An inadvertent physical exam

“Nobody does this …” Dr. D said as a greeting as he walked in holding the 700-word letter I had sent him some weeks before my periodic physical examination.

Half the letter addressed six issues that had arisen during the year and a half since my last physical. I thought, nearing age 62, that it’d be both efficient and prudent to provide my GP an update on my health experiences. Half a page devoted to that didn’t seem excessive to me.

The other half repeated my need to know Dr. D’s stance and boundaries around end-of-life matters, a subject which he deflected at my previous physical, citing youthfulness despite my turning 60 and being known to him as the author of a range of end-of-life reform works. I figured it was time to have a clarifying talk about this given my belief in aided dying and that the issue was set to come before my state’s legislature. I wanted to let him know that my query was coming again.

“Nobody does this … you should make an appointment to discuss all this.” (I had thought the physical was an appropriate venue.)

Dr. D’s a mainstream GP. Too mainstream for my wife, who left his practice some years ago. I’d stayed his patient as much out of inertia as of making it to my seventh decade with no serious health concerns; he’s a decent man and doctor. Even though the appearance of half a dozen issues had begun to rattle me, they were either transitory or a nuisance. On the whole, and given my entry into my 60s, I was sufficiently concerned about and ignorant of the potential for long-term consequences to put them on the agenda. No occurrence of any issue was sufficient to cause me to make a dedicated appointment (aside from a specialist procedure for one and over-the-counter management of another). I thought I was doing us both a favor with the advance letter offering concise but sufficient detail. I was asymptomatic and interested in forecasting.

Instead, Dr. D thought I was trying to shoehorn an unreasonable number of concerns into a single office visit.

“Nobody does this …” he had said about my document, adding another remark I can no longer quote but which indicated the belief that I was trying to take advantage of him. “Dr. D, you know me; I wouldn’t do that!” I mindlessly exclaimed — except that, in his view, I already had.

I thought that this was my physical exam.

I was wrong; it was Dr. D’s physical exam, following exactly and only the protocols I knew well from dozens of repetitions during years when I had zero health concerns. I just happened to be there that morning.

I thought that Dr. D would, with interest and concern, address my issues, especially because I’d never brought in a clutch of them before — I hadn’t had the need.

To his credit, he did address my end-of-life concerns, if a bit obliquely, answering, “Yes, depending upon the circumstances,” to my question, “If aided dying becomes legal here and I were to qualify medically and legally for the ‘cocktail’ would you prescribe it?” Not the definitive answer I wanted but not a refusal.

So Dr. D banged this and squeezed that and inserted his gloved finger, the familiar routine addressing “medicine’s” concerns, but not mine. A week later the labs came and after viewing them I entered select values into a spreadsheet I maintain to make assessing my history fast and easy.

I called a doc I met at a Lown Institute event in the nearby metroplex and asked him if he knew of any GPs in my town whose practices followed RightCare and Slow Medicine principles. He’s a younger guy and didn’t know directly. But he asked a colleague who identified a doc in an office that it turns out my wife and I left decades ago, for Dr. D, due to insurance plan changes. I’ll call to see if he’s taking new old patients the next time I need medical services or when I next decide upon a physical (I’m moving away from the annual model).

Over the past half year, my six concerns have dwindled to five. Of those three have not recurred, one has receded, and the last occurs periodically. I have yet to obtain an allopathic medical assessment of them.

Bart Windrum is an end-of-life reform advocate.

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