[Paleopsych] NYT: When Is a Doctor Too Old? Or Too Young?
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Tue Feb 8 21:26:58 UTC 2005
The New York Times > Health > Essay: When Is a Doctor Too Old? Or Too Young?
By ABIGAIL ZUGER, M.D.
Look closely at the top of your doctor's head the next time you get a
chance. Do those odd gray hairs worry you at all? Do they speak to you
of wisdom and experience? Or do they remind you it may be time to
leave the old fool for a source of more up-to-date care?
In Britain, the National Health Service imposes draconian limitations
on physicians wishing to work after age 65, and essentially forbids
work after 70. The policy is clearly intended to guard the population
from doddering idiots, but some may argue it squanders the best
We know all about dog-years and cat-years. No expert yet has come up
with an estimate for doctor-years. How old do doctors really become,
after 10 years in practice, or 50? Can we safely drag wrinkled,
elderly frames around like tortoises, knowing that at work we are
relatively immortal? Or should we retire while still chronologically
young but, in doctor-years, obsolesced beyond repair?
I once had two colleagues who graduated from medical school over 40
years apart. The young one was fresh out of training, the old one
heading for retirement. Watching the two of them at work was one of
the best possible lessons in the passage of medical time.
The old doctor had taken care of some patients for decades. The
intermittent half-hours they spent together had coalesced over the
years into tight, loyal partnerships.
The young one had never taken care of a patient for more than a couple
of years before saying goodbye and moving on.
The old doctor had learned medicine from a set of principles that were
almost antique, as the drugs and tests of successive decades were
replaced by newer, better models.
The young one was fully versed in the newest tests and drugs, and had
only a passing acquaintance with the historic standbys.
The old doctor, although reasonably conversant with computers, was a
hesitant typist who preferred paper charts, prescriptions, textbooks
and journals to computerized medical records and cyberliterature.
The young doctor played the computer keyboard like an organist at a
Wurlitzer. Doctor and patient often plumbed the Internet for
information together. Patients could take home freshly printed data
analyses to study for themselves.
So which one of these doctors did the better job? As far as I was
concerned, they were in a dead heat.
The old doctor, warm and informal, loved many long-term patients
deeply, sometimes to the extent of forgetting they were patients, not
friends. Just as you might avoid mentioning a friend's weight problem,
drinking habits or bad breath, delicate issues were sometimes let
slide in a culpably unprofessional way.
The young doctor never let anything slide. Still, the atmosphere in
that office was formal and more than a little chilly. Nothing smoothes
the rough edges of medical care like some mutual affection - a lesson
the young doctor had yet to learn.
The old doctor used tests and medications fluently - up to a point.
Some of doctor's habits were admittedly outmoded. Still, the years had
left behind a certain supple flexibility of practice: after witnessing
enough changing fashions in medical care, a doctor generally learns
that most "best practices" are evanescent.
The young doctor chose tests and treatments based on the premise that
there was a single right way to do things. That doctor had yet to
learn that absolute trust in any drug or treatment is often a major
The old doctor stored important details about patients in memory, and
nowhere else. The doctor's hesitantly typed notes recording office
visits were brief and old-fashioned - a few sentences at most,
difficult for anyone else to interpret.
The young doctor remembered little about each patient from visit to
visit, but typed volumes, and was a big fan of medical software that
supplies preformed phrases, sentences and paragraphs - the results of
an entire physical exam, for instance - at the click of the mouse.
Sometimes the mouse clicked just a little too quickly and erroneous
information crept into the charts.
Insurance reviewers occasionally confused the old doctor's terse notes
with incompetence. Patients occasionally complained bitterly about the
young doctor, deploring that habit of pounding the computer keyboard
for the duration of their visit and never once looking them in the
eye. Both doctors, learning of these misunderstandings, were mortified
and furious. Colleagues who had to wade through charts belonging to
either one just tore their hair.
In some ways, the young pup was much too young for the work, and the
old dog much too old. In other ways, each was just right, and would
never be better.
Does the practice of medicine have a natural life span? Every doctor,
every patient (and every insurer) would probably answer differently.
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