Physician Competency, But What About Politicians?

Physician competency is coming under increasing scrutiny. All medical specialties require maintenance of certification by their various specialty boards as a means of demonstrating competency and life long learning. The American Medical Association is taking this issue further, using age as a factor in deciding when doctors need to hang up their white coats.

The AMA argues that physicians have no mandatory retirement age, but similar to other professions that do, such as pilots or military officers, physician mistakes can be deadly. One in four physicians is older than 65 years, with this figure increasing as people are living longer and healthier, physicians included. Should such age scrutiny extend beyond doctors?

How about Congress? In the House of Representatives, Democrats average 60 years of age compared to 55 years for Republicans. The Senate is even older, with Democrats averaging 63 years of age compared to 61 years for Republicans. So much for Republicans being the party of old men. Looking specifically at the US Senate, more than a third of its members are older than 65 years, a higher percentage of senior citizens than among physicians.

Are senators making life and death decisions on a daily basis, as are physicians? If you don’t count pushing and shoving to get in front of the nearest TV camera, the quick answer is no. Debating and passing legislation is hardly life and death work. Yet a more thoughtful analysis shows otherwise. Those senators, and subsequent presidential candidates that voted, “for the Iraq war before they were against it” made a decision that cost the lives of 6,800 American troops. And countless civilians. The Senators that voted for Obamacare made a life and death decision for many patients suddenly losing their medical insurance or discovering that they can’t afford their new deductible.

No competency test is needed for US Senators making life and death decisions, even for those pushing 80 years old, but according to the AMA, older physicians can’t be trusted to exercise good judgment, including knowing their own limits.

How about the US Supreme Court? Six of the nine justices are over the age of 65, with the oldest being 82 years old. The justices routinely make life and death decisions. Some are direct as in stays of execution. Others are indirect as in gun laws, which affect lives in the commission of or in self-defense of crimes. Or abortion, which affects the life of the unborn.

John Kerry, the secretary of state, is 71. His decisions can lead the country into or out of war, losing or saving the lives of US soldiers depending on his decisions and diplomacy. House Minority Leader Nancy Pelosi is 75 and was also in favor of the Iraq war as was Mr. Kerry. Even members of her own party question her age and fitness for leadership.

And what about the presumptive Democrat presidential nominee Hillary Clinton? If elected she would be 69 years old when inaugurated, the same age as “older than dirt” Ronald Reagan when he was inaugurated. In fact, Hillary would become the second oldest US President ever, only a few months younger than Reagan when he assumed office. Remember the concerns about Reagan being too old back in 1979 when he was running for President? Not so now. The National Journal tells us, “Why You Can't Compare Hillary Clinton's Age to Ronald Reagan's.” Of course. Age is only an issue for Republicans and physicians.

Speaking of Hillary, she suffered a concussion in 2012, also known as traumatic brain injury. The National Institute of Neurological Disorders and Stroke explains that TBI disabilities include problems with cognition, meaning thinking, memory, and reasoning as well as aggression and acting out. Age is one of the factors influencing prognosis following TBI.  

Are these legitimate concerns for a potential commander in chief? This is what the AMA is scrutinizing in aging physicians. Would it be appropriate for physicians who suffered recent TBI and are pushing 70 years old to have their thinking and judgment assessed before being allowed back into the operating room?

Yet we are to assume that Hillary is of sound mind and judgment after her concussion, serious enough for her to need prism eyeglasses to correct double vision after her concussion. Hillary won’t even answer questions from the media, much less release her medical records or submit to testing to demonstrate being of sound mind and judgment. If older physicians need, “an evaluation of physical and mental health” to demonstrate competency, shouldn’t our elected leaders, especially presidents, be held to a similar standard?

Brian C Joondeph, MD, MPS, a Denver based physician and writer. Twitter @retinaldoctor.

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