Time is Running Out for the Aging Doctor

Life's tragedy is that we get old too soon and wise too late

Ben Franklin

http://www.nytimes.com/2011/01/25/health/25doctors.html?_r=1&pagewanted=2

I always considered myself a smart guy, but I am glad I was able to retire early. I am not as smart as I once was, and would not be as good of a doctor as I used to be. Keeping up with the many advances in medicine was always difficult, but it gets even harder as one's memory fades. Time is not kind to doctors. Many careers, such as law, teaching and business allow the opportunity to change one's activities as one's skills decay, but not medicine. Age does not dismiss the requirement to bring top level knowledge and skill when treating patients. Unfortunately, the optimal combination of experience, brain function, and technical skills tend to peak in the 40's or early 50's, and decline from there. Experience cannot combat the combination of fading powers and distance from residency training.

Unfortunately, the decline for some is great, and the degree of impairment can be severe. Because of denial or financial pressures, doctors tend to downplay the impact of age, and sometimes practice long after they should have stopped. That kindly old physician so honored in our literature and on TV may well be a menace, practicing antiquated and substandard medicine.

The article referenced today discusses higher complication rates among older doctors and the difficulties with identifying and sanctioning these older doctors. The problem is far more widespread and insidious than the article indicates. Every doctor is aware of colleagues, whose skills have been decimated by age. In contradistinction from the greedy or incompetent doctor, these older physicians represent the full spectrum of medicine, from the marginal to the well-respected. Unfortunately, in order to address this problem one must confront everyone, from the clearly incompetent to the wise, honored and trusted mentor.

The problem is reminiscent of that faced by aging drivers. How can you demand someone stop driving when they have had no accidents and limit their driving to the daytime? How can you tell a doctor to stop practicing when he continues to keep his patients happy. As a colleague once said of his aging doctor father “He and is patients are getting senile together”.

Addressing such issues if further complicated by the impending doctor shortage, and the financial meltdown that has decimated many portfolios. I think the best option may well be to offer aging physicians wider opportunities to do things other than practice. Quality assurance, administrative tasks, and implementing Obamacare are possible options, writing blogs is another.