FEATURE
THE GOLDEN AGE
AUTHOR David Seligson, MD
I
looked down at my forearm – it was bleed-
ing. One advances in a medical career by
being compliant; compliant means not
making waves. So, I dutifully reported for
the annual mandatory tuberculosis (TB)
screening and after filing out the paper-
work, took a seat in the waiting room.
Finally, an employee not known to me applied
the required subcutaneous dose to my forearm – no Band-Aid. A
drop of blood wandered toward my hand, enough perhaps to create
a problem if I tried to scrub in. It was a bright, blue-sky day but this
medical testing made me feel old and used. Today TB, tomorrow
whatever. It was not productive to muse how many times this annual
Mantoux test ritual produced a positive result in Native American
physicians with no exposure to TB. Some assistants who had Bacillus
Calmette–Guérin as children and took a diluted test with the false
promise of no reaction, wound up with ugly sores that lasted for
weeks. TB testing is an exercise in the executive power of institutions
mobilizing their army to send notices, threatening emails and even
6
LOUISVILLE MEDICINE
certified letters to get a job done that does not need doing—another
reminder that it is no treat to grow old. Where are the results of this
activity? What is the cost-benefit analysis?
It is not entirely unexpected that a certain amount of indignity
comes naturally with older age. I spent three hours between flights
in the Sky Lounge in the Atlanta airport trying to register for a
security clearance program that required fingerprints. No amount
of rolling, oiling, powdering or pressing would get the computer to
accept my identity – the ridges and swirls on my fingers had simply
worn off from 40 years of scrubbing, brushing, wiping and gloving:
the small price of surviving into the computer age.
My malpractice insurance carrier sent a formal letter last year
to inform me that all their doctors 72 years of age and older would
be required to have a physical exam with their own primary care
physician to include an EKG. Does this constitute age discrimination
since doctors not yet 72 can be insured without an EKG, or since
all 72-year-olds are to be treated equally, does this demand meet
the requirement of the law mandating equality for all without age
discrimination? There are really no damages, so it would be hard to