By Delia Berlin
Our health status does not change instantly when we turn 65. But for most Americans, their medical insurance does. This, in turn, triggers other changes. Neither patients nor their health care providers can escape the transformation that suddenly affects preventive exams and routines.
It could be said that as we hit Medicare age, we become metaphorical zombies. You may know that there is an entire genus of fungi that parasitizes insects and converts them into zombies, who live the rest of their existence exclusively satisfying their parasitic fungus’ needs. In this allegory, the corporate health care system is the fungus. Both patients and health care providers are zombies, forced to go through senseless motions to keep feeding the parasite. The following fictitious examples may illustrate some of the zombie motions that our parasite requires from us.
You wait for 20 minutes in a doctor’s waiting room. Finally, someone appears at the other end of the room and calls your name. You get up from your chair and follow the person into an office, where you are offered another chair to wait some more. In a while, someone comes in and asks you to step on the scale. You get up from this second chair and comply. Then, the person proceeds to ask you the same questions that you already answered in questionnaires previously mailed to you and, for good measure, also online. One of the questions asks if you have trouble getting up from a chair. By now, you have been seen getting up from a chair more than once and without any trouble. But the question must be asked. And answered.
You arrive at a health care specialist’s office and announce yourself. You are given forms to complete. One of the forms asks if you had a flu shot this season. According to the CDC, as of mid-November, there have been 330 flu deaths in the US this year, and just since September more than 1,000 covid deaths have occurred in the US each single week! Also according to the CDC website, only 17% of the total US population received a bivalent covid booster last year. While the CDC still shows no intake data for the newly updated covid vaccine, early indications indicate that it’s been dismal so far. Yet, nobody asks you if you have received an updated covid shot. But you are asked the question that must be asked, and you do answer it.
You completed five lengthy questionnaires prior to a doctor’s appointment. Some of the questions clearly relate to your mental health and social support system. Several are quite intimate, such as frequency of church attendance or sexual activity. You may also share other related information, like family difficulties or losses, but during your actual appointment there is no acknowledgement or exploration of these subjects. You then hear that the office cannot locate your printed questionnaires. Now you wonder if your religious or sexual practices may have become public information. There was no benefit to the providers or you from asking or answering these questions. But both parties cooperated in their zombie dance.
I could list other examples of Medicare “wellness” practices that provide no benefit to patient or medical practitioner. They are as distracting and useless for one as they are for the other, but they must be followed because they are part of the established protocols. All the fields in the fungal databases must be checked off.
Some of these protocols may have started with good intentions. It would be fine to determine if patients are socially engaged, if something helpful could be done with that information. But in the absence of such interventions, those questions are at worst intrusive and at best a waste of time.
The times when one could walk into a doctor’s office and openly share concerns, while the practitioner listened and acted solely according to experience and knowledge, are over. Doctors, selected from the best and the brightest and put through years of grueling training, are now unable to freely use their own brains and instincts for many of the problems they encounter. Burdened by the protocols established by their employers, mainly to maximize profits and minimize liability, many doctors are experiencing burnout and 20% plan to leave their field within two years.
The US spends more money per capita in health care than any other country in the world. Yet, our life expectancy is declining and is now five years lower than in the UK. I remember that my grandfather was reluctant to go to the doctor. In my youth, I saw his reticence as stubbornness, but recently a delayed sense of empathy woke up in me. Sorry Grandpa, I can hear you now.