My father-in-law Joe doesn't have a primary care doctor. Or if he does, he hasn't been to see that doctor in years. It drives my husband and my brother-in-law crazy that Joe is in his early 70s and never goes to the doctor.
Actually, it's not true that he never goes to the doctor. I remember he had some issue with his ears a year or two ago and got treated in the emergency room. So he does go to doctors if he has a problem. But definitely doesn't engage in any primary care.
As the doctor in the family, I'm supposed to be the one to convince Joe to see a doctor. But actually, I'm sort of on Joe's side with this one.
As I said, Joe is in his early 70s and appears to be in good health. He doesn't smoke or drink. He has had his blood pressure checked, and it's normal. He eats well and is skinny as a rod. He probably walks about 5 or 6 miles every day, maybe more. He seems to have lots of energy.
Even if his cholesterol is a little high, would it really help him all that much to go on a statin that might have unpleasant side effects? If he has borderline diabetes, is that really such a big deal at his age when the negative effects take years to accumulate? I suppose he could get cancer screening, but he's probably at an age where it's not worth it to do that either. Prostate cancer is generally slow growing, and testing isn't recommended for men over 75. I guess he could have a colonoscopy, but again, he's getting to the age where anything they could do that would prevent cancer probably isn't worth it. And if he has colon cancer, he's probably screwed either way.
He feels good, lives a healthy lifestyle, and I figure if he prefers not to take any medications or find out about any terrible diagnoses he might have, I don't see anything wrong with that. I suspect healthcare is over utilized in the elderly anyway, so I actually really respect his decision not to go to a doctor.
What do you think? Should Joe go to his primary care doctor or should his sons leave him alone?
I agree with you. It would be nice if the sons could adjust their perspective so they can just enjoy the fact their father is actively enjoying remarkably good health for his age. They're very fortunate.
ReplyDeleteI could introduce them to numerous adult children of older parents whose schedules revolve around taking their folks to see various doctors and help manage numerous medications for the same conditions you mentioned.
I agree with with you as well. I think healthcare is under-utilized by folks in their 20s, 30s and 40s and way over-utilized by the elderly. If older folks want to battle cancer and diabetes and blood pressure then fine. But if they re healthy and happy, I think it's very reasonable to forego screenings after age 70.
ReplyDeleteMy grandmother moved into an assisted living facility in her early 90s. At that time, she was diagnosed as diabetic & put on a low sugar diet. She told them that if she didn't get decent food, she would move out. She lived to be 96.
ReplyDeleteIt's just as well you didn't donate your proceeds of your book to the Red Cross. They do badly mishandled Haiti they have no idea where the money went.
ReplyDeletehttp://www.rawstory.com/2015/07/confidential-docs-reveal-red-cross-may-not-know-how-millions-donated-for-haiti-were-spent/
I'm probably going to donate to some deworming organization.
DeleteIt's just as well you didn't donate your proceeds of your book to the Red Cross. They do badly mishandled Haiti they have no idea where the money went.
ReplyDeletehttp://www.rawstory.com/2015/07/confidential-docs-reveal-red-cross-may-not-know-how-millions-donated-for-haiti-were-spent/
You get no argument from me. Joe's a grown man with all his faculties and can do whatever he damned well pleases. Even if his health wasn't so great, as long as he is mentally competent, it's his choice whether or not he wants medical care.
ReplyDeleteI agree with you 100%---you laid out your case so well, I can't see anyone dissenting! I personally don't just "go to the doctor" either, unless I'm sick with something I need a prescription for. what a waste of time (mine & theirs) and resources. Its true, many elderly people arrange their lives (and those of their children, who end up accompanying them) around visits to multiple specialists and end up with horrible polypharmacy and to what end? So numbers look good on labs that should never have been drawn in the first place? Makes me want to NEVER go to the doctor, and encourage my parents to stop going too!
ReplyDeleteOnly reason I can see for having a primary care doctor in his position is so that he doesn't have to go to the emergency room for the occasional acute problem that isn't really an emergency (perhaps whatever was wrong with his ears) since they tend to over utilize invasive diagnostic tests in the ER. Unfortunately, the current system in the US usually forces people into going to the ER or urgent care for non-emergencies anyway.
ReplyDeleteI think urgent care is a good choice for a problem that isn't an out right emergency, but doesn't fall into the category of primary care.
DeleteI'm somewhat unimpressed with urgent care. The ones around here mostly just seem to hand out antibiotics even when it isn't appropriate... but I'm sure the quality of care varies from place to place. (And, of course, some primary care doctors just hand out antibiotics even when it isn't appropriate too.)
DeleteIf I make it another ten years and am in your fil's condition I will also likely forgo anything that I deem is unnecessary. Save it for those who really need it.
ReplyDeleteI'm 76 years young and I only see my doctor when I'm called in to check thyroid hormone levels. Yes, I'm lucky. Yes, like Joe, I work at staying vertical with exercise and careful eating. Yes, some of my joints hurt from time to time but Excedrin Extra Strength - taken as directed - is my friend. My signature scent is Icy-Hot.
ReplyDeleteA visit to the doc in the past for head and chest congestion misery resulted in over-medicaion of antibiotics and steroids which made me feel even worse. An OTC nasal inhaler gave me the relief I was looking for.
I know kids worry about their parents, but Joe and I are the best judges of what works for us.
I'm a bit...flummoxed by the arguments that he should *NOT* go to the doctor. These arguments have the unspoken assumption that going to the doctor necessarily means you have to get treated. There's an incredible difference between living in ignorance and living with the consequences/benefits of not treating.
ReplyDeleteGot diabetes but don't want to treat? Fine, know that you might spiral into DKA or start losing sensation in your feet and have to amputate some day (or die of sepsis), or you may go blind from the #1 cause of adult blindness (diabetes). Your choice.
Got hypertension but don't want to treat? Fine, you might have yourself a hemorrhagic stroke or toast your heart and die from heart failure some day. Your choice.
Got arthritis but don't want to replace joints? Fine, but you can get advice on pain control. I saw an old vet at the VA who was taking 6000 mg of tylenol + NSAIDs every day for joint pain. He didn't have the foggiest that that was bad and his kidneys weren't that great either.
Etc. Etc.
My mind is always blown when people choose to live in ignorance. I would love to hear how this is not the case.
"These arguments have the unspoken assumption that going to the doctor necessarily means you have to get treated."
DeleteIf you're not going to be treated and you know for sure, what is point of being lectured about how you're going to die a horrible death? That doesn't sound very pleasant. On job as physicians isn't purely to make people miserable.
Hey Fizzy I can think of some physicians who job it is is to do that? Grease their own ego.
DeleteObviously, I wouldn't literally say the above things to a patient I was actually working with. Lecturing scare tactics is not my style. I think the avoidance of aggressive therapy is a completely valid attitude.
DeleteEssentially, what I'm reading is like saying you're just going to drive your car for as long as it will drive, and when it breaks down...that's it. Game over. That doesn't preclude you from getting your mechanics advice occasionally and accepting the risk when, say, your brake pads wear down. So you just avoid going over the Rockies.
I'm with Joe on this one. If he feels healthy then why fix what's not broken? There's some risk that there's some hidden disease that could be detected with some kind of test, but there's also a risk that he'll end up being treated needlessly because that test came back positive even though there was nothing actually wrong (see also: current controversy on mammograms)
ReplyDeleteI guess he could have a colonoscopy, but again, he's getting to the age where anything they could do that would prevent cancer probably isn't worth it. And if he has colon cancer, he's probably screwed either way.
ReplyDeleteUh, I'm not quite sure why having a screening FIT +/- colonoscopy wouldn't be reasonable. If there are polyps, these could be dealt with easily. An early stage malignancy could be potentially cured with surgery alone.
That's not to suggest that putting him on a statin or ASA for primary prevention makes much sense - the NNT is significant for either - but there's a big difference between appropriate medications and unbridled polypharmacy.
Ultimately, of course, it's up to Joe.
After 65, unless they're hurting themselves or someone else, they've earned the right to do as they please without getting hit up for it.
ReplyDeleteMy experiences with urgent care have been less than stellar, and it can be really difficult to get into see a doctor if you're not already in the system. That said, most primary care appts are a total waste of time for everyone. I was recently sick and everyone was all up my grill for not having a primary care doctor. It was really annoying.
ReplyDeleteGood point i agree.
ReplyDeleteI'm with you. Grandma is 101, and broke hip two years ago. ER doc shocked to find she's on no meds lives alone and drives a red sportscar everywhere. She feels fine and doesn't see the point in all the fuss.
ReplyDeleteI agree with you. I think some doctors focus only on fixing the current problem and not looking at the big picture and that's quality of life. My grandma is 87 and not doing well. But her family doctor is constantly referring her to this or that specialist, including a cardiologist who wanted to do a stress test on her. The type where she would have to go on a treadmill! My grandma can barely walk -assisted AND with a walker - from her arm chair to the bathroom like 10 meters away and they wanted her to do a stress test? To tell us what, that she has a bad heart? She is already on some many meds (which alone has caused problems because there have been some bad interactions that weren't caught). I feel like she's been "just" alive for the past 10 years and I don't want to go down that road.
ReplyDeleteI'm going to side with you and Joe and this doctor: http://www.cbc.ca/news/health/renowned-doctor-ezekiel-emanuel-says-75-is-good-age-to-die-1.2862410
As a Radiologist, and a soon to be 50 year old physician I've learned one thing: All of us are overrated. We are well meaning, and want to save the world. But the world (disease) is complicated. Bad genes dictate high intervention, bad lifestyles do too. For this e no in wither camp, we may not make a huge impact outsdie of basic are: HTN, etc etc etc.
ReplyDeleteAnd because I am really far behind.......regarding your FIL. YES, he's a grown man & the choice should be his not those around him. However, I'm going to play Devil's Advocate (sort of) since the following comes mind?
ReplyDeleteBy Joe having some of the recommended tests he'd not only be prolonging the healthy life style he's currently trying to live/maintain in order to live a long & prosperous life (he could find a treatable issue very early on) he'd also be affording his children, grandchildren, etc., an amazing gift by catching possible hereditary diseases/conditions/disorders early on?
Just another thought? Maybe?