Aging Doctors Face Greater Scrutiny

By Sandra G. Boodman
Originally published on December 10, 2012
Kaiser Health News in collaboration with The Washington Post

A distinguished vascular specialist in his 80s performs surgery, then goes on vacation, forgetting he has patients in the hospital; one subsequently dies because no doctor was overseeing his care. An internist who suffered a stroke gets lost going from one exam room to another in his own office. A beloved general surgeon with Alzheimer's disease continues to assist in operations because hospital officials don't have the heart to tell him to retire.

These real-life examples, provided by an expert who evaluates impaired physicians, exemplify an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators: how to ensure that older doctors are competent to treat patients.

About 42 percent of the nation's 1 million physicians are older than 55 and 21 percent are older than 65, according to the American Medical Association, up from 35 percent and 18 percent, respectively, in 2006. Their ranks are expected to increase as many work past the traditional retirement age of 65, for reasons both personal and financial.

Many older doctors remain sharp, their skills up-to-date and their judgment honed by years of experience. Peter Carmel, the AMA's immediate past president, a 75-year-old pediatric neurosurgeon in New Jersey, recently wrote about "going full tilt."

Unlike commercial airline pilots, who by law must undergo regular health screenings starting at age 40 and must retire at 65 -- or FBI agents, whose mandatory retirement age is 57 -- there are no such rules for doctors. Nor are any formal evaluations required to ensure the continued competence of physicians, many of whom trained decades ago. Most states require continuing education credits to retain a medical license, but, as Ann Weinacker, chief of the medical staff at Stanford Hospital and Clinics in California, observed, "you can sleep through a session, and if you sign your name, you'll get credit."

The entire article is here.

Social media: how doctors can contribute

The Lancet
Volume 379, Issue 9826, page 1562
Published on April 28, 2012

On April 18, The General Medical Council, which regulates medical practice in the UK, opened up its draft guidance on doctors' use of social media for consultation. Comments can be made until June 13, and the results will be published by the end of the year. The guidance emphasises the need to maintain patient confidentiality, provide accurate information, treat colleagues with respect, avoid anonymity online if writing in a professional capacity, be aware of how content is shared, review privacy settings and online presence, declare conflicts of interest, and maintain separate personal and professional profiles.

The entire article is here.

Medical Schools Teaching Little About Gay Health

By CARLA K. JOHNSON, AP Medical Writer

Future doctors aren't learning much about the unique health needs of gays and lesbians, a survey of medical school deans suggests.

On average, the schools devoted five hours in the entire curriculum to teaching content related to lesbian, gay, bisexual and transgender patients, according to the survey results appearing in Wednesday's Journal of the American Medical Association. A third of the schools had none during the years students work with patients.

More than a quarter of the medical school deans said their school's coverage of 16 related topics was "poor" or "very poor." The topics included sex change surgery, mental health issues and HIV-AIDS.

While nearly all medical schools taught students to ask patients if they "have sex with men, women or both" while obtaining a sexual history, the overall curriculum lacked deeper instruction to help "students carry that conversation as far as it needs to go," said lead author Dr. Juno Obedin-Maliver of the University of California, San Francisco.

Without such education, doctors are left guessing and can make faulty assumptions, Obedin-Maliver said. For instance, lesbians need Pap tests, which screens for the sexually spread virus that causes most cervical cancer, as often as heterosexual women do. But some doctors assume they don't need them.

"I'm an ob-gyn and I have had lesbian patients come to me and say I haven't had a Pap test in 20 years because my doctors said I didn't need one," Obedin-Maliver said.

Earlier this year, the Institute of Medicine reported that there's little research to guide doctors in the treatment of lesbians and gays. But some things are known: There are increased risks of depression, suicide attempts, homelessness and being victims of violence for lesbians, gay men and bisexuals. Lesbians and bisexual women may get less preventive care to stay healthy, and have higher rates of obesity and breast cancer.

The Association of American Medical Colleges recommends that medical schools ensure students master "the knowledge, skills and attitudes necessary to provide excellent comprehensive care" for gay, lesbian, bisexual and transgender patients.

The new findings are based on a Web-based survey that drew responses from 85 percent of U.S. and Canadian medical schools.

That's a remarkably high response rate, which shows the deans believe it's an important issue, said Dr. Raymond Curry, vice dean for education at Northwestern University Feinberg School of Medicine in Chicago.

In an accompanying editorial, Curry wrote that the researchers missed the opportunity to find out how many medical schools have gay and lesbian faculty and how many have student groups for gays and lesbians.

"Trying to assess the adequacy of a curriculum in addressing these issues is perhaps not best approached in counting hours of instruction," Curry said.

Original article in JAMA found here.