Saturday, July 27, 2019

Retrospective #161: Why Go to the Doctor?

Why go to the doctor, seriously. When my doctor of 21 years died in 2012 (the one I eulogized in Retrospective #95), my medical records were transferred to the internist/cardiologist who used to ‘cover’ for him. At my first appointment, after the physical/history, the doctor asked me what he could do for me. I said I would like to be seen 3 or 4 times a year, to which he replied, to my surprise, that that didn’t seem necessary to him.
What did this tell me? It told me that, from his review, that I was a fairly “healthy specimen” compared to the rest of his patients. I think his view of me was also influenced by my comment that I thought my previous doctor, of whom I was very fond – he saved my life, I used to tell him – had perhaps “milked the system” to help “pay the rent.” I say this about others too, like my auto mechanic: I know I am helping him make his boat payments.
What this also told me was that my desire to be seen 3 or 4 times a year was driven by me – that it was not “medically necessary.” Of course, my desire was influenced by the fact that I am on Medicare and have good supplemental coverage. The result is that, I have no co-pays and a low annual deductible. So, I have “no skin in the game” and can see a doctor as often as I want. I think this is a lousy way to pay for medical care, but it is what it is.
My desire to be seen 3 or 4 times a year also provides insight into what motivates me. Now, no offense intended, doc (I think he reads the column sometimes, and certainly will read one titled “Why Go to the Doctor?”). But I don’t go to see him for his personality. Although his is great; he is always positive, conversational, jaunty, indeed, almost bubbly. And, interestingly, besides being board certified in his specialties, he holds a PhD. How cool is that!
What reason do I have for more than, say, an annual or semi-annual visit? The answer is to monitor the metrics that I use to track my diabetic health. I put the emphasis on “that I use because the metrics that I use are very different from the ones my doctor uses. I just want to point out and stress that, if you do the same, that is, rely on the standards that your doctor uses, you do so at great risk to your health. I’m sorry, doc, but that’s the truth, folks.
Understanding this point is crucial to the Type 2 diabetic who is taking responsibility for his or her own healthcare and who has chosen to do it “through diet…mostly,” in the words of David Letterman in his 2013 conversation o with Tom Hanks (See Retrospective #160 below). If you leave it to your doctor, you will learn that Type 2 diabetes is a “progressive” disease, and you will be monitored at annual or semi-annual appointments until you “graduate” to being diagnosed a Type 2. Then you will be prescribed, progressively, oral or injected medications. Congratulations!
So, to repeat, if you leave the evaluation of the measurement of your health to your doctor, most of them will rely almost entirely on the standards which they must follow to assure that you’re covered and they get paid by your insurance company. If you do this, you will, in my opinion, be poorly served. That’s a bit strong, but it’s the truth.
Bottom line: the reason I want to see my doctor 3 or 4 times a year is for a LAB REPORT. And until I have him trained (sorry, Doc) in what I am interested in knowing each time I go, knowing what my insurance will cover, I usually have to ask for what I want tested. Of course, his office weighs me and takes my blood pressure, as I do at home. I also test my fasting blood glucose daily, for discipline and as a reminder and a check on what I eat. It’s the other blood tests that I want: the metabolic panel, the A1c, the C-reactive protein (chronic systemic inflammation), electrolytes, and once-a-year thyroid tests and kidney function tests (eGFR, urea nitrogen and creatinine).
Last week a copy of my most recent tests arrived in the mail. My doctor is good about that; I don’t have to request it, and the lab report is accompanied by an evaluation letter. That’s nice. My blood pressure, by the way, was 110/70 (on meds). My lipid panel: Total Cholesterol = 186; HDL = 80; LDL = 92; triglycerides = 56; Non-HDL = 106; A1c = 5.5. Fasting glucose was 102mg/dL. I don’t know how that happened. It was 93mg/dL before I left home.
With lab reports like this, going to the doctor 3 or 4 times a year is something I look forward to. I think my doctor does too. From my perspective, it motivational. From his, it’s not having to badger and cajole me. It’s a pleasure.

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