THE DEPROFESSIONALIZATION OF PHYSICIANS
(Published nationally in Psychiatric News, February, 2000)
Back in the last millennium when I was a young doctor, becoming a physician meant that one had a “calling”, something quite different than “going into business.” In those days, being referred to as “doctor” meant you commanded respect and were esteemed. Back then, the purpose of insurers like Blue Cross and Blue Shield were to see that their clients’ claims were paid. And in those days, the purpose of the hospital was to provide care for the ailing patient until s/he was well and could return home healthy.
Times have changed! CEO’s and other “bean counters” and business people of all sorts have hijacked American medicine and run it as if it were a manufacturing plant. Their “calling” is to make a profit, and the purpose of the insurer is to deny claims. The hospital’s goal, once the procedure or treatment is completed, is to get the patient out of there as soon as possible.
The latest tactic in the health care industry is to supplant the physician with all sorts of “physician extenders”, much like “beef extenders”, I guess. The physician’s care is becoming limited to doing the procedure or supervising the treatment. There is no need for the doctor to have a relationship with the patient--the “extender” will do that!
The art of medicine is dead. Even we psychiatrists, specialists in forming therapeutic relationships, talk more these days about neurotransmitters than about the angst of mental illness. Calling a physician’s office is now less of a personal experience than calling an airline to get a plane reservation. At least the person making my reservation talks to me politely and takes time to explain things. My doctor’s answering machine, in contrast, tells me to hang up and call 911 if I am having a life threatening emergency; otherwise I am instructed, after pushing many numbered options, to leave a message which may be responded to within 24 hours.
Physicians have been deprofessionalized. We are now all just “providers” in a massive health care industry which is increasingly impersonal, detached, and profit driven. Forget about even calling yourself a physician--your patients won’t know the difference between you and your “extender” anyway.
Fortunately for me, my career is in its late stages, and I am still able to practice the old fashioned way. I have a small one-man “cottage industry.” I try to provide personal attention for my patients, answer incoming calls when possible, return peoples’ messages promptly, and (of all things) even do my own psychotherapy. But I fear, as do my peers, that there will be no doctors left in the future to take care of us with the personal attention, patience, and understanding that once was common practice.
Don’t get me wrong, I appreciate much of this new high-tech age in which we live. I love the ease with which the internet connects me to information, and I value the convenience of my cellular phone. But I’ll take the physicians of yesteryear any day over today’s “providers.” Those doctors did have a calling and did know how to practice medicine as an art form. They knew how to comfort and how to ease suffering, and they understood the importance of a therapeutic relationship.
The tragedy of American medicine falling from its Golden Age, to what it has now become, is clearly a product of capitalism at its worst. When medicine is governed by health care planners whose only concern is profit, then the number of people who die because of premature discharge from the hospital amounts to a simple calculation of potential malpractice losses versus salaries saved. But if the person who died unnecessarily happens to be your loved one, the result is actually incalculable! Perhaps if every business person or insurer working in the health care industry today was required to work on an oncology unit, a hospice, or a psychiatric facility for a period of time, they would appreciate the nature of medicine rather than seeing it as just a business.
Medicine was never designed to be a business, and it never has been a good business, as measured by business parameters. Yet, one of the greatest accomplishments of twentieth century America, has been the nearly doubling of the human life span. This occurred, not in the context of worrying about every dollar spent, but by persevering in the development of medical science and improving the practice of medicine.
We are no longer struggling with recessionary pressures in our economy as we were 8 years ago, when the dismantling of American medicine began for the sake of controlling inflation. With the explosion of wealth over the past several years, maybe we can get back to quality in medicine, and let physicians run the show again. Business people can return to running businesses, and we’ll all be better off!
Hugh R. Winig, M.D.
Thursday, May 31, 2007
Wednesday, May 30, 2007
SONS OFF TO EUROPE
(Published in the Contra Costa Times on Memorial Day, 1995)
This Spring I will be attending three graduations--my daughter's from graduate school, my older son's from college, and my younger son's from high school. Our family will also be celebrating my wife's 50th birthday--she was born exactly on V-E Day itself! As my children look forward with hope and optimism to their new lives, and in the midst of all of these wonderful family celebrations, my own thoughts turn to remembrances and gratefulness.
Coincidental with this 50th anniversary of V-E Day, both of my sons independently settled on the idea of marking their graduations by backpacking abroad this summer with a few of their best buddies to see the sights of Western Europe. My wife has felt a bit of maternal trepidation about their plans, especially the younger one's, even though he has traveled or lived abroad the past two summers. But, as their father, I can tell you I have a very different take on this bit of freedom my sons are exercising.
This summer is 50 years since the end of World War II! Fifty years since the liberation of Auschwitz and the loss of 6 million Jews! Fifty years since the Russian war dead numbered 20 million! And fifty years since the execution of Mussolini and the death of Hitler! Fifty years later, and my sons are the beneficiaries of all those who fell at Normandy, on Omaha and Utah Beach. My 22 and 18 year-old young men will be off to Europe with backpacks bought at our local mountaineering store, not government-issue duffel bags. They will leave with water bottles for hiking in the serene hills of Italy and France, not with canteens and mess kits issued by the military to help them survive battle-torn Europe. And they will buy eurail passes to crisscross Europe freely, not find themselves herded into cattle cars headed for a certain death in a concentration camp.
How does a father like me thank all those men lying under crosses and stars in Europe's battlefields and war cemeteries? How do I convey to my sons the good fortune they have to live in this generation, not the one that came of age fifty years ago? Who was looking over them and me when our turn came to travel this way?
I'm not a "love it or leave it" patriotic type, but I do like to fly the American flag on the Federal Holidays. I don't like it that school kids today have little sense of why they don't go to school on Memorial Day. There seems to be little appreciation for how the freedoms we take for granted were earned--most young people simply feel entitled to it.
If we can remember what this last fifty years has wrought, then there should be little but gratefulness that would fill our hearts. Had World War II ended differently, one can only try to imagine the nightmare that would have followed. Surely, none of us would have a life as we know it, or even have a life at all! From my perspective, I can honestly say, it's good to have 2 sons off to Europe this summer.
(Published in the Contra Costa Times on Memorial Day, 1995)
This Spring I will be attending three graduations--my daughter's from graduate school, my older son's from college, and my younger son's from high school. Our family will also be celebrating my wife's 50th birthday--she was born exactly on V-E Day itself! As my children look forward with hope and optimism to their new lives, and in the midst of all of these wonderful family celebrations, my own thoughts turn to remembrances and gratefulness.
Coincidental with this 50th anniversary of V-E Day, both of my sons independently settled on the idea of marking their graduations by backpacking abroad this summer with a few of their best buddies to see the sights of Western Europe. My wife has felt a bit of maternal trepidation about their plans, especially the younger one's, even though he has traveled or lived abroad the past two summers. But, as their father, I can tell you I have a very different take on this bit of freedom my sons are exercising.
This summer is 50 years since the end of World War II! Fifty years since the liberation of Auschwitz and the loss of 6 million Jews! Fifty years since the Russian war dead numbered 20 million! And fifty years since the execution of Mussolini and the death of Hitler! Fifty years later, and my sons are the beneficiaries of all those who fell at Normandy, on Omaha and Utah Beach. My 22 and 18 year-old young men will be off to Europe with backpacks bought at our local mountaineering store, not government-issue duffel bags. They will leave with water bottles for hiking in the serene hills of Italy and France, not with canteens and mess kits issued by the military to help them survive battle-torn Europe. And they will buy eurail passes to crisscross Europe freely, not find themselves herded into cattle cars headed for a certain death in a concentration camp.
How does a father like me thank all those men lying under crosses and stars in Europe's battlefields and war cemeteries? How do I convey to my sons the good fortune they have to live in this generation, not the one that came of age fifty years ago? Who was looking over them and me when our turn came to travel this way?
I'm not a "love it or leave it" patriotic type, but I do like to fly the American flag on the Federal Holidays. I don't like it that school kids today have little sense of why they don't go to school on Memorial Day. There seems to be little appreciation for how the freedoms we take for granted were earned--most young people simply feel entitled to it.
If we can remember what this last fifty years has wrought, then there should be little but gratefulness that would fill our hearts. Had World War II ended differently, one can only try to imagine the nightmare that would have followed. Surely, none of us would have a life as we know it, or even have a life at all! From my perspective, I can honestly say, it's good to have 2 sons off to Europe this summer.
THE NEW SOUTH AFRICA
(Published in the Esst Bay Psychiatric Association Newsletter, April 2007)
This past February, my wife and I spent 10 days touring 3 major cities in South Africa: Johannesburg, Cape Town, and Port Elizabeth. We went on a Study Tour with The American Jewish World Service (AJWS). This charitable organization provides funds as well as volunteer and technical assistance to grassroots organizations in the developing world. It helps support over 300 projects in some 36 countries in Asia, Africa, and South America. We visited about a dozen such non-governmental organizations (NGO’s) in an effort to understand their efforts in combating the HIV/AIDS pandemic now ravaging South Africa. One thousand people a day are dying there from this disease, and twice that many are becoming newly infected daily.
I knew little about South Africa prior to this trip, outside of its history of apartheid. I learned that from 1948 until 1994 blacks not only had no vote, but that they also were deprived of any meaningful education. In 1994 after South Africa became a democracy and freed itself of their racist white government, blacks were left uneducated, unskilled, and living in townships where they had been forcibly moved, in conditions of abject poverty. Shacks housing millions of people with little or no amenities or employment opportunities stood on the outskirts of the cities we visited. These slums were worse than anything I could imagine, although I have since learned that 1 billion people worldwide, or more than 1 in 7, live in such conditions. I was unprepared for what I saw, and my emotions welled up inside me more than once.
Nearly 19% of South Africa’s adult population is now HIV positive. The Mbeki government made things worse for a time as they denied the link between HIV and AIDS and promoted folk remedies and stood in the way of people getting the Anti-Retroviral Drugs (ARV’s) critical to controlling the virus. Conditions in hospitals were unlike anything we westerners are familiar with. In one hospital, I saw hundreds of people filling every nook and cranny waiting to be seen. The AIDS clinic opened at 8 am and closed at 4 pm that day. People started queuing up in the early morning hours in hopes of being seen. The elderly would have someone younger in their family hold a place in line for them until the clinic opened. If you were fortunate, a health worker would examine you and report to the single physician manning the clinic that day so that you could receive medication and/or other treatment. If you were not so lucky, 4 pm would roll around and you would go home to start the same process again the next day.
In South Africa HIV/AIDS is primarily a disease of heterosexuals, transmitted in the black community by the men who do not acknowledge their HIV status, to the women they have sex with, either consensually or forcibly. The ABC’s that are being taught to the populace are “Abstinence, Being Faithful, and Condomizing.” Because of the overwhelming number of AIDS deaths every week, and because funerals are held only on Saturdays and Sundays by custom, weekends are consumed with funerals, and the graveyards are fast filling up.
Because we were traveling with a group that helps support the agencies we were visiting, nearly everywhere we went the workers greeted us with songs in their tribal dialect with beautiful South African rhythms and harmonies. One Sunday we went to services in a Church in the townships and heard perhaps 1000 such voices singing Gospel songs. Even for a non-believer like myself, it’s difficult to imagine that the beauty of these voices was not being heard on high. It was a powerful spiritual experience.
Every time we witnessed situations that seemed overwhelming and made me feel hopeless, we would meet ordinary people doing amazing work to overcome the double scourge of the residues of apartheid and the current blight of AIDS, and I’d feel hopeful again. We met exceptional human beings throughout our trip, but of special note were three people from three different generations: Helen Suzman, age 89, was the leading voice in the Parliament for 35 years speaking out against apartheid; Helen Lieberman, age 63, a social worker in Cape Town, founded her own NGO, Ikama Labantu, and has devoted her entire adult life to providing social services for blacks despite enormous personal danger to herself for doing so; and Jacob Lief, a precocious 29 year old American, has set up his own extensive non-profit social services organization in Port Elizabeth and demonstrates the acumen of a corporate CEO in dealing with his complex organization.
We drove down the only street in the world where two Nobel Peace Laureates reside—Bishop Desmond Tutu and Nelson Mandela. The prestigious international recognition of these two contributors to overcoming apartheid signifies the importance that others have attached to building a new South Africa.
South Africa looks very much like the United States, unlike what I felt when I was in East Africa some 10 years ago where everything there looked different to me—the sky, the landscape, and the cities. But in South Africa, I felt at home. Johannesburg was like New York City, Cape Town felt very much like San Francisco (including having its own wine lands an hour away), and Port Elizabeth was a lot like many moderate sized beach towns along our coasts. The country is a mix of first world western conditions contrasted with, and lying adjacent to, developing world conditions. It’s a country worth visiting for many reasons, not the least of which is that it is on the brink and needs our help. I encourage you to go there and to educate yourself about this vast land on the opposite side of the globe half surrounded by the Atlantic and Indian Oceans. You won’t regret having made the effort. It’s quite a place to behold and a place worth saving.
--Hugh R. Winig, M.D.
(Published in the Esst Bay Psychiatric Association Newsletter, April 2007)
This past February, my wife and I spent 10 days touring 3 major cities in South Africa: Johannesburg, Cape Town, and Port Elizabeth. We went on a Study Tour with The American Jewish World Service (AJWS). This charitable organization provides funds as well as volunteer and technical assistance to grassroots organizations in the developing world. It helps support over 300 projects in some 36 countries in Asia, Africa, and South America. We visited about a dozen such non-governmental organizations (NGO’s) in an effort to understand their efforts in combating the HIV/AIDS pandemic now ravaging South Africa. One thousand people a day are dying there from this disease, and twice that many are becoming newly infected daily.
I knew little about South Africa prior to this trip, outside of its history of apartheid. I learned that from 1948 until 1994 blacks not only had no vote, but that they also were deprived of any meaningful education. In 1994 after South Africa became a democracy and freed itself of their racist white government, blacks were left uneducated, unskilled, and living in townships where they had been forcibly moved, in conditions of abject poverty. Shacks housing millions of people with little or no amenities or employment opportunities stood on the outskirts of the cities we visited. These slums were worse than anything I could imagine, although I have since learned that 1 billion people worldwide, or more than 1 in 7, live in such conditions. I was unprepared for what I saw, and my emotions welled up inside me more than once.
Nearly 19% of South Africa’s adult population is now HIV positive. The Mbeki government made things worse for a time as they denied the link between HIV and AIDS and promoted folk remedies and stood in the way of people getting the Anti-Retroviral Drugs (ARV’s) critical to controlling the virus. Conditions in hospitals were unlike anything we westerners are familiar with. In one hospital, I saw hundreds of people filling every nook and cranny waiting to be seen. The AIDS clinic opened at 8 am and closed at 4 pm that day. People started queuing up in the early morning hours in hopes of being seen. The elderly would have someone younger in their family hold a place in line for them until the clinic opened. If you were fortunate, a health worker would examine you and report to the single physician manning the clinic that day so that you could receive medication and/or other treatment. If you were not so lucky, 4 pm would roll around and you would go home to start the same process again the next day.
In South Africa HIV/AIDS is primarily a disease of heterosexuals, transmitted in the black community by the men who do not acknowledge their HIV status, to the women they have sex with, either consensually or forcibly. The ABC’s that are being taught to the populace are “Abstinence, Being Faithful, and Condomizing.” Because of the overwhelming number of AIDS deaths every week, and because funerals are held only on Saturdays and Sundays by custom, weekends are consumed with funerals, and the graveyards are fast filling up.
Because we were traveling with a group that helps support the agencies we were visiting, nearly everywhere we went the workers greeted us with songs in their tribal dialect with beautiful South African rhythms and harmonies. One Sunday we went to services in a Church in the townships and heard perhaps 1000 such voices singing Gospel songs. Even for a non-believer like myself, it’s difficult to imagine that the beauty of these voices was not being heard on high. It was a powerful spiritual experience.
Every time we witnessed situations that seemed overwhelming and made me feel hopeless, we would meet ordinary people doing amazing work to overcome the double scourge of the residues of apartheid and the current blight of AIDS, and I’d feel hopeful again. We met exceptional human beings throughout our trip, but of special note were three people from three different generations: Helen Suzman, age 89, was the leading voice in the Parliament for 35 years speaking out against apartheid; Helen Lieberman, age 63, a social worker in Cape Town, founded her own NGO, Ikama Labantu, and has devoted her entire adult life to providing social services for blacks despite enormous personal danger to herself for doing so; and Jacob Lief, a precocious 29 year old American, has set up his own extensive non-profit social services organization in Port Elizabeth and demonstrates the acumen of a corporate CEO in dealing with his complex organization.
We drove down the only street in the world where two Nobel Peace Laureates reside—Bishop Desmond Tutu and Nelson Mandela. The prestigious international recognition of these two contributors to overcoming apartheid signifies the importance that others have attached to building a new South Africa.
South Africa looks very much like the United States, unlike what I felt when I was in East Africa some 10 years ago where everything there looked different to me—the sky, the landscape, and the cities. But in South Africa, I felt at home. Johannesburg was like New York City, Cape Town felt very much like San Francisco (including having its own wine lands an hour away), and Port Elizabeth was a lot like many moderate sized beach towns along our coasts. The country is a mix of first world western conditions contrasted with, and lying adjacent to, developing world conditions. It’s a country worth visiting for many reasons, not the least of which is that it is on the brink and needs our help. I encourage you to go there and to educate yourself about this vast land on the opposite side of the globe half surrounded by the Atlantic and Indian Oceans. You won’t regret having made the effort. It’s quite a place to behold and a place worth saving.
--Hugh R. Winig, M.D.
TIME MOVES IN ONLY ONE DIRECTION
(Published in the East Bay Psychiatric Association Newletter, May 2007)
When my Dad turned 80 some years ago, a friend of mine gave him a book entitled “Getting Old Is Not For Sissies.” I didn’t fully realize then the implications of the title, as I was still in my late 40’s at the time. Now, as Medicare and Social Security loom around the bend for me, I am beginning to appreciate better the hard work of getting old that lies ahead. The march of time takes its toll on everyone, and everyone needs to train him or herself to be old in order to avoid certain pitfalls. Getting older requires major attention to one’s emotional, attitudinal, and physical wellbeing.
The emotional side of things is probably the subtlest. People have to learn to be comfortable when they no longer have a schedule, when they no longer are earning an income, and when they are spending more time alone. For most people this is a radical change, as one’s earlier adult years were usually spent maximizing income within the context of a job with a schedule and social interactions. Leisure time, although previously yearned for, may now feel unnatural; and time alone, rather than being enjoyable, may be experienced as isolative.
A shift away from one’s earlier sense of purpose begins to occur between ages 50 and 70. It is during this period that one needs to behave more like we did as children--to be able to play, to enjoy whiling away the time, and to pursue activities just for the sheer pleasure of them. One has to strategize about these new realities or one will be bored, no matter how much money and freedom one has carefully planned for. I’ve known retirees who can’t find enough hours in the day to pursue all the interests they have, but I’ve also known those who complain that “retirement is not all that it was cracked up to be,” and they dread the boring days that stretch out before them.
For those living in the transitional stage going from “working hard” to “hardly working,” it is important to take the time to understand your new needs, to assess your physical, emotional, and financial health, and to develop a plan to address your new realities. Retirement can be a time of creativity, newfound freedom and interests, and revitalization, but alternatively it could become a time of stagnation, isolation, and decline. There are academic courses to be taken, arts and crafts to explore or master, cultural interests to pursue more extensively, more time to spend with friends, and time to travel more extensively.
Attitude can be critical. A year ago my wife and I took an adventure trip to Costa Rica and Panama. It was a small boat cruise with elective physical activities every day, including kayaking, snorkeling, hiking—you name it. One of our travel companions on this trip was a 90 year-old man named Sidney who had taken the trip with a much younger female friend (his wife had died many years earlier), knowing he could no longer partake in the challenging physical offerings on the cruise, but wanting to continue to travel nonetheless. Every evening after the rest of us were pleasantly fatigued from our day’s activities, Sidney and I would sit on deck with a cocktail and he would wax eloquent about his past years of growing his own business and about all the other places he had traveled to. He reported that he had turned over the ownership of his company to his son years ago, but still went to his office regularly to keep busy because “my son was kind enough to give me an office to go to.” Sidney’s companionship greatly enhanced my trip, and I know that he had a wonderful time that week as well. But it was Sidney’s attitude of continuing to engage life so fully that impressed me the most.
The other major challenge of old age is attending to one’s physical wellbeing. The major tactic for helping oneself is this area is developing the habit of exercise. If there is one single thing to do for oneself that can enable you to look better, feel better, and live longer, it is to exercise regularly. This doesn’t mean running marathons. It’s a simple matter of a three-mile walk or its equivalent four or more days a week. Forget all those other claims of revitalization that are advertised. Exercise is as close to the fountain of youth as you can get.
Despite maintaining a regular schedule of exercise, the ravages of physical decline with age may become overwhelming nonetheless. There can be losses that can change everything for the worse, and these losses may mount up and become overwhelming. Your own good health is one crucial requirement for happiness, but for those who are in a long-term committed relationship, the life and health of one’s partner is as critically important as one’s own. If you or your partner’s health seriously declines, or your partner dies, retirement becomes a far different experience than you may have anticipated or predicted.
I would recommend a recent article in the New Yorker magazine (April 30 edition) by Atul Gawande, the Harvard surgeon who is also a gifted writer. The article, “The Way We Age Now,” describes the physical aspects of the body’s inevitable deterioration and what can be done to manage these changes. Gawande is particularly concerned about that lack of trained geriatricians who know how to treat the physical and emotional needs of the elderly, as opposed to the average internist who is best at primarily treating disease entities. Geriatric patients are mainly at risk for depression, social isolation, malnutrition, and the danger of falling. Having a personal doctor who looks after you with regard to these risk factors is important if and when you get to be in your 80’s and 90’s.
To the degree that one does have some control in life’s later stages, it would seem best to exercise that control to maximize one’s happiness. Some things are, after all, out of our control, and since time moves in only one direction, the one thing we know for certain is that eventually we will all run out of time itself!
Hugh R. Winig, M.D.
(Published in the East Bay Psychiatric Association Newletter, May 2007)
When my Dad turned 80 some years ago, a friend of mine gave him a book entitled “Getting Old Is Not For Sissies.” I didn’t fully realize then the implications of the title, as I was still in my late 40’s at the time. Now, as Medicare and Social Security loom around the bend for me, I am beginning to appreciate better the hard work of getting old that lies ahead. The march of time takes its toll on everyone, and everyone needs to train him or herself to be old in order to avoid certain pitfalls. Getting older requires major attention to one’s emotional, attitudinal, and physical wellbeing.
The emotional side of things is probably the subtlest. People have to learn to be comfortable when they no longer have a schedule, when they no longer are earning an income, and when they are spending more time alone. For most people this is a radical change, as one’s earlier adult years were usually spent maximizing income within the context of a job with a schedule and social interactions. Leisure time, although previously yearned for, may now feel unnatural; and time alone, rather than being enjoyable, may be experienced as isolative.
A shift away from one’s earlier sense of purpose begins to occur between ages 50 and 70. It is during this period that one needs to behave more like we did as children--to be able to play, to enjoy whiling away the time, and to pursue activities just for the sheer pleasure of them. One has to strategize about these new realities or one will be bored, no matter how much money and freedom one has carefully planned for. I’ve known retirees who can’t find enough hours in the day to pursue all the interests they have, but I’ve also known those who complain that “retirement is not all that it was cracked up to be,” and they dread the boring days that stretch out before them.
For those living in the transitional stage going from “working hard” to “hardly working,” it is important to take the time to understand your new needs, to assess your physical, emotional, and financial health, and to develop a plan to address your new realities. Retirement can be a time of creativity, newfound freedom and interests, and revitalization, but alternatively it could become a time of stagnation, isolation, and decline. There are academic courses to be taken, arts and crafts to explore or master, cultural interests to pursue more extensively, more time to spend with friends, and time to travel more extensively.
Attitude can be critical. A year ago my wife and I took an adventure trip to Costa Rica and Panama. It was a small boat cruise with elective physical activities every day, including kayaking, snorkeling, hiking—you name it. One of our travel companions on this trip was a 90 year-old man named Sidney who had taken the trip with a much younger female friend (his wife had died many years earlier), knowing he could no longer partake in the challenging physical offerings on the cruise, but wanting to continue to travel nonetheless. Every evening after the rest of us were pleasantly fatigued from our day’s activities, Sidney and I would sit on deck with a cocktail and he would wax eloquent about his past years of growing his own business and about all the other places he had traveled to. He reported that he had turned over the ownership of his company to his son years ago, but still went to his office regularly to keep busy because “my son was kind enough to give me an office to go to.” Sidney’s companionship greatly enhanced my trip, and I know that he had a wonderful time that week as well. But it was Sidney’s attitude of continuing to engage life so fully that impressed me the most.
The other major challenge of old age is attending to one’s physical wellbeing. The major tactic for helping oneself is this area is developing the habit of exercise. If there is one single thing to do for oneself that can enable you to look better, feel better, and live longer, it is to exercise regularly. This doesn’t mean running marathons. It’s a simple matter of a three-mile walk or its equivalent four or more days a week. Forget all those other claims of revitalization that are advertised. Exercise is as close to the fountain of youth as you can get.
Despite maintaining a regular schedule of exercise, the ravages of physical decline with age may become overwhelming nonetheless. There can be losses that can change everything for the worse, and these losses may mount up and become overwhelming. Your own good health is one crucial requirement for happiness, but for those who are in a long-term committed relationship, the life and health of one’s partner is as critically important as one’s own. If you or your partner’s health seriously declines, or your partner dies, retirement becomes a far different experience than you may have anticipated or predicted.
I would recommend a recent article in the New Yorker magazine (April 30 edition) by Atul Gawande, the Harvard surgeon who is also a gifted writer. The article, “The Way We Age Now,” describes the physical aspects of the body’s inevitable deterioration and what can be done to manage these changes. Gawande is particularly concerned about that lack of trained geriatricians who know how to treat the physical and emotional needs of the elderly, as opposed to the average internist who is best at primarily treating disease entities. Geriatric patients are mainly at risk for depression, social isolation, malnutrition, and the danger of falling. Having a personal doctor who looks after you with regard to these risk factors is important if and when you get to be in your 80’s and 90’s.
To the degree that one does have some control in life’s later stages, it would seem best to exercise that control to maximize one’s happiness. Some things are, after all, out of our control, and since time moves in only one direction, the one thing we know for certain is that eventually we will all run out of time itself!
Hugh R. Winig, M.D.
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