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.

Fischerism

• A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.

• A good teacher must know the rules; a good pupil, the exceptions.

• Diagnosis is not the end, but the beginning of practice.

• Don't despise empiric truth. Lots of things work in practice for which the laboratory has never found proof.

• Facts are not science — as the dictionary is not literature.

• Here's good advice for practice: go into partnership with nature; she does more than half the work and asks none of the fee.

• The great doctors all got their education off dirt pavements and poverty — not marble floors and foundations.

• The specialist is a man who fears other subjects.

• None of the great discoveries was made by a "specialist" or a "researcher".

• Research has been called good business, a necessity, a gamble, a game. It is none of these — it's a state of mind.

• When a man lacks mental balance in pneumonia he is said to be delirious. When he lacks mental balance without the pneumonia, he is pronounced insane by all smart doctors.

• Whenever ideas fail, men invent words.

• I find four great classes of students: The dumb who stay dumb. The dumb who become wise. The wise who go dumb. The wise who remain wise.

In Every Patient Tells a Story

The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, What is wrong with me? They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it on some level, restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer. A healthy young man suddenly loses his memory, making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment, only to have their symptoms mysteriously return. A young woman lies dying in the ICU, bleeding, jaundiced, incoherent, and none of her doctors know what is killing her.

Lisa Sanders, MD
The doctor behind the "House"

The best physician is also a philosopher.

To be great, a surgeon must have a fierce determination to be the leader in his field. He must have a driving ego, a hunger beyond money. He must have a passion for perfectionism. He is like the actor who wants his name in lights.

The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness.

The person most often late for a doctor's appointment is the doctor himself.

Physicians are rather like undescended testicles, they are difficult to locate and when they are found, they are pretty ineffective.

Often the confidence of the patient in his physician does more for the cure of his disease than the physician with all his remedies.

No physician is really good before he has killed one or two patients.

No physician is really good before he has killed one or two patients.

Medicine is a science, acquiring a practice an art.

Life is short, the Art long, opportunity fleeting, experience treacherous, judgment difficult. The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals.

Let the young know they will never find a more interesting, more instructive book than the patient himself.

It is a mathematical fact that fifty percent of all doctors graduate in the bottom half of their class.

If popular medicine gave the people wisdom as well as knowledge, it would be the best protection for scientific and well-trained physicians.

I wondher why ye can always read a doctor's bill an' ye niver can read his purscription.

Doctors are just the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you, too.

A physician is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.

A physician is an unfortunate gentleman who is every day required to perform a miracle; namely to reconcile health with intemperance.

A doctor is the only man who can suffer from good health.

I don't dawdle. I'm a surgeon. I make an incision, do what needs to be done and sew up the wound. There is a beginning, a middle, and an end.

Good Doctor (1)

All other articles are written by "good doctors". I thought it would be useful to have opinion of a "bad doctor" too, so I decided to write from my own experience. Making a good doctor is a complicated for the system and painful for the trainee.

A good doctor is the one who is considered to be good by his consultants. To reach this goal he should;

1- alway accepted wherever his seniors say,

2- always ask the question the consultant knows the answer of

3- never challenge on any issues with the consultant

4- always make sure colleagues, managers and nurses are happy, whatever the circumstances

5- never blow a whistle

6- if you do not know the answer to a question, never say I do not know, always make it up or just talk around it. In a worst senario just say I am not too sure.

7- never try to change things around yourself just go along the stream

8- never do an audit result of which is damaging to the department or the hospital

9- always prescribe whatever your consultant likes

10- in one word be a "sheep", always follow.