Registering

Worrisome lab work, results with the potential to reduce longevity, brought me to a specialist.  Despite my familiarity with possibilities and likelihoods, mostly in my favor, I fretted over the encounter.  I drove to a big place, a suite that comprised the entire third floor of the building's west wing.  Chairs everywhere.  Quite a lot of doors.  Stuff hanging on walls, with a small display case for awards that members of the medical group have received.  

My turn at the reception desk came quickly.  Insurance cards.  Driver's license to confirm that I am really me.  A clipboard with registration forms and a pen of the type they discount at back to school sales.  No practice promotional logo.

I took my clipboard, then headed to a chair with arms in a place largely unoccupied.  Demographic data straightforward.  Name, address, birthdate as medical facilities now use that to confirm identities.  Emergency contact.  That took some thought.  My wife came first.  Back-up?  Neighbor or Friend.  It reminded me of how few close people I have.  I named a friend who could rescue me in an emergency.  Who to discuss what to do if I couldn't engage in decisions myself.  My wife.  They needed a backup.  I have two children, both physicians.  One is a clinician, the other a researcher.  One can drive to my side in five hours.  The other can fly to my side in five hours.  They have different personalities.  I wrote the name of the more distant on the line.  A reminder that this specialty has patients who sometimes do not do well.  I might become one of them.  I have an advance directive.  I think I know where it is.

Next page, About Me.  Have I ever had?  Our electronic record keeping has distilled all responses to yes/no, ignoring context which often matters more than yes/no.  I have had a right upper lobe walking pneumonia,  no subtlety by X-ray.  I remember slight pleuritic pain, and I probably had a fever which is why they did the film.  I think I took a course of antibiotics.  I remember where the x-ray had been taken, at a facility that went belly up some time ago after private equity purchasers milked what they could of its assets.  So I have had pneumonia.  When the blood bank screener asks if I have ever had a problem with my lungs, I say no. No reason to deprive some really sick people of platelets that they need.  It healed and subsequent chest x-rays have been normal.  My cholesterol is controlled.  Do I have kidney disease?  By current criteria, I have minimal CKD of minimal clinical consequence other than a reluctance of my doctors to prescribe anything that might upset that stability.  Anemia?  It's been treated.  Covid?  Took a course of Paxlovid.

Surgery?  Appendix they care about.  Mucosal tags and arthroscopy and wisdom teeth they probably don't, but EHR record keeping still gives that a yes.  

Family?  I know very little of my relatives' past.  There have been malignancies.  There have been cardiovascular events.  My siblings, my closest genetic contemporaries, are not in my loop.  My children keep their adult medical situations private.  I know how long my parents and grandparents lived and their cause of death.  A few more Yes responses on the checklist.

My Review of Systems, a very cursory checklist.  A pittance of what I used to solicit from patients. HEENT OK, though I think they could figure out from my age that hearing decline and cataracts are in evolution.  CV, pulm, GI, musculoskeletal, hematologic all had some intrusions.  None limiting but all an invitation for the doctor to expand our interview when she thinks it helpful.

Medical parts done.  Statement of financial obligations signed.  Clipboard returned to the front desk for somebody to type my responses onto their computer forms to remain in cyberspace for perpetuity, though with some privacy protections.  I kept the pen, with their permission.

This introduces serious medical care.  Perhaps their registration form, carefully considered by whoever designed it, hints at what their new patients like me want out of the assessment, and later the treatment.  I think everyone, including me, wants the doctor's talent.  Usually that entails technical decisions that extend life when it is threatened, or at least ease discomfort.  But as I filled out my answers, an emotional component became apparent.  I've been through my share of illness.  Until now I've prevailed.  In my Medicare senior years, I've accumulated fewer people that I can count on than I might have anticipated in the years I was more fully engaged with other people.  My children remain available from afar.  My sibs no longer are.  When I needed to identify a backup person, I chose a friend over a neighbor.  Friends are few, though not absent.

Some diagnosis remains.  A chance to recoup my resilience exposed by my past medical history and my current array of symptoms.  I remain fully functional despite them.  I conveyed to my medical care team a few things they needed to know, some they probably didn't need to know.  Those fifteen minutes with the form, pondering that Yes But which an electronic data set cannot capture, enabled an overdue interview with myself.  It left me with a different impression when I returned the clipboard than I had driving to their office.