EW YORK — Checking in at the front desk of the geriatric clinic, I suddenly felt I had made a ghastly mistake.
At 68, I was the only one in the waiting room not accompanied by a caregiver — and one of the few not using a walker or a wheelchair.
“What was I thinking?’’ I asked myself. Looking around, I saw my own feeble future spread out before me, a tableau of what the next 20 years would bring. The exhaustive intake form that I’d filled out at home — it asked (among other things) what I ate in a typical day, whether I needed help bathing, and whether I’d had my bone density tested — suddenly seemed more ominous than reassuring.
But I couldn’t just leave. A spate of new health problems, requiring a gaggle of doctors with no connection to one another, had persuaded me to find the right person to quarterback my care, now and in the years to come.
Rationally, I knew this geriatric clinic at Mt. Sinai Hospital was the place to do all that. So I swallowed hard and sat down.
That intake form had taken hours to fill out; in one section, I had to review a catalog of 88 symptoms and say whether I’d had any of them in the past three months. (Among those I checked: weight change, blurry vision, excessive thirst, and fatigue.)
My appointment was just as thorough as the form.
At recent appointments with my internist, she began looking at her watch after 10 minutes and abruptly dismissed me after 15, the average length of a doctor’s visit these days. By contrast, my geriatrician, Dr. Christine Chang, spent two hours with me, most of it talking.
The sense that Dr. Chang had all the time in the world was a first for me. So, too, was the participation of a nurse practitioner and a social worker, both part of her team. They asked questions I had never been asked before, but surely should have been: Was I sexually active? Did I have any mental health issues? Had I always been so skinny?
The contrast in approach and attitude highlights much of what is wrong with the American health care system. It also explains the dire shortage of geriatricians, who typically serve patients in their 80s and beyond, providing primary care and coordinating among necessary specialists.
There are only about 7,000 geriatricians practicing in the US, and their numbers are dwindling even as the need increases, with 20 percent of the population projected to be elderly in 2030.
Sad to say, in America’s fee-for-service system, it’s procedures and prescriptions that are reimbursed, not discussion that may lead to a decision to do nothing. Thus, the better geriatricians do their jobs, the less they are paid, a problem compounded by the low rate of reimbursement from Medicare. The median compensation for geriatricians is $200,000 a year, the lowest of all medical specialties, although their reported job satisfaction is among the highest.
While I’m sure Dr. Chang would treat me aggressively when appropriate, her default approach was less-is-more — simple remedies before complicated ones and the less medication the better.
When I reported slight hearing loss, Dr. Chang suggested a week of drops to soften ear wax before considering a hearing aid that costs thousands of dollars and is not covered by Medicare. Knowing I had recently taken a terrible fall on my head, and still had dizzy spells, she tested my balance by having me walk heel-to-toe, first with my eyes open and then with eyes closed. Tai chi would help, Dr. Chang said, and the clinic offered free weekly classes (along with meditation and yoga) to patients, their caregivers, and clinic staff.
Dr. Chang actually “did’’ only three things aside from routine measurements: administered a pneumonia vaccine; checked my vitamin D levels, protective against broken bones; and conducted a mini-mental state examination, a short cognitive test that helps diagnose Alzheimer’s disease in its early stages.
Luckily, she had taken my blood pressure before the test because anxiety about the results must have sent it soaring.
Who among us, past a certain age, doesn’t lose our glasses or walk from one room to next only to forget what we’re doing there? That’s normal aging, the experts say, but it always sets my heart pounding.
Now I would find out if those worries were justified.
I wasn’t sure I actually wanted to know.
Identifying drawings of a lion, a rhinoceros, and a camel was easy. Drawing a clock with its hands set at 11:10 went fine (after a slight pause to remember whether 11 is to the right or the left of 12).
Counting backward from 100 in intervals of seven (100, 93, 86, etc.) was daunting but doable. Listing as many farm animals as possible in 20 seconds was a snap; so was hearing words and then spelling them backwards.
The killer part was the recall test. I was given a list of half a dozen words at the start of the test. About 20 minutes later, after the animals and the numbers and whatnot had distracted me, I was asked to recite them. I remembered four (although damned if I know what they are now, more than a week later) but went blank on the other two.
Dr. Chang offered cues: “A kind of building?” Castle! “A flower?” Tulip!
The fact that I could respond to cues was reassuring, she said. It meant the words were stored in the file drawer of memory. If I’d had Alzheimer’s disease, they would already be lost.
Was I relieved? Of course. But it took a while before I stopped trembling, before the bath of cold sweat subsided.
I stopped twice on the six-block walk home, sitting on a bench and trying to calm down. I told myself over and over that everything was OK.
And that if the time ever came when it wasn’t, I’d be in good hands.
Jane Gross is a journalist in New York City.