How old’s too old to be a doctor? Why GPs and surgeons over 70 may need a health check to practise
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A growing number of complaints against older doctors has prompted the Medical Board of Australia to announce today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table.
The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine.
The second would require only general health checks for doctors over 70.
A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their professional code of conduct, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo.
Haven’t we moved on from set retirement ages?
It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “still valid in a modern society”.
However, unlike judges, doctors are already required to renew their registration annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct performance assessments if and when they are needed.
What has prompted these proposals?
This latest proposal identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years.
Studies of medical competence in ageing doctors show variable results. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour.
The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors.
In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70.
In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015.
While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate.
It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients.
So what distinguishes the two new proposed options?
The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80.
Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions.
Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia.
The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia.
In practice, both of these proposals appear to allow doctors to manage their own general health confidentially.
The law tends to prioritise patient safety
All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. That provision basically says patient safety is paramount and trumps all other considerations.
As with legal regimes regulating childcare, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional.
Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “punished” for errors in practice.
All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care.
Could these proposals amount to age discrimination?
It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws.
For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals who are “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”.
In broader terms, a licence to practise medicine is often compared to a licence to drive or pilot an aircraft. Despite claims of discrimination, New South Wales law requires older drivers to undergo a medical assessment every year; and similar requirements affect older pilots and air traffic controllers.
Where to from here?
When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different.
How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, others have suggested this would only exacerbate shortages in the health-care workforce.
The proposals are open for public comment until October 4.
Christopher Rudge, Law lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier?
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Our Verdict
When comparing water-based lubricant to silicon-based lubricant, we picked the silicon-based.
Why?
First, some real talk about vaginas, because this is something not everyone knows, so let’s briefly cover this before moving onto the differences:
Yes, vaginas are self-lubricating, but a) not always and b) not always sufficiently, especially as we get older. Much like with penile hardness (or lack thereof), there’s a lot of stigma associated with vaginal dryness, and there really needn’t be, because the simple reality is that we don’t live in the fictitious world of porn, and here in the real world, anatomy and physiology can be quite arbitrary at times.
It is this writer’s firm opinion that everyone (or: everyone who is sexual, anyway) should have good quality lube at home—regardless of one’s gender, relationship status, or anything else.
Ok, with that in mind, onwards:
The water-based lube has nine ingredients: water, glycerin, cytopentasioxane, propylene glycol, xantham gum, phenoxyethanol, dimethiconol, triethanolamine, and ethylhexylglycerine.
All of these ingredients are considered body-safe in the doses present, and/but most of them will be absorbed into the skin, especially via the relatively permeable membrane that is the inside of the vagina (or anus—while the microbiome is very different, tissue-wise these are very similar).
While this is not meaningfully toxic, there’s a delicate balance going on in there, and this can upset that balance a little.
Also, because the lube is absorbed into the skin, you’ll then need more, which means either a moment’s inconvenience to add more, or else the risk of chafing, which isn’t fun.
The silicon lube has four ingredients: dimethicone, dimethiconol, cyclomethicone, and tocopheryl acetate.
Note: “tocopheryl acetate” is vitamin E
…which reminds us: just because something is hard to spell, doesn’t mean it’s necessarily bad for us.
What are the other three ingredients, though? They are all silicon compounds, all inert, and all with molecules too big to be absorbed into our skin. Basically they all slide right off, which is entirely the point of lube, after all.
It not being absorbed into our skin is good for our health; it’s also convenient as it means a tiny bit of lube goes a long way.
Any downsides to silicon-based lube?
There are two, and neither are health-related:
- It can damage silicon toys if not cleaned quickly and thoroughly, the silicon of the lube may bond with the silicon of the toy after a while.
- Because it doesn’t just disappear like water-based lube, you might want to put a towel down if you don’t want your bed to be slippy afterwards! The towel can then be put in the laundry as normal.
Want to try it out? Here it is on Amazon
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High-Octane Brain – by Dr. Michelle Braun
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True to the title, Dr. Braun jumps straight into action here, making everything as practical as possible as quickly as possible and giving the most attention to the science-based steps to take. Thereafter, and almost as an addendum, she gives examples of “brain role models” from various age groups, to show how these things can be implemented and benefitted-from in the real world.
The greatest strength of this book is that it is the product of a lot of hard science made easy; this book has hundreds of scientific references (of which, many RCTs etc), and many contributions from other professionals in her field, to make one of the most evidence-based guidebooks around, and all presented in one place and in a manner that is perfectly readable to the layperson.
The style, thus, is easy-reading, with references for those who want to jump into further reading but without that being required for applying the advice within.
Bottom line: if you’d like to improve your brain with an evidence-based health regiment and minimal fluff, this is the book for you.
Click here to check out High-Octane Brain, and level-up yours!
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Why the WHO has recommended switching to a healthier salt alternative
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This week the World Health Organization (WHO) released new guidelines recommending people switch the regular salt they use at home for substitutes containing less sodium.
But what exactly are these salt alternatives? And why is the WHO recommending this? Let’s take a look.
goodbishop/Shutterstock A new solution to an old problem
Advice to eat less salt (sodium chloride) is not new. It has been part of international and Australian guidelines for decades. This is because evidence clearly shows the sodium in salt can harm our health when we eat too much of it.
Excess sodium increases the risk of high blood pressure, which affects millions of Australians (around one in three adults). High blood pressure (hypertension) in turn increases the risk of heart disease, stroke and kidney disease, among other conditions.
The WHO estimates 1.9 million deaths globally each year can be attributed to eating too much salt.
The WHO recommends consuming no more than 2g of sodium daily. However people eat on average more than double this, around 4.3g a day.
In 2013, WHO member states committed to reducing population sodium intake by 30% by 2025. But cutting salt intake has proved very hard. Most countries, including Australia, will not meet the WHO’s goal for reducing sodium intake by 2025. The WHO has since set the same target for 2030.
The difficulty is that eating less salt means accepting a less salty taste. It also requires changes to established ways of preparing food. This has proved too much to ask of people making food at home, and too much for the food industry.
There’s been little progress on efforts to cut sodium intake. snezhana k/Shutterstock Enter potassium-enriched salt
The main lower-sodium salt substitute is called potassium-enriched salt. This is salt where some of the sodium chloride has been replaced with potassium chloride.
Potassium is an essential mineral, playing a key role in all the body’s functions. The high potassium content of fresh fruit and vegetables is one of the main reasons they’re so good for you. While people are eating more sodium than they should, many don’t get enough potassium.
The WHO recommends a daily potassium intake of 3.5g, but on the whole, people in most countries consume significantly less than this.
Potassium-enriched salt benefits our health by cutting the amount of sodium we consume, and increasing the amount of potassium in our diets. Both help to lower blood pressure.
Switching regular salt for potassium-enriched salt has been shown to reduce the risk of heart disease, stroke and premature death in large trials around the world.
Modelling studies have projected that population-wide switches to potassium-enriched salt use would prevent hundreds of thousands of deaths from cardiovascular disease (such as heart attack and stroke) each year in China and India alone.
The key advantage of switching rather than cutting salt intake is that potassium-enriched salt can be used as a direct one-for-one swap for regular salt. It looks the same, works for seasoning and in recipes, and most people don’t notice any important difference in taste.
In the largest trial of potassium-enriched salt to date, more than 90% of people were still using the product after five years.
Excess sodium intake increases the risk of high blood pressure, which can cause a range of health problems. PeopleImages.com – Yuri A/Shutterstock Making the switch: some challenges
If fully implemented, this could be one of the most consequential pieces of advice the WHO has ever provided.
Millions of strokes and heart attacks could be prevented worldwide each year with a simple switch to the way we prepare foods. But there are some obstacles to overcome before we get to this point.
First, it will be important to balance the benefits and the risks. For example, people with advanced kidney disease don’t handle potassium well and so these products are not suitable for them. This is only a small proportion of the population, but we need to ensure potassium-enriched salt products are labelled with appropriate warnings.
A key challenge will be making potassium-enriched salt more affordable and accessible. Potassium chloride is more expensive to produce than sodium chloride, and at present, potassium-enriched salt is mostly sold as a niche health product at a premium price.
If you’re looking for it, salt substitutes may also be called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.
A review published in 2021 found low sodium salts were marketed in only 47 countries, mostly high-income ones. Prices ranged from the same as regular salt to almost 15 times higher.
An expanded supply chain that produces much more food-grade potassium chloride will be needed to enable wider availability of the product. And we’ll need to see potassium-enriched salt on the shelves next to regular salt so it’s easy for people to find.
In countries like Australia, about 80% of the salt we eat comes from processed foods. The WHO guideline falls short by not explicitly prioritising a switch for the salt used in food manufacturing.
Stakeholders working with government to encourage food industry uptake will be essential for maximising the health benefits.
Xiaoyue (Luna) Xu, Scientia Lecturer, School of Population Health, UNSW Sydney and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Carrots vs Broccoli – Which is Healthier?
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Our Verdict
When comparing carrots to broccoli, we picked the broccoli.
Why?
These are both excellent candidates that should be in everyone’s diet, but there’s a clear winner:
In terms of macros, carrots have 50% more carbs for the same fiber (giving carrots the relatively higher glycemic index, though really, nobody is getting metabolic disease from eating carrots, which are a low-GI food already), while broccoli has more protein. By the numbers, it’s a nominal win for broccoli here, but really, both are great.
In the category of vitamins, carrots have more of vitamins A and B3, while broccoli has more of vitamins B1, B2, B5, B6, B7, B9, C, E, K, and choline. An easy win for broccoli. We’d like to emphasize, though, that this doesn’t mean carrots don’t have lots of vitamins—they do—it’s just that broccoli has even more!
When it comes to minerals, carrots are genuinely great, and/but not higher in any minerals than broccoli, while broccoli has more calcium, copper, iron, magnesium, manganese, phosphorus, selenium, and zinc. So again, a clear win for broccoli, despite carrots’ fortitude.
All in all, an overwhelming win for broccoli, though once again, enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
What Do The Different Kinds Of Fiber Do? 30 Foods That Rank Highest
Enjoy!
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Asparagus vs Edamame – Which is Healthier?
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Our Verdict
When comparing asparagus to edamame, we picked the edamame.
Why?
Perhaps it’s a little unfair comparing a legume to a vegetable that’s not leguminous (given legumes’ high protein content), but these two vegetables often serve a similar culinary role, and there is more to nutrition than protein. That said…
In terms of macros, edamame has a lot more protein and fiber; it also has more carbs, but the ratio is such that edamame still has the lower glycemic index. Thus, the macros category is a win for edamame in all relevant aspects.
When it comes to vitamins, things are a little closer; asparagus has more of vitamins A, B3, and C, while edamame has more of vitamins B1, B2, B5, B6, and B9. All in all, a moderate win for edamame, unless we want to consider the much higher vitamin C content of asparagus as particularly more relevant.
In the category of minerals, asparagus boasts only more selenium (and more sodium, not that that’s a good thing for most people in industrialized countries), while edamame has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An easy win for edamame.
In short, enjoy both (unless you have a soy allergy, because edamame is young soy beans), but edamame is the more nutritionally dense by far.
Want to learn more?
You might like to read:
Take care!
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Olive oil is healthy. Turns out olive leaf extract may be good for us too
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Olive oil is synonymous with the Mediterranean diet, and the health benefits of both are well documented.
Olive oil reduces the risk of heart disease, cancer, diabetes and premature death. Olives also contain numerous healthy nutrients.
Now evidence is mounting about the health benefits of olive leaves, including from studies in a recent review.
Here’s what’s in olive leaves and who might benefit from taking olive leaf extract.
mtphoto19/Shutterstock What’s in olive leaves?
Olive leaves have traditionally been brewed as a tea in the Mediterranean and drunk to treat fever and malaria.
The leaves contain high levels of a type of antioxidant called oleuropein. Olives and olive oil contain this too, but at lower levels.
Generally, the greener the leaf (the less yellowish) the more oleuropein it contains. Leaves picked in spring also have higher levels compared to ones picked in autumn, indicating levels of oleuropein reduce as the leaves get older.
Olive leaves also contain other antioxidants such as hydroxytyrosol, luteolin, apigenin and verbascoside.
Antioxidants work by reducing the oxidative stress in the body. Oxidative stress causes damage to our DNA, cell membranes and tissues, which can lead to chronic diseases such as cancer and heart disease.
Are olive leaves healthy?
One review and analysis combined data from 12 experimental studies with 819 participants in total. Overall, olive leaf extract improved risk factors for heart disease. This included healthier blood lipids (fats) and lowering blood pressure.
The effect was greater for people who already had high blood pressure.
Most studies in this review gave olive leaf extract as a capsule, with daily doses of 500 milligrams to 5 grams for six to 48 weeks.
Another review and analysis published late last year looked at data from 12 experimental studies, with a total of 703 people. Some of these studies involved people with high blood lipids, people with high blood pressure, people who were overweight or obese, and some involved healthy people.
Daily doses were 250-1,000mg taken as tablets or baked into bread.
Individual studies in the review showed significant benefits in improving blood glucose (sugar) control, blood lipid levels and reducing blood pressure. But when all the data was combined, there were no significant health effects. We’ll explain why this may be the case shortly.
Olive leaves can be brewed into tea. Picture Partners/Shutterstock Another review looked at people who took oleuropein and hydroxytyrosol (the antioxidants in olive leaves). This found significant improvement in body weight, blood lipid profiles, glucose metabolism and improvements in bones, joints and cognitive function.
The individual studies included tested either the two antioxidants or olive leaf incorporated into foods such as bread and cooking oils (but not olive oil). The doses were 6-500mg per day of olive leaf extract.
So what can we make of these studies overall? They show olive leaf extract may help reduce blood pressure, improve blood lipids and help our bodies handle glucose.
But these studies show inconsistent results. This is likely due to differences in the way people took olive leaf extract, how much they took and how long for. This type of inconsistency normally tells us we need some more research to clarify the health effects of olive leaves.
Can you eat olive leaves?
Olive leaves can be brewed into a tea, or the leaves added to salads. Others report grinding olive leaves into smoothies.
However the leaves are bitter, because of the antioxidants, which can make them hard to eat, or the tea unpalatable.
Olive leaf extract has also been added to bread and other baked goods. Researchers find this improves the level of antioxidants in these products and people say the foods tasted better.
Olive leaves can taste bitter, which can put people off. But you can bake the extract into bread. Repina Valeriya/Shutterstock Is olive leaf extract toxic?
No, there seem to be no reported toxic effects of eating or drinking olive leaf extract.
It appears safe up to 1g a day, according to studies that have used olive leaf extract. However, there are no official guidelines about how much is safe to consume.
There have been reports of potential toxicity if taken over 85mg/kg of body weight per day. For an 80kg adult, this would mean 6.8g a day, well above the dose used in the studies mentioned in this article.
Pregnant and breastfeeding women are recommended not to consume it as we don’t know if it’s safe for them.
What should I do?
If you have high blood pressure, diabetes or raised blood lipids you may see some benefit from taking olive leaf extract. But it is important you discuss this with your doctor first and not change any medications or start taking olive leaf extract until you have spoken to them.
But there are plenty of antioxidants in all plant foods, and you should try to eat a wide variety of different coloured plant foods. This will allow you to get a range of nutrients and antioxidants.
Olive leaf and its extract is not going to be a panacea for your health if you’re not eating a healthy diet and following other health advice.
Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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