Modern American Medical Adventure

Like many men of a certain age (old) I have to keep an eye on my prostate gland. Of course, I don't mean that literally, but I have to let my tall, handsome urologist do it.  His name is Bob.

I've been going to Bob for 6 years, ever since a routine blood test showed a high PSA. Fortunately, usually high PSAs mean only a benign enlargement, which I had, but Bob did a biopsy and sees me once or twice per year.

Wifey once visited Bob, and he reported to her that "I really like your husband." At first, hearing those emotions from a man who does to me what Bob does was disconcerting, but I realized he meant no harm.

I was to see Bob Monday, and Friday I happened to see him at Shula's in South Miami. We hugged, which my friend Carole thought was adorable. I told him I was due to see him, and maybe we could be more efficient and just do the exam in the men's room. Bob thought that was hilarious. He likes me.

When his office called to confirm the appointment, the staff member noted I hadn't yet gotten my 4K score. She was right -- I forgot to go for the blood test. 4K is the latest arrow in the urological quiver -- it tells whether you have the genetics for really BAD prostate cancer, or just the normal, friendly type. This latter version is the kind most men WILL get, and I mean WILL. Turns out that if you autopsied 100 dead 95 year olds, 95 % would have prostate cancer -- though none may have died from it. But there's a lethal variety that will indeed spread and kill you. Just ask the widows, of Dan Fogelberg, Frank Zappa, and Joey Ramone. Maybe you have to be a successful musician to have it.

Anyway, this am I went to the special lab to get the 4 K test. Usually I go to my regular doc's nurse, Nancy, for blood draws, but Opko, the pharma company that does 4 K,  makes you use their own labs. Phil Frost didn't become a billionaire and give away hundreds of millions by letting any profits from his companies slip away.

The lab was right next to the Miami office of Mark, my CPA. For some reason, I chuckled to myself about that. I walked in, and there were two pregnant women waiting in the lobby. I announced I was there for a 4 K test, and the receptionist asked for my paperwork. I didn't have any -- Bob's office said to simply go over.

Nope -- no tickey, no test-y. So we both called Bob's office and got placed on 20 minute holds. Finally the staff member answered, and transferred me to another 5 minute hold. The pregnant ladies started eyeing me suspiciously -- and their looks were a bit scary.

I couldn't help myself, and said "Look -- I know you both have men in your lives, and they're probably younger than I am, but in 20 years or so, they'll be dealing with stuff like this." They both laughed, and agreed. Then I realized, wait -- this is Miami -- a pregnant woman could well have a boyfriend or husband in his late 50s, like me, or even older. I really have to keep my thoughts private.

Finally the assistant came back on. "Oh, Dave -- you have Av-Med, and they won't pay for the 4K. You can pay yourself if you want -- it's $500."

Normally I'd have said -- the hell with it and just paid, but my monthly premiums to Av-Med are near $2 thousand dollars -- the least they could do is pay for this.  So I bid the receptionist and the pregnant ladies good day, and left.

I'll likely have a different insurer come January -- maybe they'll pay.  As my very smart friend Ken said -- most screening tests are a waste. They don't lead to decreased mortality. Exceptions are colonoscopies and skin cancer screening. I can well do without the fancy 4 K.

Ah -- the joy of American medicine.  It truly is best to avoid it as much as you can.