AI-generated image from Kalsstockmedia.
A common question for advice columnists is, “My spouse refuses to see a doctor. When they get sick, am I supposed to take care of them?” This column from Carolyn Hax is a good example. The wife worries that she’ll be active “in retirement” while her husband is sidelined and unable to join her.
I’ve heard live comments, too. A male coworker said (many years ago), “I told my wife I wouldn’t take her on vacation unless she went to the doctor for a checkup.”
Statements like these make me very, very happy to be single…aside from the fact that the speakers are not just being coercive: they are exaggerating the benefits of “preventive” health care. Of course this kind of pressure can appear in non-spousal contexts, but in the letters to the advice column you can almost hear the desperation.
And of course there’s a consideration: married people have to consider the impact of health decisions, as well as financial and child-bearing decisions, on their partner.
It’s different when you’re single.
As a single person, I used to get a lot of horror stories from friends. I was one of those people who never went to doctors. I skipped mammograms, colonoscopies, and yearly blood tests. When asked why, I explained that I hated the medical profession and was skeptical of their advice.
Of course no one would suffer from my choices. My will included provisions for the pets. I exercised, ate more or less sensibly, skipped the sugar soda, and didn’t let my mind rot on daytime television. I went decades without entering a doctor’s office. Those were my personal tradeoffs.
And now that I’m well beyond Medicare age, nobody bothers me. They can’t say I’ll die young if I skip the tests. Doctors bite down their surprise at my lack of test records. They know I’ll reject their well-meaning offers of tests and drugs. They nod resignedly when I say, “I don’t care about living to be 100. I want to die before I go into a nursing home.”
Ultimately, it’s all about tradeoffs. Specifically:
(1) Data on so-called preventive care doesn’t send a clear message.
Screenings miss a lot of disease and give you a lot of false positives. Read books by Gilbert Welch and look for his videos. False positives can send you for more tests that increase your risk of life-threatening consequences that are worse than the original disease. Unless you have a history or symptoms, the benefits of screening can be murky.
One local hospital routinely sends out postcards with the message, “Mammograms save lives.” That’s true, but how many do they save? The National Cancer Institute estimates you’d have to screen 1300 women to save one life. You have to make your own tradeoff.
(2) Population-based evidence may not apply to you.
We all know people who were careless about their health and lived to be 90, while fastidious, fit vegetarians die painful deaths at fifty.
All you can do is move the needle–and often not very far. Eating a heart-healthy diet won’t necessarily save you from bad genes or a dust-filled environment. ? There are no guarantees. You could could do everything right and still wind up helpless as the victim of an accident, obscure hereditary illness, or just the wrong side of the statistics.
(3) It’s a deeply personal decision.
People differ in the amount of discomfort they experience at medical visits. Some population segments get treated worse; some places treat everyone like pieces of meat. Some treatments are more painful than others; both treatments and side effects can bother people differently.
People also differ dramatically in their beliefs about medical interventions. I once encountered a professional woman – a lawyer – in the dog park. She mentioned that mammograms were a yearly non-negotiable. I asked her if she knew the statistics.. She said, “I don’t care. I want my medical tests.” That’s her prerogative. It’s not a mandate for everyone.
Bottom line…
It’s legal for people to choose high-risk factors that could kill them, such as smoking and sugar sodas. It’s legal to refuse care, even if the consequences are serious. And most importantly, I believe it’s up to each of us to make this decision independently, from a place of information, even if we seem to be acting against our own best interests.
And every time I read one of those advice columns with the question, “How can I make my spouse see a doctor?” I am even more grateful for my life as a single person. I make my own tradeoffs.
