005). It will certain include a 12-lead electrocardiogram. I think it will probably involve scheduling a colonoscopy.

When I worked for ING (I was “retired” at the end of 2001 during the post 9/11 downsizing) the company paid a wellness bonus for taking an annual physical, which I actually took (in Minneapolis) just before the layoff announcement. There were about $400 of covered bloodwork, including liver, kidney, heart hormones, prostate hormones, etc. That’s when the beta blocker started. I was 58 then. In fact, until my 40s, my blood pressure had always been very low.

What I dread is the “David Letterman” situation. You go to the doctor, and you don’t go home. You know what happened to Letterman in January 2000 (admittedly, he wasn't a "senior" yet). Emergency coronary bypass surgery. He didn’t even have many symptoms, and he wound up in the defaced zipper club. Even Esquire made light of it with rotoscopic drawings of his new chest. A weekend angioplasty, as what happened to Charles Gibson (ABC news anchor) is all right; he went back to work in a couple days and showed the angioplasty photos on television.

And then there’s the issue of prostate. Most men will develop some prostate cancer, and most of the time it is very slow growing and they will die of something else eventually if nothing is done. Rudy Giuliani had his treated aggressively, but I don’t know what subtype he had.

My own father died and passed to his reward, of suddenly and widely metastasized prostate cancer at age 82 on New Years Day 1986. He had a long active life (still substantially longer than average for his time) and had been ill only for four weeks. I think he knew what the radical treatments could be, and felt a sense of shame at the idea, and preferred the quick result that happened. Prolonging the end with such treatments violated his own personal moral convictions, and I know only too well what his convictions were, as he raised me. His had been a life to celebrate, up to the very end, with no real medical hardships, no soap-opera-like emotions. The funeral was not a mourning, but a remembrance of an epic life that had spanned eight decades of American history and seen almost everything. It was a life that would shape my own values for a world that would change, oh so radically, to seem almost like another planet by now.

I think that medicine needs to take a deep breath, and do a lot less sometimes, and give the patient the choice to resist undignified body snatcher invasions. But Medicare, along with the malpractice threat, and along with a strange perversion of pro-life ideology and familial emotion, is subjecting many seniors to humiliating ordeals that they probably really don’t need. With chemotherapy, for example, sometimes “cure” is worse than disease.

My physical is June 24. I keep my own fingers crossed.

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