Navigating the System: Learning to Say No

Since 2010, when I was sixty-one, I’ve dealt with three major health issues: coronary artery disease, which led to two stents and one heart attack; a prostate cancer diagnosis, which led to a radical laparoscopic prostatectomy; and degenerative disc disease in my cervical spine, which led to removal of a disc, the fusion of two vertebrae and shaving bone spurs that were compromising my spine. Not exactly the decade I was anticipating.

I didn't always need this much care

Prior to 2010, my biggest issue was a kidney stone in 2007 that got very complicated and came close to having consequences that could have landed me in the hospital for a long time; or worse.

In every case I feel that I received excellent medical attention from highly qualified specialists, all of whom treated me with great respect and, when necessary, patience. I am, currently, quite healthy and my daily regimen of medicine includes only a low dose aspirin, a statin and a couple of supplements. All of my most recent check-ups with specialists have been positive.

Am I just a medical chart?

But recently I had an experience that made me feel like a medical chart more than a healthy, active seventy-one year old man. The physician’s assistant I’d been seeing for years moved, and, dealing with some tinnitus, I made an appointment to meet and establish a relationship with my new PA. A somewhat comic scene ensued.

After nearly a decade of many tests, scans, screenings, surgeries, recoveries, etc., I generally don’t look forward to medical appointments. I’m reluctant to agree to more of the above, unless, of course, something serious needs attention. Tinnitus is not serious, but it was a good enough reason to get started with a new PA, and, I thought, maybe the problem was being caused by wax build up which could be reasonably remedied.

Pigeon-holed an an older man with health issues

I was on time for my appointment and promptly found myself in an examining room. While waiting, I noticed that my new PA graduated with a degree in science in 2013. Quickly doing the math, I estimated that she would be somewhere in her late twenties or maybe thirty, and when she walked in the room, I knew I was right.

I don’t practice reverse ageism. I know how competitive and how hard it is to excel in science and medicine (she had attended excellent schools), so I wasn’t worried about her knowledge and relative lack of experience. What concerned me was how she would view a man my age with my medical history.

I'm not interested in piling on the tests

My new PA was personable and friendly. I didn’t feel like she was in a rush. So far, so good. But then she looked at my records and started asking questions:

“I see that a bone scan done following your cancer diagnosis revealed osteoporosis in your hip. It’s probably time for another scan. Would you like one?” “No.” “Since you don’t want another scan, would you like me to prescribe medication to help with your condition?” “No.”

“Have you had your flu shot? “No.” Would you like one?” “No.” Have you had your pneumonia shot? “No.” Would you like one?” “No.” “For people your age we recommend having a test for hepatitis C. Would you like one?” “No.”

And on in went. I felt like a defiant two-year-old, but eventually I just started laughing. “I know you’re doing your job, but you must understand by now that I’m not interested in more tests, needles and medicine. I’ve had my fill for the foreseeable future. I’ll let you know the next time I see you if I’ve changed my mind.”

I'll advocate for the care I do & don't want

I’m not a conspiracy theorist. I don’t see Western medicine as an opportunity for people in the profession to leverage money out of me at every opportunity. That hasn’t been my experience. But, as I age, I think it’s even more important for me to be my own advocate, to not succumb to what can feel like relentless pressure at times. And it’s also important to maintain a sense of humor about it.

Another serious challenge will present itself down the road. In the meantime, I’ll keep that defiant two-year-old handy. And, by the way, the tinnitus? Old age!