H

e struggled to hear when people talked to him. He asked the same questions over and over. He fell asleep when really important conversations were going on around him.

But it wasn’t until he missed an emergency call that I knew I had to act.

I spoke to a higher-up about this elderly doctor out of concern for patient safety, and for several weeks the guilt tested my dual loyalties — one, to the people in my profession, and two, to my patients.

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On one hand, it didn’t feel right throwing another doctor, especially one of color, under the bus. After all, we are few and far between and need to support each other. But on the other hand, I was seriously concerned that his ability to care for patients properly was compromised.

The doctor was a locum tenens, a traveling physician who covers for other colleagues when they go on vacation or maternity leave. Parachuting into a hospital setting is challenging for the most acute-sensed doctor, but for this man, who struggled with electronic medical records, whose hearing aids barely worked, who would write discharge notes for patients I’d already sent home, I’m sure it was worse.

I was a resident. I was supposed to be learning from him. Instead, I felt like I was cleaning up after him, which I had no business trying to do.

The night after I spoke about my concerns, I couldn’t sleep.

“I just feel really bad about what I did,” I explained to my husband. I could feel the tears pooling in my eyes.

I, the resident, was the only doctor who responded to that emergency. The patient was a complicated case, and I was frustrated that the more experienced doctor wasn’t there. My frustration fueled my complaint, but after the adrenaline died down, I wondered, had I done the right thing?

“That’s your snitch guilt,” he replied.

I was looking for reassurance, which I got from some fellow residents, but my husband was right. I didn’t want to do it, but I really felt like patients would suffer.

While the older doctor was working with me, two patients pulled me aside and asked me why was he so rude, why he didn’t listen, and why he was so unprofessional. I didn’t want to undermine this attending physician or the trust that should have developed between him and our patients. I defended him, offering flimsy excuses — maybe his hearing aids weren’t properly adjusted — to convince our patients he was a good doctor, even as I knew these were terrible justifications.

Did his decades of experience matter if he couldn’t communicate well? What if he actually wasn’t a good doctor? I hated being in this position.

I wasn’t the only one — a social worker and another medical student pitched in to try and keep the ship afloat. But we were ancillary and less experienced. This was about authority, but it was also about trust. I didn’t trust him.

This was a complicated situation, but perhaps not uncommon.

In his book, “Complications: A Surgeon’s Notes on an Imperfect Science,” Dr. Atul Gawande wrote that whether due to age, or substance abuse, or even plain incompetence, “3 to 5 percent of practicing physicians are actually unfit to see patients.” And to further complicate matters, he wrote, the people “in the best position to see how dangerous” these doctors have become, are often in “the worst position to do anything about it.”

So the typically danger looms, until somebody gets hurt.

To be fair, there are plenty of elderly doctors who are really on top of their game — I work with many every day. But could my concerns about this one doctor be part of something that might become more common?

According to the the Federation of State Medical Boards, the number of actively licensed doctors age 70 and older grew from 75,627 in 2010 to 94,969 last year — it’s unclear how many still practice day to day.

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What’s challenging is that doctors can’t always tell when their skills are declining. One article described an elderly surgeon who could not find his own office after a day of surgery. Another article in Annals of Surgery told of a surgeon who fell asleep during surgery and another who operated on the wrong side of a patient’s brain.

Some hospitals are considering policies requiring cognitive testing for doctors over a certain age. While this could make a difference, I wonder if these policies are fair? Or perhaps discriminatory?

My guilt was also driven by the idea that I might be negatively impacting someone’s career, that my words carried weight.

In grade school, we complained about an English teacher who seemed to be fixated on one lesson for weeks and weeks. The school didn’t invite her back to teach the following year, and I saw her dressed as an elf at a Santa display at the mall. My words derailed her career.

I wonder what will happen to this elderly doctor — I doubt he’ll be invited back to my hospital, but if he does the same at another hospital, will a patient there get hurt? Either way, my guilt haunts me.

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  • You did the right thing. It is not easy to live with integrity and reporting your concerns shows your integrity as a physician. It is normal to feel guilty when rocking the boat and breaking the ‘no talk rule’ in a situation like this. It is unearned guilt, but that doesn’t make it less painful. I have spoken up a few times when I felt a physician was not competent and it felt lousy but I slept better at night knowing I did what I could to expose a problem that protected not only patients, but the physician. Bravo!

  • I’m glad you came down on the side of patient safety. When I was a medical student in the late 1970’s, physical diagnosis was taught in gender-segregated groups. My group of four women had two male tutors, both in their early 60’s. One was an outstanding teacher, the other an impaired physician. We tolerated his tardiness, absences, and failure to provide feedback or instruction but when we observed that his incapacity posed serious patient risks, we resolved to report it to the course director. When we met with him and explained our concerns in the most humble and discreet manner possible, he replied that the real problem was that the medical profession was admitting “too many young ladies” who couldn’t handle the training. Nevertheless, we noticed that the next year our tutor had been assigned a desk job in alumni relations and was no longer seeing patients. I knew that a male medical student who lived in my apartment building had been assigned the same tutor the previous year. When I asked whether he’d noticed the same problems and whether he’d complained, he said yes, the tutor had serious problems, but “Frankly, I just didn’t want to deal with it.” Doctors want the right to police their own profession and with that right comes responsibility. I actually felt no guilt whatsoever in reporting this physician. My only feelings were disappointment and anger at the way my report was received. At least 40 years later, you can assume that your words will be heard and appropriate action taken.

  • Thank you for your heartfelt article. I have just one question for you that may help you reconcile the guilt you’re feeling, “Would you have felt any less guilty if a patient was harmed by this physician by you not acting?”

  • Hi. You have done the correct thing. May God Bless You. If anyone else finds themselves in a similar situation, I hope and pray the do not hesitate to notify the Decision Makers. Especially the Head Financial Executives as surely they do not want an expensive lawsuit to deal with.

  • More people should speak up if someone in profession is harming patients,no matter the age or years of practice,I have reported impaired people of all ages!

  • You would serve this doctor best by urging him to see an audiologist. With the proper hearing aids he can successfully continue to work; without them he may be asked not to return. Irrespective of race or gender, hearing can be amplified successfully, even if it takes a cochlear implant.

  • You absolutely did the right thing to prioritize patient safety. His career should’ve been over and he may suffer, but that’s not due to your choice. He made the choice to continue to work under those circumstances. From what you report, there is no way he could have not known he was putting patients at risk. Who knows how many people suffered as a result of his incompetence? You likely helped prevent much more suffering.

  • Jennifer, you did the right thing. As someone uncomfortably close to this point in my career, I hope that I will know the right time to stop. And if I don’t, I hope someone will be kind enough and brave enough to tell me. My goal as a physician has always been to do my best to help my patients, and when I’m not able to do so, it will be time to stop.

  • Two things-
    To feel guilty about potentially throwing this doctor under the bus especially because he is a doctor of color is as racist in protection of him as it would be if the doctor were terminated because of his race. While you didn’t protect him due to his race-it was one of many thoughts and quite normal under the circumstances. People don’t generally like to “snitch” on others–primarily because it is an awkard,uncomfortable thing to do; it causes us to pause and question our perceptions of events; and generally we are not there or hired specifically to seek out incompetence. It is an uncomfortable position to be in and you are a compassionate young woman; it may never get any easier to do–but you did the right thing. I would feel sad about the teacher losing her job–BUT sometimes these things happen–a big part of life is coping with//how we cope with challenges thrown at us AND the strength we get in resiliency and learning to turn negatives around into positives. See the whole picture; get our feelings out; AND get something positive out if everything in life-even if it is simply a “hard learned lesson.” God bless you/feel better-you did the right thing

    • 1st you did the right thing and i admire you for that.After reading your story,it took me almost 1/2 h.befire I could reply. I retired 3 years ago from FP and still continue to do periodic locum at some clinics in the community. It is difficult ult to keep up with the updates in the computer field and with medical info in general as one ages. I do not feel finances are the reason most of us try to continue practicing. I view medicine as an addiction and so ,find it hard to give up. As a younger pcp i saw older mds making mistakes and covered for them as much as I could but looking back maybe I was wrong. However I would hope that fellow PCP would let me know their observance of me and what I am doing wrong before I hurt someone. Again you did right and god bless.

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