My Wife Made Me Go to the Doctor

My wife forced me to make an appointment for a physical exam.

After avoiding it every way possible, I went. I had to find a new doctor because “my” doctor retired a couple of years ago. I suspect you are surprised I am resistant to go for an annual exam and to get blood work done.

Ninety percent of Americans believe that an annual physical exam is a useful and effective use of time and money. Medicare and most insurance providers pay for it, and we spend 12 percent of our healthcare dollars on physical exams.

My reluctance is based on my 30 years of experience in doing physical exams and the scientific evidence that clearly states physical exams do not improve health outcomes. Multiple studies culminating in a Cochrane Review (a scientific organization based in Copenhagen and the definitive word in these matters) concluded that annual physical exams failed to decrease deaths, hospitalizations or costs. The US Prevention Services task force does not recommend them and, in my own experience, I have found them extremely unhelpful in caring for people. This is especially true for young adults who feel healthy.

The annual physical exam came into vogue in the 1940s. Prior to that, you only went to the doctor if you were sick. But with new diagnostic tests and a refined understanding of disease, it made sense that early detection was a good thing.

Soon, medical schools taught the ritual of the physician with a stethoscope examining a patient from head to toe and patients came to expect it.

The problem is that a physical exam rarely, and in my experience almost never, unearths a problem in a way that leads to an improved outcome. That is, finding cancer that can be instantly cured or treating any disease early so that it doesn’t ravage the person’s body. More likely, a test will be positive and lead to further expense and uncomfortable procedures that produce anxiety, only to have them relieve the anxiety by ultimately telling the patient, “Everything is all right.” This happens a lot.

The only benefits that have been shown to result from annual exams is the detection of high blood pressure and cervical cancer through pap smear. But even pap smears are now only recommended every three years for women over 21 and every five years for women over 30 if combined with a check for HPV. Pap smears are to be discontinued in women over 65.

So, why have I agreed to go to the doctor?

1. I want to have a physician who knows my medical history before I have a significant medical problem.

2. I am at an age where I do need selected tests done that have been shown to be effective at improving outcomes (you can see these recommendations at http://www.healthfinder.gov).

3. I chose a physician whom I know believes as much as I do in true prevention. When I see her, I expect to devote as much time to a discussion of my diet, my exercise and my spiritual health as she spends poking and prodding my body.

To summarize, it is important to have a doctor who knows you and your health history. There are periodic health screenings that do need to be done that can help you remain healthy, but an annual physical exam and blood tests no longer makes sense for many people (unless your wife insists that you go).

Have You Lost Your Mind?

Every morning my wife, Mary, does the crossword puzzle in the in ink and in less than 15 minutes. I don’t even try because I could spend all day and only have half of the squares filled in. Mary does it because she is convinced it will help prevent her from getting Alzheimer’s disease.

There is actually some evidence that intellectual activity like doing crossword puzzles is effective in small ways in preventing dementia. Mary is worried because her mother suffered and died from Alzheimer’s. It was a terrible thing for everyone involved.

The disease has now impacted me also through several close friends. It is hard to say whether the disease is worse for the patient or the caregiver. The commercials on TV would have us believe that if we only start taking the right drug soon enough, there is nothing to worry about. Sadly, this is just not the case.

Although what we now call Alzheimer’s has been around for thousands of years, it was not fully described as a disease until 1901 by a German psychiatrist named Alois Alzheimer. He described the disease in a patient he called Auguste D., who died in 1906 at the age of 50. Until 1977 physicians gave the diagnoses only to people younger than 65 years old, but now it applies to anyone who meets the criteria.

Alzheimer’s is now the sixth leading cause of death in America. As the population ages, it is predicted that 1 in 85 people will one day be affected.

All of us at some time worry we are developing the disease. We lose our keys, we forget our friend’s name, we forget which way to turn, and we start to worry if we are losing our minds. Thankfully, this is rarely true.

Unfortunately there are no effective screening tests for Alzheimer’s disease, partly because we still do not know what causes it. While there appears to be reason to think there is a genetic link, this can be proved in less than 5 % of cases. There are multiple hypotheses for the cause, but none are yet proven.

The fact that we don’t know the cause is why the drugs currently on the market are at best nominally effective. Those known as Acetyl cholinesterase inhibitors (the ones advertised on TV) have shown only a small benefit. None of them delay or halt the progress of the disease, despite how happy the people look in the commercials.

So what are we to do to prevent this horrible disease?

It should not surprise you that the same ingredients for a healthy body lead to a healthy mind. Since the brain needs an abundance of blood flow, the activities that we know help keep the heart strong also help ward off dementia. That’s right, regular exercise, not smoking, eating a Mediterranean diet (more fruits and vegetables and less red meat) and keeping your cholesterol low are the best preventions we have for dementia.

In addition people with strong social connections are less likely to be affected. Having friends is good medicine. These things are also true for caregivers who must have time for themselves when the people they love enter the long goodbye. The disease can become socially isolating for both patient and caregivers.

If someone you love is affected, do not hesitate to include your family, friends and faith community in the process. Until there is a certain cause and effective treatment, the best medicine we have is to show love and understanding every way we can.

(To learn more about Alzheimer’s disease go to http://www.ALZ.org.)

Two Are Better Than One

I am not afraid to ask for help. This is not because I can’t make a decision—I make countless important decisions every day. But as the book of Ecclesiastes tells us, “two are better than one because they have a good reward for their toil” (4:9). This verse appears in a passage that acknowledges that work is hard. That’s why two are better than one! We hold each other up. We do not shoulder our callings and responsibilities alone.

We don’t have to look long before we find this truth sprinkled on the pages of the Gospels and the book of Acts. Notice the familiar pairs among the original 12 disciples: Peter and Andrew, James and John, Philip and Nathanael. Jesus called them in pairs, and together they entered a new life of learning from the rabbi. Together, they took on Jesus’ work.

Together is a consistent image in the early church, and we do well to embrace it.

One of my favorite passages about the gospel’s call to healing ministry is when Jesus sends out 70 followers on a mission—in pairs. The mission includes “cure the sick who are there, and say to them, ‘The kingdom of God has come near to you’” (Luke 10:9).

Luke tells us that Jesus sent these followers “on ahead of him in pairs to every town and place where he himself intended to go” (10:1). Jesus didn’t ask his followers to do what he didn’t want to do, but to join him in his work by preparing the way for him and experiencing for themselves what would result—curing all sorts of diseases.

This did not mean the work would be rosy or without challenge. Jesus’ instructions in Luke 10 acknowledged that not everyone would welcome the disciples. In fact, Jesus said, “I am sending you out like lambs into the midst of wolves.” When we think about that image, we realize the impossible survival odds! Perhaps this is one of the reasons Jesus chose not to send his followers out alone. One alone might cower and run, while two will hold each other up. 

The heart of these early gospel partnerships is the kingdom of God. Healing miracles point to the wholeness God desires for every person.

The book of Acts reminds us that this pattern of partnership in God’s work continued in the early church. Once again the pages of history are full of pairs or groups who worked earnestly for God’s kingdom. Paul’s letters are full of gratitude for people he calls “fellow laborers.” Sometimes the ministry teams rearranged themselves and redistributed the work and travel, but still they labored together in the cause of God’s kingdom. And the book of Acts brims over with healing miracles. Where the kingdom of God is, there is healing.

The gospel still calls us to the cause of God’s kingdom, and the kingdom is still revealed in our journeys toward health and wholeness. Whether a health ministry partnership is two people holding each other up in their shared congregation or multiple agencies with an ambitious joint agenda, we are not meant to be alone in health ministry any more than God wants us to be alone in life. Community brings health.

And let us follow Paul’s example and be grateful for those who labor alongside us, for we share in the privilege of doing God’s work.