Just when I thought the residents forgot all about mascots for the psychiatry consult service–we get a new mascot! It’s becoming a tradition of sorts. I’m not sure why a turtle was chosen although age could have something to do with it–my age I mean. I’m only half kidding. I read the recent JAMA article about aging physicians, raising the question about when we ought to retire.
It turns out that the turtle can symbolize the wisdom which can accrue from getting older, making it important for policymakers to think very hard about what kinds of standards for doctors should be crafted in order to avoid discriminating against geezers unfairly. This also reminds me of my death grip on the mission to persuade certification boards to release their own death grip on Maintenance of Certification (MOC) programs, which are poorly studied, raising doubts about the promise they truly measure physicians’ clinical competence because they’re not supported by high level evidence.
I don’t doubt that as we age, we’re at risk for not keeping up with medical knowledge and clinical skills. On the other hand, I can still climb several flights of stairs and beat it all over the hospital at a pretty good pace.
But I realize you have to be able to do more than just climb the stairs to be a doctor. That’s why we have practical ways of promoting the principle of lifelong learning here that are relevant to our practice and which connect to the other core competencies because, after all, they are deployed more or less simultaneously in the real world of everyday medicine. Speaking of practical, this reminds me that the next Psychosomatic Medicine Interest Group (PMIG) meeting is February 1, 2016.
One piece of turtle-like wisdom arising from the awareness of how real world medicine works today is the changing medical school curriculum. I imagine most educators realize now that the earlier young doctors in training are exposed to how real doctors must practice in today’s technologically-driven society the better, which is cultivating innovation in the medical school curriculum. Our medical students now are beginning clinical rotations in their 2nd year. I am very proud of one of them who is on the consult service currently. He’s the guy with the stethoscope in his pocket. As a geezer, I now wonder how I’m supposed to know when he’s ready to to begin being a real doctor–and when I’m going to be ready to stop.
Another reminder about the importance of turtles is the old saying, “slow and steady wins the race.” That also applies to remembering that it will likely be necessary to take Hal for walks to the Gift Shop periodically to give him some gas and to get small, dude–so walk slowly. That’s just another way to remind ourselves to be “tamed by the gentle and the small.”
Kupfer, J. M. (2015). “The graying of us physicians: Implications for quality and the future supply of physicians.” JAMA: 1-2.
When should a physician retire? This question is being asked more frequently as the number of physicians in the United States older than 60 years continues to increase. In 2012, it was estimated that 26% or nearly 241 000 of all actively licensed physicians in the United States were older than 60 years.1 Patient safety advocates, consumer groups, and policy makers have questioned whether older physicians maintain the necessary cognitive and motor skills to continue to provide safe and competent care. In response, the American Medical Association has announced plans to identify organizations that should participate in the development of guidelines for the testing of competency of aging and late-career physicians that may include periodic evaluation of physical and mental health, neurocognitive testing, and review of clinical care.2