Medicine, A View From The Bottom Of The Pyramid……….

America loves it’s doctors. As we age, we become exposed to an expanding group of these intelligent purveyors of care. In fact we place our lives in their hands, often following their suggestions and advice without bothering to become acquainted with the reason we are standing in front of them. In todays tightly controlled medical care environment, relationships are difficult to form in the insurance allotted 10 minute office call. The doctor is listening, of that you may be sure, but his or her other eye is on the clock. You should also know that all doctors are not created equal. Blasphemous you say? Read on.

When you get to our age, stuff wears out and breaks. Just like an automobile, maintenance is required, speaking of which I was once closely associated with a fine group of mechanics at the Highway Patrol garage in Jefferson City, our state capital. As good as they were, some were better than others within a specialty, and the supervisors knew who they were. We even had an “oil expert” on staff who had graduated from a specialized school where the nuances of motor oil were taught at levels far above multi-weights and brands. Our head mechanics recognized excellence and pursued it relentlessly. Back to medicine. As we age, our care providers must add a strategy to their bag of tricks in caring for us. Age related care requires adherence to the “4 M’s” of care. That is Medication, Mentation (memory and mood), Mobility and what Matters to us. These issues present far differently in older people as opposed to younger. They are also difficult to address in a 10 minute sound bite with the insurance company holding a stop watch when the doc walks in. Geriatricians are hard to find so as an alternative, seek a practitioner who adheres to the 4M approach.

Make this happen………..

I recently visited with an old Patrol friend that I have a very high regard for. He, like all of us, has a few nicks in his armor and a system or two that is not performing at an optimal level. He is under the care of a, presumably, good PCP who is helping him manage a problem with the electrical system in his heart. I know about these things as there was a time when you could not take my pulse accurately as a result of an excessive number of premature ventricular contractions. My PCP said that I needed the services of a electrophysiologist. Sharon and I sat down with a book entitled “The Top 100 Doctors In America”, scrolled through to the cardiologist section and located the top world ranked specialist in electrophysiology. We made an appointment with the doctor at the Cleveland Clinic Hospital in Cleveland Ohio. This is the top ranked heart care hospital in the world and has been for 20 plus years. We travelled to Cleveland, met this doctor who diagnosed the problem and two ablations later, my heart is purring right along with the best of them. He also diagnosed a pesky valve problem while I was there, and I found myself on the table for open heart surgery a few days later, without which I would not be here writing this piece. With all due respect to my home town cardiologist, he was throwing pills at a problem that was killing me. A center of excellence extended my tour of duty on Mother Earth. I queried my then local cardiologist and he replied, sharply, “we can’t all be the Cleveland Clinic”. Indeed.

I’ll wrap this up. There are many fine doctors practicing in America and God bless you if you are associated with the best of the lot. Do not be afraid to seek care in centers of excellence when a new and potentially life altering malady rears it’s ugly head. Assemble a team of local talent. I would put my team of practitioners up against any team, but have worked through a number of docs to get there. My PCP is an excellent quarterback, backed by one of the best cardiologists in a four state region. I have an out of town urologist that is a wizard with old man issues and a nationally recognized hand surgeon to stand between me and arthritis. Is your team meeting your expectations? Do you clearly understand the maladies you are dealing with? Are you willing to travel to internationally recognized specialists to help with the big issues? Is your doctor practicing the 4 M’s? If you are in or near my generation, you have paid your dues. Seek and meet with the best available to keep you around to aggravate the younger generations with earned wisdom and opinion. In short…..take care of yourself.

Have a great week!


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