A nice old fellow who came to see me was his usual funny, cantankerous self, hobbling with his cane and grumbling about the ravages of time on his body. We had a nice visit, checked up on the usual things, and as we got to the end of the visit, we needed to schedule a return visit. Given his age and condition, I suggested he return in three months. He wanted none of this nonsense: "Look, Doc. This week, I got my cardiologist on Monday, my urologist on Tuesday and my oncologist on Thursday. It's not like I'm getting paid for this either. Make it six months, and if I'm still around, I'll see you then."

I think I probably over-medical-ize my patient's lives.

Several years ago, I heard a story. I don't know if it's true, but it illustrates my point. This old gentleman with heart failure spent so much time running to the bathroom because his diuretic, Lasix, made him urinate like crazy for six hours after he took it. (It's named "Lasix" because it "lasts six" hours). So he decided he wouldn’t take it, leading him, of course, to build up fluid in his lungs. Seeing his young doctor in the office, the doctor read him the riot act, and when he protested that the Lasix made him pee too much, the doctor said, “So pee when you have to pee! Use a plastic bedside urinal if you have to!” At the same visit, the same doctor insisted that he get out more and start walking: “Take a walk every morning. You need to exercise!” Being the sort of gentleman who takes the advice of his physicians, he went out for a walk, carrying in the pocket of his overcoat a urinal. And since he takes his Lasix every morning, he didn’t have to go very far before he had to relieve himself, which he did as discreetly as he could behind a tree, in the shade of his overcoat. When someone saw from her kitchen this old guy in an overcoat exposing himself behind a neighborhood tree, well, the authorities were called, and the poor old fellow got arrested for being a pervert. I can only imagine that it took him awhile to explain the situation, which didn't help his urgent bathroom situation. Or his heart failure.

The more a person's health starts to fail, the more dependent he or she becomes on this imperfect medical system of ours.

I have noticed that when it snows in the winter, most of my patients under 65 don’t venture out in their cars and either cancel their appointment or just assume that it’s a snow day. Oh, but not the over-65 crowd. I was leaving my office in a snowstorm last winter, as we were closing early. There, in the parking lot, slipping and sliding on the icy walkway, was my patient, trying to stabilize her walker on the black ice. I saw her and asked what she was doing there, and she said, “Well, I had to come. I had an appointment with you.”

And the more dependent on the medical system, the more the imperfections of the system manifest themselves.

Some of my patients take more than 20 different pills each day. I had enough problems with the side effects of just two different medications I had to take that I can’t imagine what the side effects of 20 different pills would be like, not to mention the drug interactions. Is it any wonder that patients who choose hospice care live longer than patients who wish to continue to use aggressive medical care to try to live longer?

I’m not saying that medicine is bad or that our healthcare system is bad. On the contrary, our health systems and especially our own community hospital delivers superb medical care. It's just that that maybe, sometimes less is more.