Charles is none to happy. He is sitting tall on the exam table, towering over the three concerned women in the room. “Charles, I see you brought the team!” he responds ,” More like a coven!”. His daughters giggle and wife, also in her mid 80’s looks perplexed. Immediately, I see that something is troubling him and may just get expressed to a new doc. After the exam and detailed questions, I open the door to the discussion which he seems reluctant to have or to “make waves” in front of them. They are gracious to give us the room.

“You know doc, I was the CEO of my company in Massachusetts. I paid health insurance for hundreds of people over the years. I have good insurance myself, but I’ve been let down. I know I won’t live forever, especially at my age, but I can’t help but feel abandoned. It upsets my family to hear, but just getting this diagnosis in September, I am still blown away.”

Charles has metastatic prostate cancer. His doctors stopped checking for it at 80. 80% of men will have it by that age as the gland breaks down and many will die with it, never having a problem and not from it, so routine screening past this age is not often recommended. What’s the problem? Charles has no health issues. He is fit, strong, his parents lived into their 90’s and for that generation it was remarkable.

He is absolutely flabbergasted that he has Stage IV disease which we try to avoid specifically with screening. 80 was too early to stop for Charles. The rule is that a patient who may live another 10 years, should have screenings: mammograms, colonoscopies, prostate screenings, skin checks. There are even tests to determine when a prostate cancer is found, if treatment is advised. Charles was let down. Even with hormone therapy and radiation for symptoms, this disease will take its toll as will the therapies. He opens the opportunity to reiterate my stand on this.

Do NOT accept less care because of your age. Medicare (due to cost) is searching for ways to stop screening and treating super seniors. Exactly the group who needs the care and by the way, who paid into the system since their first job at 16! It is getting expensive with baby boomers living longer. There is absolutely no reason you should not receive screenings. If cancer is found, then you can decide what to do, but ignoring is not appropriate medical care. Added tests like low dose ct scans, should be done if you are or were a smoker. Head and neck exams are important if you have a history of alcohol and or smoking. GYN check ups for women (recent report last week found cervix cancer deaths are rising in over age 65 group and many have stopped screening….. because they were told to!)

Charles is right to be upset. I meet many people who are healthcare minimalists and that is fine. You should live life your way. But if you are someone who takes care of themselves, eats well, exercises, avoids alcohol and especially has longevity in the family, don’t let anyone talk you out of screenings. They are not doing you any favor. You are not somehow protected. There is no magical thinking.

Four other men in the clinic that morning are close to Charles’ age and getting therapy for their prostate cancers. Some headed to golf or pickelball afterward. They have early stages found on screening.

For over 100 of my posts, there is a common thread: take control. Insist on care. Search out those who will work for you. You deserve to live your best life- perhaps even more so in your golden years.