So what is this Wellness Visit and how does it differ? For one, I see an assistant and then a nurse practitioner – but not my doctor. I have to convince the assistant to check my height after she weighs me. “It was checked last year. It’s not like it’s going to change,” she says. Wrong – one of my concerns is that I am shrinking. Bone loss.
I wonder if she is the same young employee who, when I asked a couple of years ago about a hepatitis inoculation, told me that I didn’t have to worry because it was only for sexually active people! “Let’s make a bet,” I answered in anger, “about who is getting it more – you or me.”
This Wellness Visit involves no physical exam, no taking off of clothes, no touching. It opens with the assistant’s irritation that I have not brought the completed form – a form which I only find in my mailbox back home later in the day. She will not allow me to fill it out on the spot and insists on doing it herself, which, it later transpires, she does very poorly.
When I do see the form later in the evening, I realize that it has nothing to do with wellness and is, in fact, entitled “Medicare Health Risk Assessment Form.” It asks if I’m capable of basic activities – feeding, clothing, and bathing myself; shopping and cooking (not so good). It asks about home safety and falling down.
They ask about nutrition. And about alcohol and drug use. The assistant kindly explains that by drug use, “They mean like marijuana and heroin.” Well, that narrows it down.
And they ask about “Your emotions and social support.” When I am going over the form again, this time with the Nurse Practitioner, I ask her, “And if an elder is isolated and has no social support, what do you suggest that she do?” As someone who has long worked with elders, I am interested in what resources they bring to bear on those with revealing answers.
“Some of them just don’t want to know anyone,” she replies with scorn. “I know all my neighbors. We have coffee together, our kids play together. Some of these patients don’t even know the name of their nearest neighbor.”
“Yes, in the suburbs. Of course.”
“Well, I rent, and I do not know my neighbors and I don’t really want to.”
“Why not? That’s ridiculous.”
“No, it’s rental. It’s big buildings. Neighbors come and go – they’re renters. There is nowhere to escape from a bad one. I can’t ‘go home’ the way that you do. They share walls with me. I want my privacy.”
I know so many elders in subsidized housing in large buildings who have to weigh how many intimacies to promote, surrounded by old people, many sick and needy, people one sees in the elevator, in the dining room if it’s that kind of facility. One makes choices.
The nurse practitioner lectures me about the function and structure of the ear for too long because she cannot answer a simple question: Should I get a baseline hearing test or not? She says she is not an Ears/Nose/Throat person.
At the end she sends me for blood tests. I warn the blood taker – my regular person isn’t around – that I have rolling veins and that if she misses, I do not want her to dig around in my arm. She misses and digs. I tell her calmly, “Remove the needle now, please.” She does and sulks. “You don’t have rolling veins. You moved. No one can do it if you’re moving.”
“They won’t get you either, with you twitching and moving.” She puts the rubber tourniquet around my other arm and then starts searching in my hand.
“Please bring me someone else.” She finally agrees, petulantly, and a man comes, I explain the situation, and although he too digs around, he does manage to extract some blood – although today I find out that it wasn’t enough for one of the tests. That’s a photo of my arm today, by the way.
So if you’re heading for Medicare, let me be your big sister. Be sure to ask for a follow-up appointment with your doctor in light of something or other that you bring up. Then you can actually sit down with her and tell her to check your lumps and pangs.
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