Where did the doctors go?

I don't know if it bothers my children. It’s not something that seems to bother my parents. But I don't understand where my doctor went.

Remember those medical practitioners who did your check-up? When you went to their office they nearly always provided you with one stop shopping. "Take off your shirt and pants the doctor will be right in". The nurse (I do mean Registered Nurse) actually means to say: after you begin to turn blue with hypothermia the doctor will be in. I've stopped complaining, because when the doctor arrived they did an examination. Remember cold stethoscopes, palpitations, prodding and poking? Diagnosis? Each new physician as long as I can remember would discover that my liver is not quite where most people keep theirs. Long ago I learned to wait for them to reach that point below my ribs and then tell them I knew what was concerning them. It had become my personal lie down comedy routine.

I don’t understand where the doctors went.

Today I take a parent to the doctor. We're taken to the exam room by an assistant, it's still chilly, but now we keep our coats on. The exam seems to be primarily talk therapy: how do you feel, have you been taking your meds, are you changing your behavior? I wonder sometimes if we're at a psychologists’ office. No. This is the modern doctor, a provider who spends more time doing data entry than touching. Patient care is determined by tests which are administered off-site. This is one of the joys of modern medicine; art is only used as a defense to explain errors. Medicine is a statistical study. In California doctors are required to examine patients prior to treatment. This is supposed to provide the patient with better care, and it seems to be the most reasonable of arguments until an insurance company or Medicare become involved. Those agencies seem to be the exception. In both cases they are apparently able to determine the appropriate type and duration of treatment without patient contact.

Dad uses a wheel chair (please excuse for being indelicate here) and he has sores on his butt. Medicare and insurance will pay for a pad to prevent the sores, but only if they’re already severe. The doctor has recommended the pad, in the hope of preventing deterioration and infection of Dad’s butt. However insurance only pays for it if his butt becomes worse. Those determinations are made by a person that I'm sure has never even seen my Dad, with his pants on or off.

Do we need to change health care in America?

Of course we do, we need to find the doctors again; physicians who are trained in patient care, who are doctors rather than corporations, doctors who can diagnose and judge, doctors with the desire and ability to make contact with their patients.

My parents are totally opposed to a single payer system, they love Medicare. Sure they’re a little confused, but they grew up in another age. Do we need to change how we get treated? Yes. We need to stop letting statisticians that are doing cost benefit analyses control our treatment.

But first we have to find where the doctors have gone.

Elder Care

The surprise of being part of the "between generation" is overseeing health care for
your parents. Actually it's not a surprise; what is the surprise is
the level of duration and intensity of the activity. I was always
expecting a short period of need with a rapid end. After all, that was
my total experience based on what I had seen from my grandparents. My
grandparents were so considerate, living full and active lives.
They toiled with children through a depression and when their time came
they accepted support from those around them for a short time and
moved on as their lives ended.

Someone forgot to tell us that they can keep a person alive forever now. My parents are withering. The same pair that remained continually active is now nearly sedentary, often in pain, and nearly always
disagreeable. As true modernists they know that one more pill or drink of elixir
will make them well. Mom & Dad didn't help themselves when it came to
health. Many years of extreme alcohol consumption has taken a toll on
them. However this has provided me the opportunity to meet interesting people;
their doctor is becoming a friend, we've found common interests other
than my folks. The social worker at the hospital knows me by sight
when we pass on the street. She asked me once how I deal with the
challenges of parental care. I had to be honest with her "I drink". The
stunned look was worth every moment. I do drink but there is a lot of
difference between a quart of vodka and a cocktail in the evening.

Dad recently pushed me a little further into the parent role. We thought he had a stroke. He provided us the opportunity to experience the local emergency room in the evening, a very busy time. Following a battery of tests which included bloodwork, CTs and x-rays it became clear that Dad hadn't had a stroke that day. Rather he had consumed a great quantity of spirits. Doctors give lectures to children about parents in a much sterner manner than they do to parents who's child was injured.

I'm not sure when I became my father's keeper.

I think my parents operated under the same misconception as me
(maybe that's where I got it): they saved and invested so they would be
able to enjoy their golden years. They just didn't know health care
would be able to keep them alive forever.