About eight years ago, at the age of 78, a vascular surgeon in California operated on a woman who then developed a pulmonary embolism. The surgeon did not respond to urgent calls from the nurses, and the woman died.
Even after the hospital reported the doctor to the Medical Board of California, he continued to perform operations for four years until the board finally referred him for a competency assessment at the University of California, San Diego.
“We did a neuropsychological exam,
MBT M.Walk, and it was very abnormal,” said Dr. William Norcross, director of the physician assessment program there, who did not identify the surgeon. “This surgeon had visual-spatial abnormalities, could not do fine motor movements, could not retain information, and his verbal I.Q. was much lower than you’d expect.”
Yet “no one knew he had a cognitive deficit, and he did not think he had a problem,” Dr. Norcross continued. The surgeon was asked to surrender his medical license.
One-third of the nation’s physicians are over 65, and that proportion is expected to rise. As doctors in the baby boom generation reach 65, many are under increasing financial pressures that make them reluctant to retire.
Many doctors, of course, retain their skills and sharpness of mind into their 70s and beyond. But physicians are hardly immune to dementia, Parkinson’s disease, stroke and other ills of aging. And some experts warn that there are too few safeguards to protect patients against those who should no longer be practicing. “My guess is that John Q. Public thinks there is some fail-safe mechanism to protect him from incompetent physicians,” Dr. Norcross said. “There is not.”
Often the mechanism does not kick in until a state medical board has found it necessary to discipline a physician. A 2005 study found that the rate of disciplinary action was 6.6 percent for doctors out of medical school 40 years, compared with 1.3 percent for those out only 10 years.
In 2006, a study found that in complicated operations, patients’ mortality rates were higher when the surgeon was 60 or older, though there was no difference between younger and older doctors in routine operations.
Patient advocates note that commercial pilots,
Nike Sneakers, who are also responsible for the safety of others, must retire at age 65 and must undergo physical and mental exams every six months starting at 40. Yet “the profession of medicine has never really had an organized way to measure physician competency,” said Diane Pinakiewicz, president of the nonprofit National Patient Safety Foundation. “We need to be systematically and comprehensively evaluating physicians on some sort of periodic basis.”
Some experts are calling for regular cognitive and physical screening once doctors reach 65 or 70, and a small cadre of hospitals have instituted screening for older physicians. Some specialty boards already require physicians to renew their certification every 7 to 10 years and have toughened recertification requirements. But such policies have met resistance from rank-and-file doctors.
“I do not believe that diminished competence attributable solely to age is a significant factor in the underperformance of most poor-performing physicians,” Dr. Henry Homburger, 64,
MBT Sale, professor of laboratory medicine at the Mayo Clinic, said by e-mail. Mental illness like depression, substance abuse and a “failure to maintain competence through continuing education far outweigh age as causes of poor performance, in my opinion,” he wrote.
Others doubt that a single type of exam can be used to assess the performance of doctors from a variety of specialties. “More research is needed for us to define what combination of cognitive and motor issues are important,” said Dr. Stuart Green, a member of the ethics committee of the American Academy of Orthopaedic Surgeons.
Physicians do have to meet minimal requirements to continue to practice. To renew a medical license in most states, doctors must complete a certain number of hours of continuing medical education every year or two.
This does not impress experts like Dr. Norcross. “You can be asleep during those courses and no one would know,” he said.
Even the tougher new policies of specialty boards do not usually apply to older physicians, who, because of “grandfather” clauses, are not required to renew their certification — an expensive,
MBT Shoes, time-consuming process.
They are being encouraged to do so voluntarily,
MBT Walking Shoes, but few do — less than 1 percent of the 69,000 so-called grandfathered members of the American Board of Internal Medicine, for example.
Doctors with mild cognitive impairment may not be aware they have a problem or their performance is flagging. Changes are often subtle at first: a person may not be able to recall words, learn new material, apply knowledge to solving problems or multitask.
These deficits can make it hard to carry out the latest recommendations for diagnosis and treatment, learn new computer-based technology,
MBT Shuguli Gtx 一個讓QQ快速升級的驚天祕密, remember prescribing details about medications, or function well in a stressful environment like the emergency room.
Only when a doctor’s behavior starts to become odd are other physicians, nurses and patients likely to take notice.
MBT Sale As Doctors Age, Worries About Their Abili
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