Knowing when to give up practice is an important decision for most ageing doctors but there are few clear rules about when, and how, they should hang up the stethoscope for good.
“The question of timely retirement is not unique to the medical profession, but issues of public safety place a particular responsibility on medical practitioners, their colleagues and medical regulatory authorities,” a recent commentary said.
The narcissistic blow of retirement, the all-consuming nature of medicine and feelings of indispensability might contribute to the sense of loss for doctors when they stopped working. The problems might be less intense for younger doctors who, the commentary noted, “seem to have a less single-minded commitment to medicine than their workaholic predecessors.”
One difficulty was that doctors with mild cognitive impairment or early dementia often lacked the insight to accept that they were no longer able to practise safely. However, doctors could accommodate the first stages of cognitive decline by ceasing procedural work, allocating more time to each patient, using memory aids, seeking advice from trusted colleagues, and seeking second opinions more readily than in the past.
“Clinical wisdom is likely to stand the practitioner in good stead with routine problems, but unusual or unexpected problems are more likely to cause difficulty for older practitioners,” it said.
Medical registration boards were ultimately responsible for ensuing the public’s safety, but experience suggested that colleagues were reluctant to notify boards about a doctor’s declining cognitive function. More commonly, the matter was raised by treating doctors and occasionally by concerned or disgruntled patients.
Compulsory continuing professional development and a requirement for regular recertification would help address this and other problems. The challenge was to make such procedures effective without being unduly bureaucratic or onerous.
Reference
Adler, R. Constantinou, C. 2008, ‘Knowing — or not knowing — when to stop: cognitive decline in ageing doctors.’ Medical Journal of Australia vol. 189, pp. 622-624.
Abstract