Friday Reflections: Extending the Sweet Spot

I asked my age-matched colleague the other day, “Do you think we will know when it happens to us?”

He responded, “I know…I worry about that too.. a lot.  I’m getting out before it happens to me.”

We were talking about our fears of being labeled as an “old” doctor.  Not just old in years, our children and bifocals remind of us of that, but old in our mindset.   We fear becoming one of the dinosaur doctors who get known for their excessive attachment to old dogma, premature dismissiveness of novel new approaches, fear of social media, and of course the tell-tail (pathognomonic) sign of agedness, ranting mindlessly in front of Fox news about healthcare reform in the doctor’s lounge.

This transition can happen fast.  One moment a doctor might be in their sweet spot–a period of time where the nearness of training meets with the treasure of experience in a capable mind, body and spirit.  Sadly, and obviously this period is finite.  It’s limited by aging.  Getting older happens to all of us, but the pertinent fact for medical practice is that, like all humans, doctors age at different velocities.

The topic of how best to deal with aging doctors came up after this provocative piece in the NY Times highlighted a couple egregious cases of bad care at the hands of doctors who should have been retired.  Kevin Pho’s follow-up piece emphasized the relevance of this topic when he suggested that more than one in three US doctors are over 65 years-old, and that unlike pilots, they are “grandfathered” into not being required to take re-certification exams.  That policy is hard to defend.

Since I am writing this post with the aid of reading glasses, how to handle aging doctors hits me pretty hard.  It’s a quandary.  For instance, I know a cardiologist in his early sixties who behaves like a chief resident–quoting journal articles, presenting interesting cases and even voluntarily re-certifying (he was grand-fathered).  Here’s a doctor with both 25 years experience and knowledge of the cutting-edge.  The quality of his doctoring speaks loudly against any arbitrary age cutoffs.  But then there are the outrageous cases cited in the Times piece.

I’d like to think there’s a way to extend the sweet-spot of doctoring.  Perhaps the answer is obvious; the same things that make healthy people healthy, might make good doctors stay good for longer.

Things like:

Staying physically fit.  Sleeping well, eating well, and exercising regularly have all been shown to improve mentation and dexterity.  Quick thinking and nimbleness both make for better electrophysiologists.

Staying mentally engaged.   I feel like a better doctor after returning from a medical meeting.  Likewise, I certainly feel more informed after researching a journal article for a blog entry.  (Immediate disclaimer:  I am not saying bloggers make better doctors–some might argue the opposite.)

Staying emotionally engaged.  In other words, caring.  Healthy people seem to have a cause that’s important to their self-esteem.  The best doctors I know hang a lot of their self-esteem on their doctoring peg.  But not too much; no peg is that strong.

Staying balanced.  Healthy people exude balance.  They may focus on one thing primarily, but keep other interests too: things like spending time with family, reading fiction, watching movies, riding a bike, or volunteering their time.

Staying open-minded.  This doesn’t come naturally to aging doctors. (First off, they are mostly republican.) Sure, much of what worked in the past stays timeless, but not always.  For instance, if I wasn’t open-minded three of my afternoon patients may still have AF symptoms, and a few more would still be taking a drug that poisons rodents.

Let the quality people try and measure these five traits with checklists and spreadsheets.

JMM