Consider Smart Choices rather than Smart Toys this Christmas

Have you finished your Christmas shopping yet or are there still some people left on your nice list?!?

With only 8 shopping days left, SRxA’s Word on Health wants to help you make smart gift choices for the little people in your life.   Bridget Boyd, MD, a pediatric safety expert at Loyola University Health System offers up the following tips to ensure you bring joy, not tragedy, on Christmas morning.

“Christmas is a wonderful time of year, but it can quickly turn tragic if we’re not careful,” says Boyd. “Sometimes in our attempts to make Christmas extra special for our kids and grandkids, safety can get lost in the mix.”

Shopping for infants and toddlers can be difficult since many toys are labeled appropriate for ages 3 and up. Though it may limit the options, Boyd said following age-appropriate guidelines is important for keeping kids safe.

“Age labels are monitored closely and should be taken seriously. Choking and strangulation hazards can mean life or death to a child,” said Boyd. “Most people do follow the guideline to avoid small parts that might be choking hazards, but there are some safety tips that aren’t as obvious.”

She suggests when opening gifts to watch out for ribbons that could be a strangulation hazard and to try to keep older children’s gifts away from younger children so there is not accidental ingestion of a small part. Toys with strings are a choking hazard as well, especially those that are greater than 12 inches in length.

“If a child is under the age of 2, they are more than likely going to put whatever they are given in their mouth, so avoid items with paint, chemicals or small parts,” Boyd said. Small magnets and button batteries are some of the most hazardous. Magnets should be kept away from small children as they cause severe damage or even death if ingested.

“Button batteries are extremely dangerous so try to avoid gifts that include them. They also can be found in musical greeting cards, hearing aids and remote controls so make sure to keep an eye on your child around those items,” Boyd said. “Go to the emergency room immediately if a child has placed a button batter into their body. This includes swallowing as well as shoving up the nose or in the ear.”

Still, gift-giving safety isn’t just about swallowing hazards, it’s also thinking about the entire well-being of a child. “When thinking about what gift to give, try to find something that encourages children to use their imagination and get up and get moving,” says Boyd.

The American Academy of Pediatrics recommends children spend no more than two hours in front a screen a day. This includes video games, computers, phones and TVs. “So many young kids want cell phones, but is that really the best gift to give a child? Think about what is age-appropriate. There will be plenty of time to give phones and videos games in the future.”

And if you do give an electronic gift, supervision is key, especially if it involves the Internet.

Unfortunately, cyber predators and cyberbullying are becoming more common and pose a very real risk to children. If your child does receive a computer for Christmas, make sure you supervise their Internet use. The best place for a computer is in the family room.  There should be no screens, including computers, TVs or phones in a child or adolescent’s room. Screen time can interfere with sleep as well as distract them from participating in healthier activities for body and mind.

Whatever gifts you decide to give this holiday season, It’s also a good idea to periodically check consumer websites such as recall.gov and saferproducts.gov to ensure gifts are safe and have not been recalled.

Holiday Hellth!

For many of us the holidays mean family, feasting and fun.  But for our nation’s 18 million health care workers  – 28% of whom will be working on Thanksgiving, all celebrations will be placed on hold while they help those who are sick or injured.

And, as Christmas approaches, things don’t get any better.  The number of 911 calls and hospital visits spike as the temperatures plummet. For example, around 5,800 people are treated for holiday decorating injuries alone, each year. On top of this, the number one day for cardiac deaths is December 25th with December 26th and January 1st coming in a close second and third.

To raise awareness of the strain put on healthcare workers during the holiday season and some ways they can address it, Carrington College, has released these infographics:

Whatever you end up doing tomorrow, let’s not forget to say a word of thanks to our healthcare professionals. And if you do end up in their care be thankful they’re there.

Pumpkin Carving without the Cuts

In previous years we’ve blogged about the health benefits of pumpkins. This year, as Halloween approaches we thought we should provide a little fair balance and warn our readers of the inherent dangers of these autumnal fruits.

While pumpkins aren’t exactly going to jump out of the patch and spook or attack you, carving them can lead to significant injuries.

“Every Halloween season we see four or five patients — both adults and children — who come into our office with severe injuries to their hands and fingers,” says hand surgeon Jeffrey Wint, MD. “Treatment can often run three to four months, from the time of surgery through rehabilitation.”

To prevent hand injuries, we bring you the following safety tips:

Carve in a Clean, Dry, Well-lit Area
Wash and dry all of the tools that you will use to carve the pumpkin, including the knife, cutting surface, and your hands. Any moisture on your tools, hands, or table can cause slipping that can lead to injuries.

Leave the Carving to Adults
Never let children do the carving. Instead, let kids draw a pattern on the pumpkin and have them be responsible for cleaning out the pulp and seeds. And it’s not just young children who need to be supervised.
“All too often, we see adolescent patients with injuries because adults feel the kids are responsible enough to be left on their own,” says Wint. “Even though the carving may be going great, it only takes a second for an injury to occur.”

Sharper is Not Better
When you do start cutting, cut away from yourself and cut in small, controlled strokes. A sharper knife is not necessarily better, because it often becomes wedged in the thicker part of the pumpkin, requiring force to remove it. Injury can occur if your hand is in the wrong place when the knife finally dislodges from the thick skin of the pumpkin. Injuries are also sustained when the knife slips and comes out the other side of the pumpkin where your hand may be holding it steady.

Use a Pumpkin Carving Kit
Special pumpkin carving kits are widely available. These usually include small serrated pumpkin saws that work better because they are less likely to get stuck in the thick pumpkin tissue. And if they do get jammed and then wedged free, they are not sharp enough to cause a deep, penetrating cut.

Should you cut your finger or hand, here’s what to do. If the cut is minor, apply direct pressure to the wound with a clean cloth and bleeding should stop spontaneously. If continuous pressure does not slow or stop the bleeding after 15 minutes, an emergency room visit may be required.

Better still, follow the above advice. Don’t let your Jack-o’Lantern jinx you and hold off on the Halloween Hand Injuries.

Kudos to Canada

This morning, SRxA’s Word on Health salutes the Canadian city of Hamilton, Ontario, for its pioneering lead in anaphylaxis safety. Hamilton is destined to become the first city in the world to require all food service outlets to have life-saving epinephrine auto-injectors on hand for people with severe food allergies.

The move is being led by Hamilton Councillor  – Lloyd Ferguson, in hopes of avoiding sudden and tragic deaths like one this past spring of a Stoney Creek girl.

Twelve-year-old Maia Santarelli-Gallo had what her doctor said was a mild allergy to eggs and milk that had only ever caused her a runny nose. But last March, while eating an ice cream cone at a Hamilton-area mall with her father and older sister, Maia experienced a sudden, severe allergic reaction.

Her sister found someone with an epinephrine injector, but by the time it was administered, it was too late. Emergency crews took Maia to hospital but she was pronounced dead.

When Councillor Ferguson heard about Maia’s death, he decided to draft a ground-breaking motion to get epinephrine auto-injectors in every restaurant and mall in the city.

He says it’s high time that food providers have access to medicines that could help their customers who develop allergic reactions. He says if automated external defibrillator (AEDs) are now being installed in arenas and other community centers, it makes sense to have epinephrine injectors in areas where food allergy reactions are most likely to occur.

“It took us about 40 years to get defibrillators into public facilities and they have been a great success. This is the next step,” he says.

Allergy specialist Dr. Mark Greenwald, Allergist, and Chief Medical Officer of EpiCenter Medical would like to go further and see public awareness campaigns that would train the public on how to use epinephrine injectors, just as there have been campaigns encouraging people to learn CPR.

Greenwald has developed an online course called EpiPenTraining.com, to offer training on how to recognize allergic reactions, and how to use the injectors. He says such training is vital because during anaphylaxis, seconds count.

And anaphylaxis isn’t rare.  Allergic disease is the 5th most prevalent chronic disease among all ages, and the 3rd most prevalent among children. Every 3 minutes in North America, a food allergic reaction sends someone to the Emergency Room. Every 6 minutes, that Emergency Room visit is for anaphylaxis, that’s 10 patients per hour!

In 25% of people requiring treatment, the reaction is their first episode, and they are completely unprepared.  And for 50% of the people who die from anaphylaxis, the victims had life-saving epinephrine, but it wasn’t used or it wasn’t used in time. The other 50% didn’t carry epinephrine despite their previous allergic episodes.

Participants in the online course become SAVE certified – Save Anaphylaxis Victims in an Emergency.

Debbie Bruce of the Canadian Anaphylaxis Initiative was part of a program this past spring to get epinephrine injectors on all fire trucks in Mississauga. She says that like Maia, up to one-third of people who have allergic reactions outside the home did not realize they had a severe allergy and didn’t carry an epinephrine injector. She is now petitioning politicians  to come up with a national allergy plan.

“I think it is a new reality,” she says. “Reactions happen and we need to be prepared.”

Maia’s mother, Leah Santarelli, backs all efforts to make the public more aware of anaphylaxis and hopes the Hamilton city council passes Ferguson’s motion.

“There’s no guarantee that an EpiPen will save your life 100 per cent of the time, just like a defibrillator won’t save you 100 per cent of the time, but it is there as a safety measure,” she says.

The motion is currently being reviewed by the city’s health team; if approved, it should go before Hamilton city council in October.

We certainly hope that it does and that this trend will rapidly spread across the borders.  As Greenwald says – every second counts!

The Sobering Buzz on School Buses

As the summer draws to a close and the new school years approaches, now’s the time for parents to sit down with their kids and have “the talk”.

No, not that one!  We’re talking about school bus safety.  According to the National Highway Traffic and Safety Administration, an average of 19 kids die each year as a result of school bus related accidents.

To help reduce this terrible statistic, Susan Laurence, injury prevention coordinator, at Cincinnati Children’s Hospital believes such a talk will help ensure a safe, enjoyable start to the school year for everyone. According to Laurence, many injuries happen when children are boarding or exiting the bus. “A blind spot extends about ten feet in front of the bus, obstructing the driver’s view. Often times, children are not aware of this blind spot and might mistakenly believe that if they can see the bus, the bus driver can see them.”

Laurence offers the following suggestions to parents on how they can ensure their child is safe before, during and after their school bus ride.

While Waiting for the Bus 

• arrive at the bus stop at least five minutes before the bus arrives
• avoid horseplay while waiting for the bus
• do not go into the street while waiting for the bus

During the Bus Ride

• remove loose drawstrings or ties from the child’s jacket and sweatshirt because they can snag on bus handrails
• when boarding or leaving the bus, children should always walk in a single file line and use the handrail to avoid falls.
• while on the bus, the child needs to remain seated, forward facing at all times and keep the aisle clear of his feet and his backpack
• do not shout while on the bus or distract the driver unnecessarily
• keep head and arms inside the bus at all times

After the Bus Ride

• wait for a signal from the bus driver before crossing the street
• look left, right, left before stepping into the street to make sure there are no cars passing the bus
• cross the street at least 10 feet (or 5 giant steps) in front of the bus
• wait until the bus comes to a complete stop before exiting
• exit from the front of the bus
• ask the bus driver for help if anything is dropped while entering or exiting the bus
• do not talk to strangers when walking to and from bus stop

Simple, sensible advice for all parents. Let’s make sure we keep the wheels on the bus this school year and prevent children from ending up under them.

COPD & asthma linked to poor anaphylaxis outcomes

Researchers have found that patients with chronic lung diseases, including asthma and chronic obstructive pulmonary disease (COPD), are significantly more likely to have poor outcomes when hospitalized for anaphylaxis and other allergic conditions compared with other patients.

Zuber Mulla, MSPH, PhD, Associate Professor and Director of Epidemiologic Research at the University of Texas School of Public Health and Estelle Simons, MD, FRCP from the University of Manitoba, Winnipeg, Canada identified 30,390 patients who were hospitalized in Texas for allergic conditions between 2004 and 2007. Of these, 2,410 had a primary or secondary diagnosis of anaphylaxis at discharge.

The 2,772 (9.1%) patients in the overall cohort who had asthma were 67% more likely to receive mechanical ventilation than patients without asthma, while the 1,818 (6.0%) patients with COPD were 35% more likely to be admitted to the intensive care unit (ICU), 41% more likely to experience a prolonged stay in hospital (over 3 days), and 98% more likely to receive mechanical ventilation than those without the condition.

In the sub-cohort of patients with anaphylaxis, patients with asthma (n=334; 13.9%) did not have an increased risk for mortality compared with other patients, but they were over two-times more likely to be mechanically ventilated than patients without asthma).

Meanwhile, COPD patients with anaphylaxis (n=149; 6.2%) were 86% more likely to experience a prolonged hospital stay and 61% more likely to receive mechanical ventilation than patients without COPD.

Other lung conditions associated with poor outcomes included pulmonary eosinophilia, which increased the odds for ICU admission in patients with allergic conditions, while chronic bronchitis, emphysema, and interstitial lung diseases were linked to an increased risk for hospital mortality.

In particular, in the sub-cohort of patients with anaphylaxis, interstitial lung disease was linked to an 8.71-fold increased odds for mortality and a 5.16-fold increased odds for mechanical ventilation.

Writing in BMJ Open, Mulla and Simons say that their “unique exploratory analysis of a large database offers new insight into the effects of chronic pulmonary disease on anaphylaxis, an area for which there has previously been a dearth of information.”

Should You Stay or Should You Go?

Picture this familiar scene. A critically injured person is wheeled into the emergency room by paramedics. Concerned, shocked and occasionally hysterical family members rush to the patient’s side. An army of doctors, nurses and techs begin emergency resuscitation efforts, inserting breathing tubes, CPR, starting IV’s, drawing blood, administering drugs and other fluids.  One of these health care professionals, nodding toward the family and screaming “Get them out of here!”

We’ve all see it… either in real life or on TV.

Cutting to the next scene, the family is escorted into a stark family crisis room. While healthcare staff work desperately to resuscitate the patient, a social worker updates the family on their progress. If the patient dies, staff  make him as presentable as possible, and then invite the family in to say good-byes. The social worker supports the family during this difficult time, and the code team return to their care of other patients.

For decades, this approach seemed to work well. The common wisdom was that if we did let the family in during the code, they’d either get in the way or become so distraught that we’d have more patients on our hands. Furthermore, we felt we were doing the family a greater service by letting them see their loved one only after we’d removed tubes and lines, even though the calm scene we produced was in total contradiction to actual events.

But recently, this traditional approach has been questioned. It turns out that many family members want to be present during resuscitation efforts, rather than hidden away in a side room.

And even though health care professionals are still divided on whether families should be present, most agree the issue must be addressed.

Now, research is starting to question whether family members be allowed to remain in the room as these potentially lifesaving efforts begin?

A two-year study led by a researcher Jane Leske PhD, has shown that family members – parents, spouses, fiancées and adult children – of trauma patients, can benefit by being present during critical moments of care.

“Those who do choose to do it really want to be there,” says Leske, professor of nursing at the University of Wisconsin-Milwaukee. “They want to watch everything and get information. It lowers their anxiety and stress to see that everything possible is being done. Seeing is believing.”

However, family presence during resuscitation is controversial and underutilized. Indeed, many health care professionals and hospitals argue against it, concerned that the procedures may be too traumatic for family witnesses, or that family members may become emotionally out of control and interfere with care.

Leske conducted this study in collaboration with medical staff at a facility where families have the option of staying and observing resuscitation efforts. It compared outcomes for family members of patients, ages 18-93, with critical injuries from gunshot wounds or motor vehicle accidents at a Southeast Wisconsin Level 1 trauma center.  The center had offered family presence during resuscitation for more than two years by the time Leske’s study began.

The study focused on 140 family members over age 18, divided in two roughly equal groups – those who opted to remain with the victim during resuscitation; and those who chose not to, or were not able to reach the emergency department in time. Researchers interviewed family members within 72 hours after admission to the surgical intensive care unit, to discuss the family’s coping resources, communication and anxiety levels.

She and her research team found a number of benefits to having family members present, and no drawbacks.

They concluded that while families can benefit from being present during resuscitation, it’s also important that the hospital have policies and procedures in place on when and how to allow the option. For example, family presence during resuscitation should not be permitted when family members are intoxicated, extremely agitated or emotionally unstable.

Other researchers agree. A large French study published last month in the New England Journal of Medicine concluded that relatives who did not witness CPR had post-traumatic stress disorder (PTSD)–related symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional stress in the medical team and did not result in medico-legal claims.

What are your thoughts on this?  Would you want to stay…or walk away.  Let us know.

Emergency! Epinephrine in Anaphylaxis: under-use and inappropriate use by EMS

Despite a decline in anaphylaxis deaths over the past 25 years, lack of epinephrine and incorrect administration of epinephrine still play a significant role in mortality.

According to a retrospective case study by researchers from McMaster University in Hamilton, Ontario only a quarter of patients received epinephrine prior to cardiac arrest, including those treated by emergency medicine personnel.

Of the 80 deaths recorded in Ontario from 1986 – 2011, 47 had a known or suspected allergy to the fatal allergen, but only 18 had been prescribed an epinephrine auto-injector and only 9 had their auto-injector at the time of the reaction. And at least 8 of these people received epinephrine that was either expired or administered incorrectly.

“The low proportion of patients who received epinephrine correctly may indicate that more information is needed by both patients and first responders regarding indications and techniques for administering epinephrine and auto-injectors,” said lead investigator, Ya Sophia Xu, MD

Most of the fatalities were caused by food allergy (n = 37), insect sting (n = 27), or medication (n = 11).  But in 5 patients, death occurred with no known allergen.

More than half (59%) of the food-related fatalities involved food eaten away from home – at public places including school, camp, or another person’s home.

“Patients with food allergies should be especially vigilant when eating outside of the home,” added Dr. Xu “restaurants need to improve the labeling and disclosure of potential allergens to the public.”

The study also revealed that Coroners’ reports are sometimes lacking information about the severity of previous allergic reactions, level of asthma control, time of administration of the first epinephrine dose, body mass index of patients, and anatomical location of the epinephrine injection.

Ryan Jacobsen, MD, EMT who is associate emergency medical services director for the Kansas City Fire Department in Missouri commented “there seems a perception among pre-hospital personnel that the administration of epinephrine is dangerous.”  He and his colleagues recently published a study with very similar results.

Dr. Jacobsen’s team surveyed 3,500 nationally registered paramedics in the United States and found that 36.2% of responders felt there were contraindications to the administration of epinephrine for a patient in anaphylactic shock. And 40% of paramedics (incorrectly) believed that diphenhydramine was the first-line medication for a patient suffering from anaphylactic shock.

“They also had challenges in the recognition of atypical presentations of anaphylaxis and determining the correct location and route of epinephrine administration,” he said.

Only 2.9% correctly identified atypical presentation of anaphylaxis, while less than half (46.2%) identified epinephrine as the initial drug of choice. Equally concerning, only 38.9% correctly chose the intramuscular route of administration, while 60.6% incorrectly identified the deltoid, rather than the anterolateral thigh as the preferred injection site location.

As an EMS educator I spend much of my time, discussing the 5 Rights of Administration: right patient, right time, right drug, right route, right dose.

Yet, according to this study, it seems as if emergency medical personnel are routinely failing on all 5 when it comes to anaphylaxis.

“Basically, we have the same issues in the United States that were found in the Canadian study,” says Jacobsen. “There needs to be an aggressive educational campaign geared toward emergency personnel in both the safety of epinephrine and its importance as the first-line therapy for anaphylaxis.  The benefits of epinephrine almost always outweigh the risks, but there’s a reluctance to use it. Patients get palpitations, they might get a headache, their heart rate goes up, but it’s a potentially life-saving treatment.

Amen to that.

A Slippery Slope?

As powerful blizzards hit the Midwest, leaving more than a foot of snow in parts of  Texas, Oklahoma, Illinois  and Missouri, many schools are closed leaving  kids to enjoy extended snow days, snowball fights, snowman building and maybe even some sledding.

But before heading to the hills, SRxA’s Word on Health wants to remind parents and children that although the adrenaline from speeding down an icy hill and feeling the snow spraying your face is hard to beat, serious injuries can also occur. While sledding has this connotation of innocence but you have to recognize that there is a potential for harm.

According to the CPSC (Consumer Products Safety Commission), each year there are more than 160,000 sledding, snow tubing and tobogganing-related injuries treated at hospital emergency rooms, doctors’ offices and clinics.

“There are some hidden dangers to sledding. It’s a great winter pastime, but there are risks involved. Parents need to be aware of these risks to help prevent injuries,” says Terri Cappello, MD, pediatric orthopaedic surgeon at Loyola University Medical Center.

In adults and older children extremity injuries such as broken fingers, wrists and ankles are the most common, while children aged 6 and under often suffer head and neck injuries. While some result in nothing more than minor concussion each year children suffer brain trauma, paralysis and even death as a result of sledding.

Over a 10 year period, the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio found an estimated 229,023 sledding injuries serious enough for ER treatment among children under 19. They also noted that:

• 26% of the injuries were fractures
• 25% were cuts and bruises
• 51% of the injuries occurred during a collision
• Collision injuries were most likely to result in traumatic brain injury
• 34% of the injuries involved the head
• 52% of the injuries occurred at a place of sports or recreation
• 31% of injuries occurred on private property
• 42.5% of injuries involved children aged 10 -14
• 59.8% of all injuries were sustained by boys
• 4.1% of all emergency department visits required hospitalization

“Parents don’t often think about putting a helmet on a child when they go sledding, but if the child is under the age of 6 it’s important. Also, never let your child sled head first. Injuries have been associated with the leading body part. If you lead with your head, you’re more likely to get a head injury,” warns Cappello.

Here’s a few more tips to keep kids safe while sledding:

1. Adult supervision is critical. 41% of children injured while sledding are unsupervised. Ensure someone is there to assess the area and make sure it’s safe as well as to evaluate and respond should an injury occur.
2. Make sure the hill is safe: that means a hill without obstacles in the sledding path, which doesn’t end near a street, parking lot, pond, or other danger
3. Sledding should only be done in designated areas that are open, obstacle-free and groomed. Most injuries occur when a sled collides with a stationary object. Make sure there are no trees, poles, rocks, fences or cars in the sledding area.
4. Kids should be taught to be on the lookout for other sledders and to avoid collisions.
5. Use helmets to avoid injuries and wear multiple layers of clothing for protection from injuries and cold
6. Always sled feet first. Sledders should sit in a forward-facing position, steering with their feet.
7. Use a sled that can steer—it’s safer than flat sheets, toboggans or snow discs

Stay safe in the snow!

Geriatric Medicine?

Picture this…a distinguished vascular specialist in his 80’s performs surgery, then goes on vacation, forgetting he has patients in the hospital; one subsequently dies because no doctor was overseeing his care.

Or imagine this? An internist who suffered a stroke gets lost going from one exam room to another in his own office.  Crazy? Unbelievable?? Well how about the beloved general surgeon with Alzheimer’s disease who continues to assist in operations because hospital officials don’t have the heart to tell him to retire.

No, these aren’t plots from a new medical drama, they are all real-life examples, exemplifing an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators.

About 42% of the nation’s 1 million physicians are older than 55.  21% are older than 65. And their ranks are expected to increase as many work past the traditional retirement age of 65, for reasons both personal and financial.

Unlike commercial airline pilots, who by law must undergo regular health screenings starting at age 40 and must retire at 65, doctors are subject to no such rules. And while most states require continuing education credits to retain a medical license, “you can sleep through a session, and if you sign your name, you’ll get credit,” observes Ann Weinacker, chief of the medical staff at Stanford Hospital.

“The public thinks that physicians’ health and competence is being vigorously monitored and assessed. It isn’t,” said geriatrician William Norcross, 64, founding director of a program at the University of California at San Diego that performs intensive competency evaluations of doctors referred by state medical boards or hospitals. The program, known as PACE, (Physician Assessment and Clinical Education) is one of about 10 around the country.

Norcross, who evaluates 100 to 150 physicians annually, estimates that about 8,000 doctors with full-blown dementia are practicing medicine. And as if that in itself isn’t worrying enough, studies have found, that approximately one-third of doctors don’t even have a personal physician, who might be on the lookout for deteriorating hearing, vision and motor coordination, or the cognitive impairment that precedes dementia.

Although doctors are not immune to the effects of aging, those with cognitive and neurological problems almost never have insight into their problems many deny that anything is wrong.

While few experts would argue that age alone should control who can continue to practice, some studies suggest that doctors’ skills tend to deteriorate over time. A 2006 report found that patient mortality in complex operations was higher among surgeons older than 60 than among their younger colleagues.

“Colleagues have a code of silence,” says New Hampshire health-care consultant Jonathan Burroughs who spent 30 years as an emergency department physician. During his career, Burroughs said he followed several elderly doctors around, quietly correcting their orders to prevent mistakes. According to him, such experiences are nearly universal in medicine. But that kindness can backfire, subjecting patients to potentially disastrous consequences such as serious injury or death, and the faltering physician to a malpractice suit or the loss of a medical license.

Although an older doctor can be a font of wisdom and experience, their skills have not necessarily kept pace; meaning that although they claim they’re practicing state-of-the-art care it’s maybe 20 or 30 years out of date.

Even so, rheumatologist Ephraim Engleman, who will turn 102 in March, said he plans never to quit. One of the nation’s oldest practicing physicians, Engleman drives from his San Mateo home to the medical campus of the University of California at San Francisco three days a week. There he sees about eight longtime patients per week.  “I’m very much opposed to retirement,” said Engleman, “As long as I’m able intellectually and physically, I’m going to continue.” His only impediment, he said, is severe spinal stenosis, which has left him stooped and dependent on a cane. “I walk like an old man,” he said.

Informed that Stanford, his undergraduate alma mater, has recently begun requiring doctors older than 75 to be tested, he quipped, “I’m glad they don’t do it here.”

So next time you catch yourself thinking cops are looking younger, maybe you should start taking a closer look at your healthcare provider.