$185 Worth of Medical Advice

     I had my annual physical the other day. I decided to go to my primary care physician (which my medical group told me would cost $185) rather than a physician's assistant (which would have been free of charge), for two reasons. I went to this doctor last year for the first time, and there were a few little issues that came up, and so I wanted to follow up on them with the same doctor. The other reason? Well, to be blunt, I figured a doctor would know more medicine, and give me a more authoritative checkup.

     The long and short of it is ... I'm fine. I have no idea if the doctor gave me any better service than a PA would have done. Still, I like the idea of developing a relationship with my doctor, however slight, so he knows my body and my history, and therefore is more likely to sense if and when something is "off." I had that kind of relationship with my old doctor, who I'd been seeing for about 20 years. Unfortunately -- and tragically -- my old doctor, who was the same age as me, got an aggressive form of cancer a little less than two years ago and he died within six months.

     So last year I found a new doctor in the same medical group. He's in his early 40s, and looks very young to me, but I have to believe he knows what he's doing.

     Anyway, I'll pass on a couple of insights from my visit (at no charge!). First, I went in looking for a shingles shot. My sister has been pushing this on me for a while. She got the shingles vaccine a couple of years ago. "You know, Dad got shingles before he died," she reminded me. "So I got a shingles shot, and you should get one too." (In case you're wondering, she's my older sister, and so has no reservations about trying to boss me around.)

     But instead, I came out of the doctor's office with a shot for pneumonia. My doctor said I could get the shingles shot, and yes, he did recommend it for people my age. But his enthusiasm for the shingles shot seemed somewhat measured, while he thought the pneumonia shot was more of a must-have. Honestly, he thought my risk profile for either disease is very low. Nevertheless, he said, if you get shingles, it can be painful. But pneumonia can kill you.

     I could have had both vaccines at the same time. But I decided to get the pneumonia shot now (it's a one-time vaccination); and do the shingles shot next year.

     The other thing he told me is that the scholarly literature has suggested that annual physicals do not, in the aggregate, extend our life expectancy. There are two theories. The annual physical approach is based on early detection. The doctor catches something early, and therefore is more likely to be able to cure it, or at least manage it. The problem is that there are many false positives, resulting in a lot of unnecessary medical tests and treatments, which (again in the aggregate) can often cause more harm than good.

     The other theory says you wait until something goes wrong. Then medicine runs it down, and in most cases is able to treat it successfully.

     All that may be true. But here's my story. I had my first colonoscopy at age 51, and the doctor found a precancerous polyp. He removed it, and I went on with my life. If it hadn't been detected, and was left to develop into cancer, I'd probably be dead by now. So I am firmly in the camp of early detection.
   
     The other advice the doctor had for me? He said that all we know about improving and extending our lives can essentially be boiled down to one paragraph. Eat a good diet with plenty of fluids, fruits and vegetables, and get a decent amount of exercise on a regular basis.

     And so with that ... I'm heading to the gym.