I feel fortunate that, at the time of this writing, I am engaged in a full-time solo medical practice in rural Connecticut. I don’t accept the occasional criticism from other physicians that I am inexperienced. I am not writing as a "media-doc." I am a real, in-the-trenches physician. I deal with real medical problems on a very personal level with my patients. I am the only widely-syndicated columnist who maintains an active medical practice. I believe having an active practice gives me valuable insights that I try to include in what I write.

A secret: I have never admitted this in writing before, but I am also medical director of the Hotchkiss School, a prestigious coed preparatory boarding school in my community. This experience gives me a wonderful perspective on adolescent medicine, that helps counterbalance my constant exposure to elderly patients. I may see football knee injuries on Saturday and arthritic knee problems on Monday. That makes medicine far more interesting.

Like most of life’s adventures, medical practice has changed dramatically in the 40 years I’ve been at it. Many of these changes are desirable: more powerful antibiotics, a giant leap in diagnostic technology, new life-saving surgical techniques, an improved understanding of disease processes, and—most important—an increase in the life span of people in the developed world.

However, as with any change, there are inevitable drawbacks: the astronomical increase in medical costs, the malpractice crisis, practitioners’ dissatisfaction with the erosion of their autonomy, unacceptable government interference, the problems with health maintenance organizations, increasing doctor shortages, less personal physician-patient relations, and the increasing tendency of many young doctors to treat the disease instead of treating the patient as a person.

This last change reflects a dynamic alteration in the culture of the medical profession and it particularly affects senior citizens. Years ago, doctors listened to their patients and adopted a more give-and-take attitude with the elderly under their care. Patients and their families were consulted and their wishes were, as a general rule, respected.

Now, I am told, new doctors often tend to avoid eye contact, preferring instead to focus on their computers, order more lab tests, and prescribe multiple drugs. In far too many instances, physicians completely disregard their aging patients’ desires, especially concerning personal choices about how best to make the remaining years of life active and enjoyable and the inevitability of death as painless and dignified as possible.

When I started practice years ago, all the doctors in my community took care of indigent, deserving patients. That, too, was my job: to serve the community. Judging from the mail I have received, this is no longer the standard. Too bad. A doctor’s prime goal should be to serve the sick, and, in the past, this was considered to be part of doing one’s job. But, unfortunately, I have no control over the current crop of medical doctors.

I try to cover a plethora of topics when I write, yet, now that I am pushing 70, health issues of the over-50 crowd, the core material of this book, have somehow reached a new level of importance with me.

I often write about these concerns in my column. I do this, in large part, because I am convinced that we—the elderly—need to be heard; our opinions are valid. The doctor serves us, not the other way around.

Now is the time for each of us oldies to step up to the plate. If, at a later date, we are suffering from advanced senility or an incapacitating disease, we may lose control of our lives and our futures—unless we have planned ahead.

We have an obligation to our loved ones and ourselves to become familiar with topics relating to common diseases, methods to maintain good health, and the rationale behind any proposed medical or surgical therapy.

For instance, overweight is a national crisis. It can lead to serious cardiovascular consequences. The treatment? A reasonable diet. High cholesterol levels predispose one to heart disease. The first step in therapy? A low- cholesterol diet and more exercise. Lung cancer is a leading cause of death in adults who smoke cigarettes. The best treatment is prevention: Stop smoking.

What is the common denominator in these examples? There is no surgery, medication, or therapy other than common sense. We can, in fact, be in control of much about our lives without medical assistance. People who behave sensibly usually live healthier, longer lives than those who don’t. Take note.

All of us will die. (You can say that you first read this startling revelation here!) But death can be comfortable and brief or agonizing and prolonged. Each of us must decide how this difficult situation should be handled. Therefore, I urge those of us who want some say in this crucial matter to make our choices and to prepare and sign the necessary legal documents, including living wills and health care proxies, and to inform our families of our wishes.

Do I dare comment about the future of medicine? Sure. The future of medicine is—in my view—undecipherable. The profession of physician is unquestionably in crisis. We are moving at breakneck speed toward a computer-generated health system that will apportion services according to bits and bytes—unbalanced by hands-on medical contact. This, I fear, will be to the patient’s great disadvantage. Maybe someday it will reach some kind of Star Trek stage: you step into a smoked-glass tube and get beamed back to good health—making medical doctors unnecessary.

Finally, I give my readers the same advice that I give myself: Find a physician who is caring, considerate and knowledgeable; maintain a living will; exercise regularly; behave appropriately; and hope that your needs will be respected when the time comes. Also, try to keep some humor in your response to life-issues. Funny is always better