I had an internist once. But when I turned 66, he gave me the bad news. “You’re old now,” he said gravely, “And you’re not going to live forever. What’s more, your veins are too small, your skin is wrinkly, and it seems like you’re always complaining about some ache or pain. The dollars and cents truth is that more aches take more diagnostic time and since my medical group only allows 10 minutes a patient, taking care of you can break the bank. What’s more, figuring out what’s wrong with you requires a lot more analysis and thinking – hardly conducive to my getting out early for a quick round of golf. You’re fired.”
So I dipped into my retirement fund and began a search for an internist that didn’t whine about my age. I thought I should look at a place where they needed some geezers to practice on – the local medical school hospital. But the medical school Dean set me straight.
“Look, my aging friend,” he lectured. We get two kinds of doctors in training here. The first kind is in it for the bucks so they certainly aren’t interested in going into geriatrics. Then they’d have to accept Medicare payments for their work. Hardly enough money there to even pay off their medical school loans.
“The other kind of doctors are in it to help the poor and indigent – the young poor and indigent. Young unwed moms. Kids from broken homes. Starving babies. The bright eyes, smiles, and grateful tears make the docs feel good. But senior citizens just don’t give them the psychic satisfaction they want.”
The Dean suggested I visit a retirement home. “Maybe they have a geriatrician with some time on her hands.”
Soon I was in the office of the Director of a local high-end retirement home. Of course, it wasn’t called a retirement home. It was a Formerly Active Adult Rest Enclave. I spoke to the Director who told me that internists who specialize in geriatrics were an endangered species. “No money. No respect. And they have to treat old people.”
For medical care, the retirement home was using a pediatrician who came in on her lunch hour to pick up a few extra bucks. Or, on a part time basis, she told me, they got a medical student who needed some extra cash to pay for his golf clubs.
The Director recommended trying a foreign country. “Doctors there still seem to care about their elder population,” she volunteered. So I took a little more money out of my retirement fund and flew off to Mexico.
When I got to Mexico City, I paid a cab driver 20 bucks for the name of a village that was supposed to have a doctor who treated older people. After a $100 dollar cab ride, I found myself in a local village where people led me to the doctor’s office. “Sì, I used to treat old people,” he explained, “but the cartels took them to use as drug mules.”
Not wanting to transport drugs for a living, I flew to Canada where I learned they did have geriatric internists. I tried to make an appointment, but was told the earliest available was in two years. I told them I would pay cash. “You’re using American dollars,” they laughed, “Maybe if you paid in yuan…”
I traveled to Europe where I was told no one treats old people because they are too healthy. The best they could do for me was to prescribe a bowl of pasta and a glass of red wine.
Returning home, I decided I was going about this all wrong. Instead of looking for a geriatric internist, I decided to look for an internist who was a geriatric. After using a few more of my retirement dollars, I found a doctor in a small town who, at age 88, was still practicing medicine. So I moved to the town and became his patient.
I just have to hope he lives forever.
For more about geezers and medicine read Inventing Medical Devices for Medicare Riches