My brother and I are both physicians. He is a pediatrician; I am a geriatrician and palliative medicine doctor. We are both getting older.
My brother has been a practicing pediatrician for almost 50 years. He had a remarkably successful solo practice in the city where he lived. He recently retired but continued to work at a free clinic several days a month. When it became time for him to renew his license, he did not have enough CMEs to do this. He has chosen not to renew. He has expressed to me what an odd feeling this is. Clearly, to his patients and their parents, his work will always be cherished.
I have also changed my practice. I have been a practicing geriatrician for 30 years. For the past 18 years, I have worked in a group practice seeing geriatric and palliative care patients in the clinic two days a week. The rest of my time was spent working with hospice, nursing homes, and home visits. Over the past year, I have been accused of various things, like not being professional, not being competent to practice, not being qualified to supervise advanced practice clinicians (something I have done for 20 years) and, essentially, not following the rules. Much of this was based on hearsay. I have chosen to no longer work in the clinic but to work primarily doing home visits.
My last visit to the clinic was with a 90-year-old woman who lives alone and is completely able to take care of her own needs with the assistance of her daughter. As a dutiful geriatrician, I asked her about falls. She proceeded to tell me about her recently adopted a 20-pound dog who was very well-trained, but she was fearful that the dog would jump up on her other frail friends. As it happened, I had a friend who desperately needed a companion. I did not follow any protocol or “best practice.” With the patient in the room, I called my friend and arranged for them to meet. They did the next day. My friend now has a companion, and my patient is no longer afraid of her friends falling. She exclaimed to her daughter as she left, “This was the best doctor visit I’ve ever had. She actually listened to me rather than just trying to give me another pill.”
My old practice has hired another geriatrician who has just finished her fellowship. She will see my clinic patients. However, I will not be able to share with her my years of experience. I am sure she is very well trained and would have enjoyed an opportunity to share both her fresh training and my knowledge.
My brother and I have suffered an unnecessary loss. We are being replaced by the next shiny object out there, such as by “best practice” in the EHR.
There is no amount of CME that would make my brother a better doctor, or take away his wealth of experience. There is no amount of following the rules that will take away from my experience and knowledge. We need to find a better way to treasure our physicians as we age and take advantage of what we bring and have brought to our professions.
Kathryn Borgenicht is an internal medicine physician.
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