Hard Decisions

Image: Wikimedia Commons

Deciding whether to move after retirement, many seniors factor in the quality of medical care. After Tim and I moved, one of the first things we did was to find a primary care physician. Tim was content with our first choice; I continued shopping. Eventually, I found a doctor to my liking who four years later tried to fire me as his patient. 

We are the stewards of our health, and the doctor is the detective to diagnose when the train runs off the track. When the flu visits or bronchitis burrows in my chest, I visit my doctor to confirm my diagnosis, get prescription drugs, and ask how his kids are doing. It was a good relationship. The less I saw of him, the better. I assumed the feeling was mutual. Then one day, when I called his office to ask for a muscle relaxant to ease back muscle spasms, I was told he wanted me to see me. Hobbling from house to car and car to office and finally sitting on the edge of the examining table, he walks in. Long story short. He said that I was using his office as an urgent care facility. That was true enough. He was getting marked down by Medicare because I didn’t do physicals and refused all routine medical tests. Unfortunate. I told him I ordered my blood work, and if anything appeared outside the normal range, I’d be showing up on his doorstep. He said, “Well, you never share those with me.” To bring levity to the conversation, I said, “You are a busy man.” I thought it was funny. It didn’t even make him smile. 

In any case, we came to a compromise. I would come and see him annually, do the blood work, the Cologuard test, and turn down other suggestions. It was the price I’d pay to continue seeing him for urgent care. Thoughts like hostage situation and what is a primary care doctor for sprung up, but I agreed to the terms. Then came another office visit for him to tell me the blood work was normal. Then another call for me to to see him about the Cologuard test. Let me digress. This is what I didn’t want—more office visits, more worries, and more tests. But here I was, just like that, caught in the net of the medical community with good health insurance which I’ve concluded is a mixed blessing. 

“Your stool test came back positive,” Dr. Detective says after a short greeting. He explained that normally the next step was a colonoscopy. He made it sound like I was not in the normal group. We discussed the error rate of Cologuard, the fact I’d never had a colonoscopy, etc. “The test is wrong,” I said like a stubborn child. He waited. “What would you do in my shoes?” I asked. He paused several seconds, “Because of family history, I would do it to reassure myself.” When I left, he asked that I let him know what I planned to do.

I abhor bad news about my health. We all do. Now I started worrying, which for sure is not good for my health. I kept the news to myself and Tim. Days later, I made an appointment with a gastroenterologist. Prepared with questions, but before I could ask the first one, Dr. X glanced at my sheet and said, “I can tell you right now, that I will recommend you do a colonoscopy.” He’d done 10,000 without a mishap. “Poor diet and lack of exercise are not the only things that can create a problem.” He said he could schedule me in three days and I would be in and out in 15 minutes. His cavalier attitude made my decision easy; I was not inviting any scope to slide inside me. At least not for now. For ten minutes of his time, my portion of the bill with my good insurance was $125.

I called my detective and asked him to order another Cologuard test. Yes, this one wouldn’t be covered by my good insurance. Three weeks later, a call from his office came to tell me that the test was negative. “We recommend you do another one in three years.”

Why such a visceral reaction to undergoing a test that saves lives? After all, colorectal cancers (combining colon and rectal) is the second most common cancer death in the world. (cancer.gov) It wasn’t the pain and discomfort. Probably partly the feelings of embarrassment and vulnerability. Complications occur in about 1 in every 350 colonoscopies (perforations) (How to Ease the Pain of Colonoscopy). Death is rare. But if you consider 15 million are performed annually in the US, that’s 15,000 Americans every year. In my mind, it was a question of the risk outweighing the benefit. 

Also, why do US doctors continue to recommend colonoscopies when other countries recommend less invasive colon cancer screening methods? Could it be? “… most physicians in the world don’t get paid by the procedure. As one gastroenterologist put it, ‘Colonoscopy is the goose that laid the golden egg.'” (Risks vs. Benefits of Colonoscopies) “A New York Times exposé concluded that the reason doctors rake in so much money is less about top-notch patient care and more about business plans maximizing revenue, lobbying, marketing, and turf battles. Who sets the prices for procedures? The American Medical Association, the chief lobbying group for physicians. No wonder gastroenterologists pull in nearly a half-million dollars a year.” (Dollars for Docs)

Two additional reasons were previous medical decisions I went along with that caused harm. I’d not asked of possible alternatives or done my homework. A friend with back problems wonders if surgery would help. Another is holding back from taking pills to ease her arthritis. What to do? What if the first Cologuard was correct and the second wasn’t? A residue of fear can remain, but making the decision myself was also empowering. If a mistake is made, let it be mine.  

According to the Cancer Treatment Center of America, while the exact cause for colon cancer may not be known, several factors are firmly linked, diet, smoking and drinking. Also, with a family history of colorectal cancers, you have a higher risk.

Setting aside drinking, smoking, and family history, how does diet protect? In a nutshell, backed up by comprehensive gold-standard research, we must feed the good bacteria (butyrate) in our colon. Fiber is the food of choice that protects the colon from cancer. If we were talking to the good bacteria, the butyrate, it would be, you scratch my back, and I’ll scratch yours. An army of butyrate in our gut can stop cancer in its track. But we can’t just eat well a day here and there; we must commit to eating fiber-rich food (whole plant foods) every day. While not a 100% guarantee, I bet it’s the best health insurance plan offered in the US. 

This may not be the last time I’m called on to make a decision, deciding if to do this or that test. People in white coats will give their opinions and friends who want me to stick around for another German beer and pretzels will share their views. 

My son Jens, the person who will make end-of-life decisions for me if Tim can’t, is taking his responsibility seriously. Last time we were together, he noticed a hangnail on my left thumb and asked, “Mamma, is that a hangnail? Do you want to go on living like this?” 

Living on the other side of 70 makes it a less emotional decision than if I was 30 with kids or a recent empty nester at 55. But my empathy for others in the same circumstances has grown. These are hard decision to make.

2 thoughts on “Hard Decisions

  1. I tried posting a comment. Let me know if it worked. It asked me to sign in to WordPress which I didn’t want to do. Thanks! Keep writing sista!!

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