A new form to fill out



I got my Medicare card 2 years ago (guess how old I am?). At this year’s physical exam (my first exam under new rules that let Medicare pay for routine annual physicals), the clerk asked me to fill out the “Health-Risk Assessment” form my PCP would need for billing.

This form had two pages. Page 1 listed 26 questions, each to be answered by checking off one of the following six choices: Never, Sometimes, Seldom, Often, Always, and Not Applicable.

Dr. Alan Rockoff

Dr. Alan Rockoff

Right away you see a problem. If this were an SAT test, say, where I actually cared whether or not I passed, I would summon a proctor and demand to know the difference between “Sometimes” and “Seldom,” or whether “Always” includes when I’m asleep, intoxicated, or filling out forms.

I will not burden you with all 26 questions. Instead, I’ll present several (these are the actual questions, folks, word for word), along with the answers I would have given had I not been hamstrung by the Six Categories. Each question is headed, “In the past 4 weeks.”

Q: How much have you felt little interest or pleasure?

A: I have very much felt little interest, and very little felt much interest. On the other hand, I have much interest in the little pleasure I have felt, and much pleasure in the little interest I have had.

Q: Has your physical and emotional health limited your social activities with family, friends, neighbors or groups?

A: No, but lack of money has.

Q: Have you needed help preparing your own meals?

A: Yes, ever since I got married, but that was more than 4 weeks ago. I can still make omelets, though.

Q: Are you having difficulties driving your car?

A: Do you know Boston drivers?

Q: Have you needed help managing your finances?

A: Not since 2008, and then it was my broker who needed the help.

Q: Have you needed help with household chores?

A: Never do ‘em.

Q: Do you have concerns about your memory?

A: What?


A: Not so much about what I can’t remember, mostly about what I can.

Q: Do any of your friends/family have concerns about your memory?

A: No, other than whether I’ll remember them in my will.

Q: Have you had sexual problems?

A: Too much. Too little. I forget. But that’s just the last 4 weeks. Six weeks ago was amazing.

Q: Have problems using a telephone?

A: Damn right. Cellular connectivity around here stinks.

Q: Do you exercise for about 20 minutes, 3 or more days a week?

A: I always exercise sometimes. I sometimes exercise always. Could you repeat the question?

Q: Does your home have throw rugs?

A: It has rugs, but nobody throws them.

Q: Does your home have poor lighting?

A: Ever since they outlawed incandescents. When I flip the switch, they’re fully lit by the time I finish breakfast, but by then it’s time to turn them off and go to work.

Q: During the past 4 weeks, how have things been going for you?

A: The Red Sox are doing lousy. Did you have to ask?

The form ends with thanks for taking the time to fill out the form and concludes with this cheery note: “Your responses will help you receive the best health and health care possible.”

When my physical was done, my doctor found the form in my paper pile. “I see you filled it out,” she said.

“By the way,” I asked her. ‘”What do you do with these forms?”

“Absolutely nothing,” she said.

“You don’t have to submit them for tabulation or something?”

“No,” she said.

If you’re not on Medicare yet, this is what you have to look forward to. Always.


Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Skin & Allergy News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years.

[email protected]

Next Article: