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Discovering the Golden Years |
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This is the first sunrise of the New Millennium.
Doctor’s Attitude and ArtOnce your retired you will find that you will spend an
increasing amount of your time talking to Doctors. Before I retired I
didn’t really have a personal doctor. I got my physical at work and I
didn’t really have any chronic medical problems. I guess I’ve been very
lucky to have good health, but I suspect that my experience is very common.
Most people don’t tend to have any medical problems until they reach their
sixties. After retirement I gradually started adding doctors so that now I
have a chief internist and a collections of specialists for various parts
of my anatomy. Doctors expect older people to have medical problems and they
will find things to worry about. Their diagnosis is based on comparing your
physical parameters and test results against the nominal values of all
other humans. When they find something that is outside the nominal values
they will either send you to a specialist or order further tests. This is a
good reason to have established your own physical parameters at an earlier
point in life so that the doctors have a more specific personal reference
for their analysis. If you have established your own personal baseline you
will get better medical care. If you have had a parent living with you or
have participated in your parent’s health care, you have gotten a preview
of your future. Old age means that you will start to have increased dealings
with the whole medical establishment, which includes insurance companies,
hospitals, standards of medical practice, medical test labs, and
pharmacies. The way your doctor interacts with you is greatly affected by a
concern that his livelihood could be terminated by lawsuits. If a doctor
loses his malpractice insurance he is in jeopardy of not being able to
continue practicing. One thing that results from this mindset is a strong
tendency to order many extensive tests. And this situation is amplified by
the fact that medicine is an Art not a Science. There is science associated
with medicine, like x-ray machines and complex chemistry involved in the
development of new drugs. But the diagnosis of medical symptoms is inexact,
it is not Science it is an Art. There are many symptoms that can be thought
of as possible indicators of medical conditions. But very few symptoms that
specifically determine the existence of a medical problem. Instead we are
dealing with probabilities. There are also many cases of false positives.
Human biology is very complicated and there is a wide variation across the
population for all health parameters. The doctor also has to worry about what insurance companies
will be willing to pay. They are in a constant battle with insurance
companies to get their fees covered. Consider a simple case of a patient
who has high blood pressure. There are maybe twenty possible individual
medications that might be used to lower blood pressure. And then there
could be combinations of two or three different medications and there could
be variations on the strengths and the frequency of use. In terms of
optimizing the medication to the patient the time required is well beyond
the number of office visits that the doctor will be allowed to charge
against insurance. In fact I question the accuracy of BP measurements made
in doctor’s offices. I personally didn’t feel comfortable basing my use of
BP medicine on a single measurement in the doctor’s office. I would
typically measure my BP several times a day, at different times of the day.
I used 100 measurements to determine my blood pressure and found quite a
bit of variation. As a result I could be comfortable with final choice of
high BP medicine. This of course is not common medical practice. Another thing that you start to hear when you are over sixty
is that the doctor is concerned that any anomaly might be a symptom of
cancer. If there is any chance that something might be caused by cancer
they tell you because if they failed to tell you and subsequently find out
that you have cancer you are likely to complain about the care that the
doctor provided. I am also sure that patients are much more responsive if
they are concerned about having cancer. Much better to tell you that the
tests find no signs of cancer. I specifically included a discussion of
cancer diagnosing in this essay so that you will be expecting to hear it
from your doctor and it won’t strike terror in you heart. One final item that be of great assistance in dealing with
doctors is to have a through history. I think that your medical history is
best developed by you and your family over a period of time. I think that
responding to doctor’s questioning may stimulate your thought process, but
it is also likely that items will be overlooked. Start with you
grandparents and parents and document how they died. Document the treatment
and medicine that they received. Document what you know about their medical
history. Check with aunts and uncles if either of your parents have passed
away. Check with your own brothers and sisters they might remember
something that you have forgotten or never knew. Then list all the same
items for yourself and your brother sisters and children. The final document
that you have constructed is very valuable for everyone in the family share
it with them and pass it along to children and grandchildren. One general rule of getting good medical care is to take
charge of your health yourself. Keep records of what your own medical
records. I have frequently found that what my doctors have written down in
their records isn’t correct. They only think about you during the time that
you are in their office. You can spend as much time as needed to document
your health records are should be much more motivated to get all the
information correct. |
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