Skip to Main Content

NEW LONDON, N.H. — The voice sounded like a child crying. It seemed to follow Dr. Anna Konopka around, echoing through the rooms of her house, audible everywhere. She thought it might be coming from the neighbors’ — but no, it was clearly inside her own walls. “Mrs. Ghost,” she called it.

Of course, she didn’t tell anyone. They would think she was unstable. She was a primary care doctor, treating both children and adults. It wouldn’t do for people to hear that she was bothered by ghosts. But finally, one night around midnight, as she was getting ready for bed — there it was, in her room, a few feet away, sobbing. “I said, ‘All right, what do you want from me? I will … pray for you for three days. Let me know if it is enough,’” Konopka recalled. “And she stopped crying. She never followed me again.”

Konopka takes that same in-your-face approach to everything. As a high schooler in 1940s Poland, when all her classmates dug out their rattiest, most proletarian clothes for the Communist Party meeting, she wore her fur coat. More recently, when she heard that doctors at the local hospital had lodged an official complaint about her, she drove over to find out their motives herself. And in early November, after she voluntarily gave up her license so that the New Hampshire Board of Medicine wouldn’t suspend it, she went to court so she could get it back.

advertisement

She is 84, and has become a symbol — if an eccentric one — for a kind of physician autonomy that is almost extinct in our era of highly regulated medical care. She works alone in a cottage next door to her house, with no receptionist, no practice administrator, no nurses, no N.P.s, no P.A.s, no hospital affiliations. She has a computer in her kitchen, but she doesn’t use it much. She keeps her files in a cabinet in her office, page upon handwritten page of careful, old-world lettering. She does not take insurance, instead charging patients $50 cash for each office visit.

Against her will, though, she has also become the face of a related debate about how best to ensure that older doctors are providing the most up-to-date care. “This is one of the big questions in the field of medical education: What should we be requiring of older doctors in terms of demonstrating the maintenance of the skill required to practice medicine?” said Dr. Anupam Jena, a health economist at Harvard and a physician at Massachusetts General Hospital.

Like drivers, doctors can be a menace at any age. Some might be the best practitioners around at 75, while others might be malpractice magnets before they’re 40. Yet many bristle at any talk of increased oversight — and Konopka is even more defiant than most.

advertisement

“You are with the system, or you are out of the system,” she said. “It’s like communism: If you are out of the system you are treated as an enemy. … I am practicing traditional medical arts. They manage the patient and I treat the patient. I’m not going to compromise.”

Dr. Anna Konopka
The entrance to the cottage that serves as Konopka’s three-room office. Cheryl Senter for STAT

To see Konopka, you drive past a trout-filled lake, along a country road, until you see a mailbox with a little sign that reads “A. M. Konopka, M.D.” Her black labradoodle greets you in the yard with growls, and then nuzzles you with his head.

Inside, the place feels at once quaint and cosmopolitan, like a professor’s mountain retreat. When she reaches for the otoscope or stethoscope in her examining room, Konopka looks out at raspberry canes and black currant branches giving way to forest. The air smells distinctly of tongue depressors. In her consultation room, your eye is drawn to a book called “Urine Under the Microscope,” and to a toy piano, bright as a Froot Loop, resting on the “Physicians’ Desk Reference,” its binding a deep, serious blue. The walls are filled with Polish paraphernalia, Catholic imagery, and, most prominently, medical degrees and certificates in frames.

Those documents of competency weren’t easy for Konopka to get. When she was born, in 1933, her father was a judge in the small city of Rzeszow, about 60 miles from Ukraine in one direction and Slovakia in the other. But by the time she was graduating high school, her family had moved to Krakow, the country was aligned with the Soviet Union, and her family had lost almost everything except their reputation as members of the gentry.

“They wanted to recruit me for the Communist Party. I told them that I am not interested because my moral standards and their moral standards — they are two different standards,” she said. “Therefore they put me on the blacklist.”

Dr. Anna Konopka
A photo of Konopka taken when she first arrived to the United States from Krakow, Poland. Cheryl Senter for STAT
Dr. Anna Konopka
Konopka laughs after playing a tune on her piano at home in New London. Cheryl Senter for STAT

No Polish medical school would accept her after that. But her dressmaker made a prediction: Don’t be upset, she said. If you wait long enough, you’ll get in.

Konopka smiles at the memory. It was a good prediction, she said. She waited three years, cleaning out laboratories, practicing piano. Then, after Joseph Stalin died in 1953, the Polish government became a little more forgiving — an extension of the Khrushchev Thaw — and Konopka started medical school. “My professor from internal medicine was always telling us, ‘You have to know medicine to take care of people in jungle or desert,’” she said. “I can really take care of any sickness.”

“This is one of the big questions in the field of medical education: What should we be requiring of older doctors … to practice medicine?”

Dr. Anupam Jena, Massachusetts General Hospital

Then, when she came to the United States in 1961, she had to prove her competency again, writing exams, doing residencies and internships, getting licensed in two different states.

The paperwork was a pain, and some of the hospitals that employed her were in rough parts of New York, but practice-wise, she doesn’t remember any problems. She saw patients at St. Catherine’s Hospital in Brooklyn, and Misericordia Hospital in the Bronx, and Jersey City Medical Center, in New Jersey, to name a few. Eventually, she moved to New Hampshire, where the mountain climate reminded her of home. She worked part-time for the Department of Corrections, and examined families in the green-shuttered office next to her house.

Dr. Anna Konopka
Konopka takes a call at her kitchen table. Cheryl Senter for STAT

The complaints, she said, began three years ago: complaints about her prescribing practices, about how and when she referred patients, about her diagnoses. She said they came from other local providers.

The one case that has been made public came to a head in September 2014. A 7-year-old patient Konopka had been treating for years allegedly came in with a heartbeat that was too fast and strangely patterned. According to documents from the New Hampshire Board of Medicine, the doctor suspected this was a side effect of an asthma medication she’d prescribed, so she changed the prescription. But the board claims that she failed to do certain follow-up tests or refer the child to a cardiologist — and that she had not attempted to treat the patient with an inhaled steroid.

She rejects the idea that she has done anything wrong. “I treated the patient here in my office and in three days the child was jumping around and was healthy,” she said, quivering. “Therefore, how they can criticize me? I know medicine, I know pharmacology, I know everything. I have been treating people for over 55 years the same way and nobody died from respiratory problems or cardiac problems of any age.”

The board disagreed, and tried to arrange a hearing in 2016. It was rescheduled twice. Finally, this past May, Konopka consented to 14 hours of continuing medical education about asthma, pharmacology, and cardiology, in addition to the minimum required to renew a physician’s license.

But then Konopka was informed that the board had enough concerning evidence about her abilities as a physician to enact an emergency suspension of her license on Sept. 13. Instead of losing her ability to see patients — at least temporarily — within days, she decided to voluntarily surrender her license, which would give her about a month to wrap up her practice.

Now, she is trying to get her license back. She wants to figure out who is bringing what she calls this “fake charge” against her, and what their true motive is. She wonders if it has to do with her anti-abortion picketing in front of Planned Parenthood, or her lack of electronic records, or the fact that she registered for but does not use the state’s Prescription Drug Monitoring Program, which is a way to curb opioid abuse. She also believes that the local hospital has been trying to steal her patients for years.

Or, she went on, it might be her age that led to the board’s disciplinary actions. “They got the idea that I am old enough to be forced to retire,” she said. “But I don’t want to retire. It doesn’t matter my chronological age: I can work right now for another 10 years.”

“I don’t want to retire. It doesn’t matter my chronological age: I can work right now for another 10 years.”

Dr. Anna Konopka

There has been plenty of controversy about how to keep doctors plugged in to the latest debates and constant updates in medical knowledge. In 2015, for instance, physicians revolted against the American Board of Internal Medicine’s proposal for more stringent mid-career testing, complaining it was burdensome, expensive, and irrelevant to patient care. That’s still a point of contention — especially for those who might be nearing the age of retirement.

“There is no point in designing an intervention that is cumbersome to physicians if we have no proof that it improves their outcomes,” said Jena, of Mass. General. “These things are big enough and important enough for patients that we should be trying to generate high-quality evidence.”

Jena has done research looking at how the age of a treating physician in hospitals correlates to inpatient outcomes. His team found that older internists tend to have higher mortality among their patients. But that finding does not tell you anything about a particular physician; it just shows that doctors and their employers as a whole need to consider how to keep practitioners sharp and up to date.

In Konopka’s case, it’s hard to know how seriously to take her conjectures about why her competency is being questioned. The medical board declined to comment beyond the documents that have been made public.

“Sometimes, as in any other industry, decisions about physician termination are made in good faith, and sometimes physicians have brought and won lawsuits for antitrust violation, breach of contract, or if you’re dealing with a state agency, a failure of due process,” said Judith Feinberg Albright, a health care attorney who has no involvement in the Konopka case. She added that it might be harder and costlier for a physician in solo practice to engage in corrective action than it would be if he or she had the support of administrators and partners.

Some of Konopka’s patients — whose phone numbers she provided to STAT — have not yet taken on other primary care providers, hoping that she will get her license back. Cheryl Hodgdon, a 56-year-old dog trainer from Croydon has not had such a strong attachment to a physician since she stopped being treated by the doctor who delivered her. She had an appointment with Konopka once a month. “She believes, like a lot of old doctors from Europe, that the less medication you take, the better. I love that about her,” said Hodgdon.

Hodgdon also loved the recipe for a honey-and-garlic elixir that Konopka gave her for a cold last winter. She loves that Konopka always picks up her phone, no matter what. She loves that Konopka will send patients to get Olbas Herbal Remedies from the pharmacy. And she agrees with Konopka that American-trained doctors might not want that kind of practitioner in the area.

As Hodgdon put it, “She’s different. She’s on her own. She’s not controlled by any hospital; she can talk to you for as long as you need her to.”

Dr. Anna Konopka
Tools of the trade and porcelain keepsakes in Konopka’s examination room. Cheryl Senter for STAT

The wooden chair in Konopka’s consultation room used to be reserved for patients. Now, it is often occupied by journalists. They come with recording devices and cameras and computers, snapping pictures, asking for documents.

But she said that her patients, too, are calling and visiting and writing letters. “It is of course very painful because the patients are coming to my office, and calling over the phone, and crying, and waiting for me, and I cannot do anything about it,” she said. “I cannot refer to any doctors because they don’t want them.”

That was the argument she made in Merrimack County Superior Court in Concord, N.H., three weeks ago. She was asking for an emergency injunction to get her license back, because her patients have too many “multiple chronic problems” for the “ACA system” to handle. She added that they cannot afford care from anyone in the area but her. The judge said he would take the matter under advisement.

Dr. Anna Konopka
Konopka speaks in her own defense during the Nov. 3, 2017, court hearing seeking an injunction to get back her medical license. Geoff Forester/The Concord Monitor via AP

“I am in limbo,” she said the following week. For a while after she lost her license, she was still taking her three customary swims every day, driving to Lake Sunapee or Pleasant Lake, doing a quarter-mile at a time. But she did her last laps of the season on Oct. 23, when the water temperature, she said, was 61 degrees. She still takes her dog out to wooded back roads every day. She has knee problems, so she can’t walk him anymore, but she lets him out of the car and motors very slowly through the autumn trees, with the dog padding dutifully behind.

She refuses to just retire, though, or to wait passively for a verdict. A few weeks after her temporary hearing, she’d had no news, and she was preparing for a confrontation, as she had with her ghost.

“Friday I am planning to go to the superior court,” she said. “I have some kind of project.” She wouldn’t give any details on what she was hoping to do. “I am keeping quiet. If you are in war, you have to be careful about your enemies. I am in a war with the people from the system, therefore I have to be careful with what I am doing — I don’t want them to come with a counterattack.”

  • A compassionate doctor who is incompetent could wind up killing you, and they might not even attribute it to their malpractice.

    In looking over all the comments on my post and that of others, I am struck by how many healthcare recipients conflate bedside manner with competence. You want both, but one does not follow from the other.

    Given Dr. Konopka ’s age and other issues mentioned in this article, I very much doubt that impatience with computers is the state licensing board’s only issue with her competence. Many things doctors were taught to do in Med School 50 years ago have been shown to be useless or even harmful. If you are frail, your body might not recover on its own if you are prescribed an ineffective or inappropriate medication.

    If your family physician is not online keeping up with new research findings and using online sites to help identify the best lab tests and treatment options for cases they seldom encounter, he or she is putting your life at risk.

    If you are getting repeated X-rays or other tests because your electronic health record is incomplete, that is as much your responsibility as a patient as it is your physician’s. An unnecessary X-ray is not likely to kill you on the spot. However, an incomplete EHR might. If you are wheeled into the Emergency Room unconscious and the medical team can access your EHR, they might not unintentionally end your life by giving you medication to which you are allergic. Knowing that you are on Buprenorphine or Naloxone is critical to prevent your anesthetist from putting you to sleep forever.

    If your healthcare provider is unaware of who your primary care physician is, do not expect them to be updating their EHR unless you are in the same HMO or group practice. If your own physician is not updating your EHR, then find another doctor! If you do not like the bedside manner of your healthcare provider, then find another doctor. It’s your life, not theirs.

  • And I’m older too. Why I dislike most younger GIs–GERD-younger ones insist on a stomach pump inhibitor medication, never mind I ended up in the ER for dehydration-on IVS- feel good intravenous. They tell me that my acid neutralizer -Zantac is wrong- modern medicine says that. Sorry but Zantac doesn’t have me in the ER unable to urinate. That’s the bare tip of the iceberg. Older doctors listen-and they understand what my words mean.

  • This is a profoundly important case. The growing shortage of primary care physicians is largely attributable to the corporate takeover of medical care. Patients have lost time with their physicians because everyone wants “a piece of the pie,” Of the business of medicine.
    Hospitals are no exception.
    The insurers and the hospitals coerce the physicians into becoming employed and then essentially broker their services. The methods are often subtle and the physicians are too busy to notice. For instance the insurers will pay you $100 more for the same care if you become part of a negotiating team like BIDCO or NEQCA in the Boston area. Inside the system, Doctors are not allowed to speak out about the deficiencies, which are numerous and continuously put patients in harms way.
    When I was employed by Tufts medical center they demanded that I write nursing home orders for patients without seeing them and that I sign Narcotic orders for patients of other physicians who never should have been on them in the first place . Their focus was to keep their patient panels high.
    I have been a patient advocate since early in my career when I helped the Attorney General in RI expose fraudulent activity at Landmark Medical Center and replace both the head of the emergency room and the head of the hospital. They were having the ER Physicians deliver Medicaid babies, while the obstetricians documented the case as if they were there. The hospital administrators took a $200 kickback from each of those deliveries .
    They were removing the do not resuscitate orders from patients’ charts to increase revenues instead of letting the patients die peacefully.
    The only way to stop the corruption inside the system is to stop empowering the system and to put the checks and balances back into place with hundreds of individual physicians practicing independently and therefore free to report the truth to the public.
    Patients need more time with their doctors to get properly treated. The corporate takeover of medical Care has turned the practice of medicine into a factory With disillusioned unhappy doctors well aware of the problem and dissatisfied patients who are continuously lost in the shuffle.
    The board of medicine indeed can be involved in all of this : “due process.”
    As an aside “the boys club” is still alive and well,” in the world of medicine and the gender inequalities in how physicians are treated is pervasive.
    It would be interesting to know whether those were men or women on the board of medicine that suspended that female doctor’s license for what sounds to be trivial nonsense.
    After I assisted Maureen Glynn, an attorney general in Rhode Island in exposing corruption at landmark medical center, which resulted in replacing Robert Walker as head of the hospital and Dan Halpen-Ruder as head of the emergency room , the Rhode Island board of medicine soon began harassing me .
    I reported a physician who killed a two-year-old girl because he was on benzodiazepines at night and soon after that the board which consisted of many of his friends harassed me again trying to find something wrong with the way I practiced medicine.
    The excellent doctors are often choosing to not be affiliated with branded institutions like Tufts, because they are refusing to participate in the growing corrupt methods of making money at the patients’ expense.

    • Thank you for stating this truth. I am not in direct clinical care but I’ve been in support for many years and agree with everything you say here. My main goal is to maintain my health and then die with minimal medical intervention. The public has been duped by medical institutions into thinking doctors have the cure for every ache and pain with magic pills that the giant pharm corps push like street corner dealers. I feel bad for patients who don’t know they don’t have to stay with a doctor who isn’t listening to them. I actually had a patient tell me she stayed with her doctor too long (7 years!) with no results because she felt bad and didn’t want him to think badly of her. I’m not sure I would go to an 85 year old doctor but I do believe the old time, independent practice way of practicing medicine is better for the patient… and probably the doctor.

  • Is there any evidence that older doctors tend to have older patients?–which would make sense. People might well tend to stay with practitioners they like and trust. And if so, you’d expect older doctors to have an older set of patients, who would presumably be more likely to die than a younger group, no matter how good their treatment. The latest ideas are not always the best, after all, as witness the fact–a geriatric nurse practitioner told me so–that patients do occasionally leave hospice because under a regime of good nursing, good food, and pleasant living, they got well enough to go home.

  • Sympathy for Konopka and dissatisfaction with current encounters is understandable. Here’s an interesting contrast on STAT- https://www.statnews.com/2017/11/08/elderly-doctor-guilt/
    The current article is so selective in its reporting as to be irresponsible. Konopka sounds like a wonderful, fascinating person. That alone in no way ensures competence. As a generalist myself, one of my greatest everyday challenges is to know when I’m out of my depth and to get a sense of urgency (or not) and seriousness/ danger. She just doesn’t sound competent.

    • This article you referenced has nothing to do with this woman. I’m not saying that she must be perfectly fine to practice because this article makes it seem so, but it’s like you just tried to lump her in with EVERY aging physician.

      I worked with one of the oldest orthopedic surgeons in my area, and he was still VERY skilled when he retired, over the age of 70, putting in 30+ hours of SURGICAL time each week and still maintaining 3 days of office time (which, not including dictation, on call, etc is over a 50 hour work week). People would wait three quarters of a year just to get in with him to have him do their surgeries. His patients outcomes were still incredible. He hated the electronic dictation systems so refused to use it. His post-op notes might be WEEKS behind. He was still the highest paid orthopedic surgeon in the area because HE could bring in the most money. No one wanted him to retire—not his patients, his colleagues, the facility he worked for. He just desired a slower lifestyle. Funny, no one was trying to force him out…

      Maybe she is a sharp as he is. Maybe she shouldn’t be FORCED to retired just because she ISN’T making the money for the insurance and pharmaceutical companies my physician did. Or maybe she IS unfit to be a physician. But really, if she has patients waiting for her, and incompetence can’t be proven, and she is willing to care for them, then LET HER.

    • To Natasha,
      If that surgeon isn’t writing post-op notes till weeks later, he is carrying a big risk for malpractice as far more successful malpractice cases occur as a result of bad record keeping than of bad medicine.
      I don’t care how much money he brings in, no hospital is going to take the risk that it is going to be sued and allow him to practice in it if he’s going to do what you say.
      And if he is post-dating those notes to make it appear that he wrote them right after the surgery, he is committing fraud.

    • Natasha.
      Yes, clearly the two docs discussed are different and in different circumstances. I don’t believe I lumped all aging physicians together, just saw a bit of contrast in the reporting and circumstances of the two articles published within days of each other. Personally, I think the current article is irresponsible in the selectivity of its reporting.
      The link illustrates that doctors and licensing boards do not go after doctors in this manner eagerly. I’d say complaints of closed communities of doctors who won’t report other physicians, and of Medical Boards that fail to monitor physicians closely enough, far outweigh articles such as this.
      Lastly at 61, I hope to practice another 8-10 years and recognize the need to remain up to date and mentally acute. I do not want to encourage discrimination based on age.

  • Patients most often assume technical competence when they see a doctor. They often differentiate based on interpersonal skills- compassion, empathy, friendliness, reassurance and devotion of time-the personal touch. While mainstream medicine gives lip service to those, we deal with tremendous regulatory demands and Byzantine payment rules that necessarily give a backseat to anything but pro forma interactions. And most of us believe in technical competence- prescribe the best medicine, order the correct test according to scientific evidence. In the office or hospital it can really be a juggling act.
    At one extreme people turn to naturopaths and other sellers of snake oil.
    I recall a survey of patients from the 90’s. Most people had high regard for their yet held low opinions of doctors in general. They were seen as greedy, arrogant, etc. I don’t think much has changed.

  • I am in Quezon City Philippines. My grandfather & his mother were traditional healers in our village.
    They treated various ailments & health problems in Catmon, Cebu, Philippines.
    From fevers to diarrhea, from pregnancies to childbirths, from sprains & dislocations.
    Now two of my children are doctors who got married to Western influenced physicians.
    Life goes on.
    I am in the pharmaceutical industry with a company making & promoting ophthalmic & otic drops.
    There are health practices that need to be followed from the old traditional ways: eating moderately on time with focus on vegetables, fish & fruits keeps a man healthy.
    Hiking to gather food and firewood keeps a man fit.
    Complete night sleep dictated by sunset and sunrise – these are the ways my late grandparents kept the villagers healthy.
    Rodolfo Kintanar, M.M.6G

  • I guarantee you that she knows each and every one of her patients medical, surgical, psychosocial and personal histories and how to appropriately treat them better than the local doctor(s) know their own patient’s names. The main reason she is being attacked is because they are intimidated and mystified by a TRUE HEALER. She has something that they will never have. She has a true patient-doctor relationship that cannot be taught or learned but is a gift. Unfortunately she does not fit the mold of today when your doctor is too busy trying to input crap for the government on a computer screen to even look at you, much less talk to you. And don’t ask any questions of the doctor because he treats conditions attached to a code not humans with fears, questions and emotions.

    Also, I am really curious how the Medical Board, who never saw the child, knows better how to treat a 7 year old asthmatic that Dr. Konopka knows well and examined?

    • umm maybe because any child who goes into afib from an albuterol inhaler needs to be worked up for underlying structural abnormality because inhaled beta agonists shouldn’t cause dysrhythmias. I dont doubt her patient- doctor relationship, but we have lots of new evidence on how to optimally treat common conditions and if you don’t keep up, thats not good medicine

    • If you read other coverage of this case, there are at least four other complaints pending against her, alleging substandard care, questionable prescribing practices, questionable medical record-keeping, etc.

      An emergency suspension of someone’s medical license is not an action you see every day.

      Age and/or refusal to learn computer skills aren’t the point. Holding a medical license is a privilege, not a right. Her statements that the allegations against her are “fake charges” and that other doctors are trying to “steal” her patients and “refuse” to accept referrals from her suggest she lacks the insight that would allow her to measure her standard of practice against what’s generally held to be appropriate medical standards.

      I’m sorry for her sake that it’s come to this, but the picture portrayed here is of someone – whether age 45 or 85 – who can’t be trusted to safely care for patients and keep up with current knowledge.

Comments are closed.