On the Thorns of a Dilemma

"I love my patients. I don't want to desert them. And I'm good at it [paediatric work]."
"Quebec has a vendetta against older physicians. I'm still as competent as I ever was."
"It's age discrimination. You investigate a physician when you have complaints, if he's incompetent, if he killed someone. You don't go after physicians just because they have a diploma from 35 years ago."
Dr. Peter Neumann, 80, Montreal paediatrician

"We're being persecuted now simply because we're older, and I resent that. We have a real age bias presenting itself in provincial licensing authorities."
79-year-old Atlantic Canada radiologist

"It's just simply not the case that reaching a certain age necessarily renders you incompetent. In fact, in a discipline like medicine where experience is so valuable, I would even say we need people in their 60s and 70s."
Dr. Chris Simpson, president, Canadian Medical Association

"There are senior doctors in specialties who are really expert, and you wouldn't want to sort of fire them on the basis that they're old."
Dr. Gordon Dickie, London, Ontario, family physician

Research reviewed in 2005 concluded, in the Annals of Internal Medicine that older doctors are possessed of less factual knowledge, less likely to be engaged in best standards of care, and as a result have the potential to experience poorer patient outcomes. A commentary produced the same year in the Canadian Journal of Family Physicians reasoned over the potential of doctors  suffering from Alzheimer's. A not-unrealistic scenario since dementia affects 13 percent of the population over age 65.

Horrifyingly, research exists that estimates eight thousand American physicians do indeed suffer from dementia. Extrapolating that number to Canada, it is possible that there are hundreds of elderly physicians still practising the profession they have immersed themselves within throughout their professional lives, in the country which has enabled them to do so, while suffering from dementia.

Roughly 19 percent of doctors who had reached age 70, whose practise had undergone inspection were found to require remediation. Unsurprisingly that represents twice the percentage for younger physicians, selected at random to determine the younger demographic's need to refurbish their medical knowledge. Reasons cited for remediation requirement were various; illegible/incomplete patient charts, lacking cognizance of professional developments, and concerns relating to their cognitive state.

"Any fair assessment of the evidence would accept that advancing age correlates with a decline in practise. But not in all cases, and not in all domains", pointed out Gus Grant, registrar of the Nova Scotia college. The College des medecins du Quebec ordered Dr. Neumann to take 40 days of remedial training after a few shortcomings in his practise were discovered.

Canada's medical colleges are becoming increasingly alert to the need to monitor practising, senior-citizen doctors whose numbers top 12,000. Some of those practising physicians are in their 80s and 90s. For their own reasons, whether because they love the practise, feeling committed by inclination and faith in their abilities to continue doing what they feel they do best, or because they know nothing else, they do offer medical services to Canadians.

Many provincial regulators mandate "peer assessments" on doctors once they reach 70. It has become standard to assign another physician to oversee a sample of cases to determine how well the older doctor managed them. A 76-year-old Toronto doctor challenged in court an Ontario College of Physicians and Surgeons order to ensure a physician "supervisor", monitored his professional activities.

A 2012 newsletter from the Quebec college made note of the fact that 100 physicians were practising in the province, aged between 80 and 84. There were thirty physicians still in practise in Quebec aged over 85. The oldest of these practising elderly doctors was 97 year of age. The question does arise -- despite the fact that it is estimated that millions of Canadians don't have a family doctor -- are people satisfied to be treated for illness or disease by such elderly physicians?



Perhaps if their capacity to diagnose properly remains intact. And their usefulness in prescribing medication and therapies. Perhaps not if it comes to professional expertise in surgery. Perhaps it's not every doctor proud of his position in a profession he loves who is prepared to admit to himself that his fine motor skills have deteriorated. Particularly if he or she has also succumbed to cognitive disability.

Time to withdraw that shingle may be an individual matter to be determined by those in full possession of all their faculties, but there most certainly are times when professional associations should be alert and prepared to act when stubborn resistance to reality fails to impact the decision making of a responsible end-of-practise declaration.