This is not a cheery post. I am going to rant about health care. A bit. You don’t want to read my complaints. It’s what old people do, complain about their health. Except I’m not going to complain about my health; this is about my health care. In the mean time, enjoy the herons on the shore.
Everyone I know seems to have a terrific doctor. One recently spent an hour with her doctor. I read that Facebook note several times. An hour. I have never had a doctor spend an hour with me, not for anything. Even with a 40-minute appointment, the nurse is with me for several minutes doing all the tests, and then the doctor? Never long.
Although I’d watched my mother suffering from osteoporosis, my previous GP insisted on telling me I’d be in a wheelchair if I didn’t take Fosamax to improve my bone.
NOTE: I’d begged my health care provider for a baseline DEXA test in my late 40s and early 50s. She would not do it. I began testing in my mid-50s. Then in my 60s my scores came back bad. Terrible scores—”The worst I’ve ever seen! I can’t believe you’ve never broken a bone!”—but those scores were later deleted from my medical history and the machinery at my local hospital changed between each test and the machines are not interchangeable. That is, scores are inconsistent from machine to machine and also from radiologist to radiologist.
Before beginning Fosamax, I sought a second opinion about my bone from a specialist at Health Sciences. It took six months to get that appointment. He didn’t (wouldn’t) look at my medical history, talked more about inter-hospital rivalry than my care, and his notes about me were inaccurate—cited results from tests I hadn’t had, noted I was “unmarried” and “elderly.” (I’d been married over 40 years, had a wedding ring on, and “elderly” starts at age 65, but I was still in my fifties.) I went ahead and took Fosamax despite his useless encouragement.
When my next visit to the local doctor was all about the DNR, I gave up. Honestly, she read the entire pamphlet aloud to me, despite the fact that she didn’t have a form to give me or because of that, and even though I’d explained to her (twice) that I was familiar with the forms and had helped my mother fill them out three times! The local hospital could never find the forms she’d already signed, so three visits in a row she had to sign them again.
My doctor sent me a note that she was pleased about my improved DEXA scores. I sent her a note back that this was on the fourth or fifth different machine, different tech, different reader. After that, I finally gave up on Fosamax and her opinions. The slightly improved score may have been meaningless.
It’s fair to mention that my mother did everything exactly wrong in terms of diet (terrible) and exercise (none). She had 25 different pills in her med drawer when she died and had been on Fosamax for over ten years (they recommend no more than two years these days). She’d broke her second hip and the surgeon shattered her pelvis trying to replace it. Fosamax will increase calcium in bones, but it also suppresses healing of minor injury, which is one reason people on that med sometimes have spontaneous fractures from minor injuries—my mother did. In recent years (recent by my standard of watching for all my life), the same med is given in America to young racehorses to make them test strong especially before sale and is one of the reasons so many horses die after breaking a leg on the track.
All of this to say, I lost faith.
That is why I didn’t see a doctor for years.
Spend an hour with a doctor? Maybe twenty minutes, including reading the DNR booklet, is the most I have had, until my new Portland doctor talked me through about my blood pressure (and she will deal with only one issue/visit). It is 123/76 today, which is good enough, though before menopause I was 90/60. I have recently cut back on salt, cut a glass of wine/day to a glass a month, cut back on salt and sugar, shifted to cotton and wool running gear, and kept off the weight—121.8 pounds this morning, 22.3 BMI. I walk miles most every day (got wet this afternoon) and run short distances. I try for 8 hours of sleep/night, but usually get 7. I have never smoked, and only tried drugs when I was a teenager. I am vegetarian and eat organic with fruits, berries, vegetables, and nuts most every day.
I do what I can.
When I had appendicitis the post-op instructions they sent me home with were for another procedure I did not have. The surgeon was annoyed when I went back to ask for specific and appropriate instructions. No apology, just “the instructions are pretty much the same” and get out of my office.
I know there are good doctors who care about their patients. I’ve appreciated them during my seven decades, but they move away or retire, or are only local for a month or for the experience. We need more doctors. Left to the younger members of the medical establishment, we’d probably have them. It was the old guard who wanted fewer doctors to enable them to charge more, and who opposed universal health care. There ought to be many specialists training to work with elderly patients these days—I am elderly now—but it’s not a popular specialty so maybe I am too optimistic about the young. They do want universal health care. I say: send them to college for free.
I could not find a single doctor of geriatrics in Portland taking on patients. I could not get an appointment, not even after a long wait, to see a recommended doctor. I even asked for help from a former student who is exactly the sort of doctor I am looking for! People have offered up suggestions on Facebook, and I appreciate that. It’s very kind. I feel fortunate to have found a kindly, listening GP in Portland, but even she’s never going to talk to me for an hour.
So I will continue to do everything I can to take care of myself.
IMPERFECT PATIENCE 
I am sorry you went through all that.
My 50s were a wreck too, but because of my mother’s health rather than my own.
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sounds like you need a nurse practitioner!
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Yeah, no.
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A top-notch medical practice will have a physician’s assistant and/or nurse practitioner onboard who can step in during super busy times or when the doctors are away from the office. Look first for the top-notch medical practice.
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Most doctors don’t have the say over our schedules we would like to have. On an off day I could talk your ear off about osteoporosis care. Fosamax has good data, but there are next steps, and more now than there used to be. Which I am aware is not the point, and clearly your care was entirely not ideal. A new osteoporosis patient takes me an hour to do well, though it is hard to get to a specialist. There is a lot wrong with the system, but I don’t think it is related to the popular opinions that doctors want more money or are paid by drug companies. It’s more that we get burned out by the system itself, administrative demands, and then patient complaints on the other side, and we are trapped in the middle, unable to do the job we envisioned we would be doing. Possibly not unlike the current state of higher education.
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Admin always makes things harder for the people who actually know what they are doing. [Is it something they learn along with their MBA? Only half kidding.] I suspect doctors are like others who go to a career they care about—they just want to do a proper job, and things get in the way. My former students who have become doctors are genuinely compassionate and caring about their patients. I wish one of them were my doctor. 😉
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Although I don’t like the information in this reply, it is all true. Be very kind to really good medical personnel. We want to keep them on the job.
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I don’t know your specific situation there, but I would think Portland must have some top-notch medical people. I was told decades ago, look for a practice that has high marks and do your best to get in there. I did that almost 40 years ago and though I didn’t get the doctor I requested, I got a new one to the practice who became one of the most highly regarded doctors in the city as the years went on.
She had to leave due to her own health and suggested a few of the doctors who are interned in her office. I chose one and sure enough, that doctor and I have now been together about 10 years and doing well, mainly because she too has become a well-known, well trusted doctor in the community and who has a good idea of the other top-quality doctors, one being her husband who is now Terry’s oncologist.
She also recommended a cardiology group to Terry 7 years ago when he was going to need something done for his heart valve. That group of doctors is now the premiere, most highly regarded group in the city. When Terry landed in ER a couple of weeks ago, he was put into a cubicle immediately, and given top care, while so many others were waiting in corridors and hallways. We heard his doctor’s name mentioned during the time as there were two other patients, one on each side, who were that cardiologist’s patients. Later when I mentioned all this to a cardiac nurse, she agreed that good insurance and good doctors gets you the best care, opening doors (and rooms) when space is tight.
My recommendation, find the top medical group in Portland and go from there. I would also recommend that you are always upfront with any medical personnel and advocate for yourself and your family members.
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A lot of advice here and on Facebook. My advice? Find a good practice early to the middle of your life. If you are fortunate to locate a thriving and strong practice, stick with it and fingers crossed it will continue to thrive. In our rural coastal community, we had three good doctors during our twenties, thirties, and forties, but they retired from practice and their replacements (I lost count) often did not stay for very long. The one doc still there and a NP [nearly all practices of any size have an NP or PA] were… not great. Changing caregivers within that practice required that I have permission from my currant caregiver, a minimum six month to two year wait, and virtually no options for someone different. I went looking elsewhere for another caregiver in the county, but the only practice taking patients that I hoped to hire would not take a new patients aged 60 or over. I was not yet 60 at the time, but Gary was, and I thought the policy was unethical [if not illegal age discrimination]. Most decisions by caregivers are not about money, but they claimed their “accountants wouldn’t let” them take patients over 60, so that was likely about the money. A few years later, when I tried again, I was told by another doctor’s receptionist that the practice as a whole had made this decision. I hoped there would be more opportunities in Portland, but found none of the practices recommended to me were taking new patients (I called six), and of course that might also be because of our age. Many doctors do not want to accept Medicare. I suspect if we’d found a practice in Portland twenty or more years ago, we’d have been fine. I have friends who did that. As it is, I am grateful to have found a doctor I like. She is part of a large medical system I do not love, but so far she’s been good. If she leaves or retires there will be choices.
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the fact is, great or good care exits
if you can afford it or know how to work the system
and you live somewhere relatively safe
there are things to be thankful for
there is always room for improvement
lives often hang in the balance
eventually we all take the long walk
until then may you live long and prosper
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We have an HMO which includes a Center on Aging where my primary physician’s office is. She once told me that the benefit of having a physician there is that they get to meet with their patients for 15 minutes instead of the usual 10 for the regular (non-elderly) patients. Wow. A whole extra 5 minutes. And while I generally like my primary physician, she’s quick to recommend apps … even for counseling 🤦🏼♀️
My husband and I frequently complain about how our doctors never do physical exams anymore. They don’t want to look much less touch your body. Even today my husband was saying he should probably go to his doctor’s appointments wearing shorts, a tank top and flip-flops so they would have to see his body. All of this is because of his several spinal stenosis which was compressing nerves and causing atrophy in his right calf which was obvious just by looking at his calves but he had to circumvent his primary physician and get an orthopedic doctor to recommend he see a neurologist before his primary physician would give him a referral. Then when he sees the neurologist, he’s told he has to have surgery asap otherwise he will eventually become incontinent and lose the use of his legs. I’m still mad at his now-former primary physician—she left the HMO and he has struggled since to find a doctor who would at least listen to him. Fortunately my husband gets good care at the local VA clinic.
Our health system sucks. It’s too fragmented and under capacity. One of my doctors retired because he just got fed up with the direction the HMO was going in. He was the kind of doctor who wanted to spend time with you, make sure all your questions were answered. And if he couldn’t answer a question, he’d find someone who could. I miss him. I saw how the system weighed on him and cheated me out of good health care. As the years went by, he was later and later to our appointments (mainly because he couldn’t stop himself from listening to his patients) and he was more and more harried as appointment times were compressed from 30 to 10 minutes.
Frankly, my cats get better health care.
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I hear you. Not touching? Yes, I can recall three visits in a row our coast doctor never once touched me. Maybe she never did. She was so eager to show me screens, but all the actual examination was by nurses. I was worried for years about my blood pressure because sometimes it was crazy-high, and all they said was: It goes up as you get older. Then I discovered the obvious culprits were menopause and salt. Lost weight, kept running, can’t do a thing about menopause, but I cut salt intake, and practiced breathing. I have concluded that doctors will help me when my appendix is about to burst, but actual “health care” is not in the program.
Yes, our pets… And vets are as highly qualified and nearly as well-trained, though over a shorter period.
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Veterinarians also have to diagnose without the patient being able to tell them how they feel. Meanwhile, my husband and I feel like we have to diagnose ourselves before seeing our doctors 🤷🏼♀️
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Doctors will complain if you self-diagnose, and also some will ridicule if you don’t understand immediately the significance of a symptom. I’ve experienced both from the same doctor. [When I’d been in labor for a day and a half by the time I drove home from a field trial in Canada—they wouldn’t believe I was in labor till I called the third time to say I’d lost my mucous plug—I asked what they were going to give me and what it was for. I heard the doctor in the hall angrily tell the nurse: Tell her to just take it! Not to mention two and a half more days in labor because they were convinced my five and a half pound baby was a three pound preemie because they got my due date wrong. In retrospect, I should have stayed in Canada to deliver.]
Now I too recognize I must figure out what ails me before I see the doctor. And I never bite or piss on the floor!
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There is so much truth to what you say, patients don’t get the care they need. I also believe that doctors are hemmed in by medical businesses whose first priority is the bottom line. Being a doctor (and a vet by the way) means a person is more likely to suffer from depression. I wonder if a lot of this has to do with a medical process that is focused on making a profit, just like medical insurance.
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