Geriatric Medicine?

old doctorsPicture 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.

mƒqƒoƒNƒVƒƒL“‡^’·èn'‚O‚X“~@”픚ŽÒ‚ðfŽ@‚·‚é”ì“c‚³‚ñAbout 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.

old-doctor-3Although 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.

Dr-Ephraim-Engleman-100-year-old-doctor-longevityEven 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.

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One test too many?

How’s this for a dichotomy?  During the same week we learned that America is $13 trillion in debt, a new study reported that over 90% of US doctors knowingly order more tests and procedures than are medically necessary.

No surprise then that the United States spends more than any other industrialized country on healthcare expenses.  A staggering $2 trillion annually to be exact.

The new survey by Mount Sinai School of Medicine, published in Archives of Internal Medicine questioned 2,416 physicians. 91% of respondents believe that concerns over malpractice lawsuits result in them practicing “defensive medicine.”

About $60 billion is spent annually on defensive medicine and many physicians feel they are vulnerable to malpractice lawsuits even when they practice competently within the standard of care,” said Tara Bishop, MD, co-author of the study.

The majority of physicians (90.7%) also stated that for them to decrease the ordering of unnecessary medical tests, better protections against unwarranted malpractice suits are needed.

Word on Health could not agree more.  At a time when the healthcare system is in such crisis that hospitals nationwide are reporting major drug shortages, we should not be forcing physicians to waste money to protect themselves from malpractice concerns. Not only are we exposing patients to unnecessary, and often invasive, procedures, this crippling fear of litigation is surely impacting health care reform efforts.

Time for tort reform?  Let us know what you think .