Don’t stamp older doctors with an expiration date

“When Are Doctors Too Old?” is the question Lucette Lagnado tackled in the June 26, 2017 issue of The Wall Street Journal.¹

According to Lagnado, nearly 25% of American physicians are 65 or older, and the American Medical Association states that 40% of these are still actively involved in patient care. In fact, an AMA working group is considering guidelines to screen older doctors for cognitive issues. These more mature doctors, the working group suggests, pose a potential risk to patients.

Essentially, the AMA is saying the doctors are just too darn old. And the AMA apparently isn’t the only organization that thinks so.

According to the article,
Stanford Health Care in Palo Alto, CA, has created a Late Career Practitioner Policy, which older physicians have been battling fiercely for over five years. They find the policy discriminatory and demeaning.

Lagnado describes how
these physicians have partially won their battle, and are no longer being sent to a neuropsychologist for cognitive exams. However, once they reach age 75, they are required to undergo peer reviews. Their colleagues at Stanford Health will be questioned to determine whether the older doctors are still mentally okay and fit to practice, Lagnado reports.

Other facilities mentioned in the article, including Cooper University Health Care in Camden, NJ, similarly require doctors 72 and older to undergo mental competency exams to check for cognitive impairment or dementia. A local neuropsychologist administers these tests, which last as long as three hours.

As it turns out, the “older-doctors-causing-harm hypothesis” may not hold much water. The article goes on to state that Dr. Martin Makary, a surgeon and health-quality expert at Johns Hopkins Medicine foun din the April 2013 issue of Surgery that catastrophic mistakes, such as operating on the wrong patient, were actually fewest in physicians aged 60 and older.

In my opinion, surgeons who have unsteady hands or a resting tremor should not operate; this would expose patients to unnecessary risk. However, if an older surgeon has careful hands and excellent judgment, it’s a positive for a doctor to have more years under his belt. A rookie doctor without experience does cause my palms to sweat. For my money, Ben Franklin was spot on when he advised us to, “Beware of the young doctor and the old barber.”²

As a radiologist, I have great respect for experienced colleagues who can quickly decipher a patient’s diagnosis following a careful and thorough history and physical exam. It’s often the more seasoned doctors who demonstrate the uncanny ability to predict a patient’s diagnosis, even before imaging. When I identify imaging findings that confirm the final diagnosis, I often think to myself as I dictate: “Good call, Doctor!”

To be sure, physicians aren’t the only professionals exposed to ageism. Aside from medicine, other professionals responsible for people’s lives and safety face mandatory retirement age requirements. Commercial airline pilots must hang up their wings at 65.³ However, I often feel safer on flights knowing there’s a chance it’s being commanded by an older ex-fighter pilot—one who has encountered many challenges.

Recall the words of Capt. Chesley “Sully” Sullenberger, who made the following statement regarding his heroic landing of US Airways Flight 1549 on the Hudson River:

“One way of looking at this might be that for 42 years I’ve been making small, regular, deposits in this bank of experience, education, and training. And on January 15, 2009, the balance was sufficient so that I could make a very large withdrawal.”⁴

Respecting the training and experience of older physician colleagues is essential. Indeed, it is gray-haired doctors who often demonstrate the best bedside manner—and perform the most thorough history and physical examinations. In addition, they have often seen the most rare and interesting cases throughout their long careers. There is no substitute for the knowledge gained from such rich experience.

Wisdom grows with age.

References

1. Lagnado L. When are doctors too old? The Wall Street Journal. June 26, 2017. A9, A11.
2. Franklin B. Wit and Wisdom from Poor Richard’s Almanack. 1/2/2013. Random House Publishing Group.
3. Nbaa.org. https://www.nbaa.org/admin/personnel/age-65/. Accessed Aug. 1, 2017.
4. Newcott B. Wisdom of the elders. AARP Magazine. 2009;52(3):42.