When Is a Doctor Too Old? Or Too Young?

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 talents instead.

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 mistake.

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.

Abigail Zuker M.D.