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Elderly Docs & Clinical Practice

In life, they say that with age comes wisdom. And just like with wine, it gets better with age. For love, however, they say that age doesn’t matter. Do the same principles apply with doctors and medical practice?

The Philippine society, which generally observes certain norms, dictates that the retiring age of a working Filipino must be within the range of 60 to 70 years old. Even the Constitution states that a Filipino aged 60 years and above is already an elderly or a senior citizen.

In most cases, the chance to work starts at around 16 years old (average age for high school graduates) or by 20 or 21 (average age for a college graduate). But for us doctors, it takes more than that. After medical school at 24, 25 or 26, board reviews and examinations are still waiting. After passing, we may already earn through general practice, or for many among us, continue to pursue a field of specialization, and for a number, continue with a subspecialty.

All in all, we can say that doctors generally start ‘working’ between 27 and 35 years old, depending on the specialty or subspecialty that we may choose. Ergo, some leeway in our retirement age, perhaps an additional eight to 15 years, is in order. But then, it’s not just the years that really matter for us and our patients. It’s the clinical expertise that we have amassed since we began to study and heal that should be considered. Taking from this point, our ‘retirement’, I believe, may only happen due to two things: first by our own volition, and second, perhaps by our age and physical limitations.

Establishing ourselves early on
For us doctors who are in our retirement age, having the opportunity to sustain our practice year after year is already an achievement. Being able to mentor new residents is a bonus. However, there may be some of us who may feel ‘threatened’ in some way, of the younger, fresher, and perhaps more agile generation of doctors coming in our hospitals.

In my practice, I find that being an elderly doctor has been to my advantage. I do the usual Neurology practice at San Juan de Dios Hospital (SJDH). In addition, half of my practice is in Clinical Neurophysiology which is a subspecialty of Neurology. The practice of Clinical Neurophysiology includes tests such as nerve conduction studies and electromyography which determine if there is any abnormality in peripheral nerves and muscles.

The patients on which I perform the tests are referrals from other physicians such as neurologists, orthopedic surgeons, rheumatologists, endocrinologists and other practitioners. Since performance and interpretation of these tests need experience, these referring doctors usually prefer a veteran neurophysiologist. In the case of neurophysiologic tests, some doctors refer their patients for a repetition of the test done by other neurophysiologists because they want my opinion. In all honesty and humility, I really feel flattered and grateful for this.

Generally, I think that for Internal Medicine and related specialties such as Neurology and Endocrinology, patients do not have special preference for younger over elderly physicians. They usually go to their doctors to whom they have been consulting for a long time. Suffice to say that if it’ll only be based on my own experience, there really isn’t any difficulty in retaining patients or having new ones.

And it’s not only because I have many colleagues who refer their patients to me. I do have patients who weren’t referred by another colleague. And when they come and see me, I often ask why they prefer me as their physician. They are usually relatives, friends or neighbors of former patients. They say that I was recommended because my previous patient got well, or the patient and I related well with each other.

So you see, it pays for us elderly doctors to really have our network of colleagues and patients established early. On a personal note, however, I refer either to younger or elderly doctors depending on my appraisal of their qualifications. After all, I believe you’ll agree with me that when it comes to our patients, their welfare still comes before everything else.

Keeping track of things
The practice of medicine is ever-changing. Clinical practice guidelinestend to change every now and then, so it is likewise important that we remain abreast with updates and trends in our practice. Whenever possible, we should try to attend continuing medical education events and conferences.

As much as I can, I attend scientific meetings, seminar/workshops and congresses which have become more frequent in recent years. Many of these scientific sessions have foreign speakers who are experts in their fields. I guess this is one of the ways on how I can make up for the international conferences that I miss since I am now not able to travel for long hours and very long distances.

And as I also miss traveling and going on tours abroad, I try to grab every opportunity to attend conferences in different parts of the Philippines—given that the travel is by air. In addition, I still have a busy life attending scientific meetings and going to social gatherings. I think these are some of the things that we have taken for granted before and now have the chance to finally do.

In fact, I find that I now have more time for these activities since I retired from teaching. On the average, I get invited to scientific meetings such as round table discussions one to three times a week. The other physicians I know also attend these conferences.

If I need some information not available in these conferences such as a rare case, I surf the net and read journals or books. Whenever new Clinical Practice Guidelines are being established, I try to adapt them because I want my patients to benefit from the new methods which have been shown to be more effective than the previous ones.

Accepting our limitations
Though most of us wouldn’t, or couldn’t, admit it blatantly to ourselves, to our contemporaries, and to our patients, there is no denying the fact that we also have our limitations due to our ‘old age.’ The other doctors I know changed their schedules, decreasing the days and hours of their practice, and giving up their clinics in other hospitals because of health limitations or to have more leisure time for their families and hobbies. However, for me, instead of decreasing my clinic hours, I had to increase them.

After graduating from the University of the Philippines (UP) College of Medicine, I was immediately recruited to be part of its full-time faculty and teach Physiology. This meant office hours of 8 to 12 noon and 1 to 4 pm, or even longer if I am doing some research. At that time, I was not yet involved in clinical practice. Then in 1970, after training, I started to practice Clinical Neurology and Clinical Neurophysiology. I had to do this after office hours.

I did my Clinical Neurophysiology every Monday, Wednesday and Friday afternoons at Makati Medical Center (MMC). My Tuesday and Thursday after-office hours were spent in my Neurology clinic at SJDH. After retiring from UP in 1993, I retained my clinic hours at SJDH but I chose to change my MMC clinic into a 2 to 5 pm schedule.

After SJDH acquired an electro-myography machine several years ago, I had to do neurophysiology tests on Tuesday and Thursday afternoons from 1 to 4 pm before my Neurology clinic. So instead of decreasing my clinic hours, I had to increase them. Patients are often amazed and kept on asking me my age because they remark that I am still strong and very active in medical practice.

I guess that a lot of us fear that as we age while dedicating our lives to our medical practice, we may become a thing of the past—a noteworthy piece of antique that is only there to be appreciated but never to be used again. Well, join me in proving them wrong. Being an elderly practitioner presents itself with a string of challenges that we have to hurdle. Yes, our old age may restrict us to do some of the things that we used to so easily do. But this should never make us feel less of the physicians and humans that we are. Instead, this should be a greater challenge to us. And surely, knowing how functional and productive we still are, I’m proud to say that it will be one that we can very well handle.

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