Of Cabbages and Coots

A doctor joke:

What is an alcoholic?
Someone who drinks more than his doctor.

My corollary:

When is a doctor an old coot?
When he's about ten years older than I am.

A gratuitous bonus:

In Kentucky, what is a pervert?
Someone who likes sex better than basketball.

A recent study in the Annals of Internal Medicine demonstrated an "inverse relationship between a doctor's age and his performance", which is a very graceful way of saying that the older we get, the less we stay up to date with the current trends in medicine. I don't think this is a very surprising study, and one does not have to assume that it's because we older docs have early Alzheimers and have short term memory loss.

I don't think it's because we have short term memory loss, either.

And I don't think it's because we have a short term memory loss.

OK, it wasn't that funny, but...what in the heck was I talking about?

Oh yeah. Losing one's grip as he gets older. Let's see, when I was just a mere slip of a doctor, we would treat peptic ulcer disease with heavy cream, and were thrilled when the wonder drug Tagamet was introduced. When Star Wars first hit the theaters CT scans were just entering the medical mainstream, and were greeted with the same wonderment as we had for the laser-saber. Now some radiological entrepreneurs want the CT scan to be part of the routine physical examination, like getting your blood pressure taken or your cholesterol checked.

The times, they are a-changin'.

I don't hold myself up as a model for up-to-datedness, but I'll share with you my attempts at trying to keep up with the Doogie Howsers of the world:

Harness the power of your inner geek.
Use some of your love of electronic toys for your practice. For example, I subscribe to JournalBytes that downloads medical abstracts of current interest into my handheld. I read them at my leisure and take a test on the handheld which then uploads it to their server. If I pass the test I get 3 CME credits. Epocrates and UpToDate are other fine services I subscribe to.

Let others feel your regulatory pain.
It is impossible to keep up with the literature AND take care of OSHA, CLIA, HIPAA, the CorrectCoding Initiative, Stark I & II, the Kennedy-Kassebaum Act, Medicaid utilization review, FMLA forms, Prior Authorizations for Proton Pump Inhibitors (half the population is on them), predatory insurance practices by such folks as National RedStar/RedSword, COBRA/EMTALA, endless credentialling and recredentialling, etc. etc. I'm approaching the point where the only time I'll fill out a form is when they threaten to jail me if I don't. If you don't like it, complain to the powers that be. I don't have enough resources to fight over every single PA for medications that you could get (almost) over the counter. Don't dump it on me.

Remind yourself every morning that you don't know squat.
This is particularly difficult for a gastroenterologist to admit. The longer I'm in medicine the less I feel I truly comprehend; combine that with trying to adopt a holistic approach to your practice by considering the emotional and spiritual aspects of humanity as it relates to their health, and I'm convinced that I won't ever master this noble art.