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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White Potato vs Sweet Potato – Which is Healthier?
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Our Verdict
When comparing white potatoes to sweet potatoes, we picked the sweet potatoes.
Why?
In terms of macros, sweet potatoes are a little lighter on carbs and calories, though in the case of sugar and fiber, sweet potato has a few grams more of each, per potato. However, when an average sweet potato’s 7g of sugar are held against its 4g of fiber, this (much like with fruit!) not a sugar you need to avoid.
See also: Which Sugars Are Healthier, And Which Are Just The Same?
The glycemic index of a sweet potato is also lower than that of a white potato, so the sugars it does have are slower-release.
Sweet potatoes famously are good sources of vitamin A and beta-carotene, which important nutrients white potatoes cannot boast.
Both plants are equally good sources of potassium and vitamin C.
Summary
Both are good sources of many nutrients, and any nutritional health-hazards associated with them come with the preparation (for example, frying introduces unhealthy fats, and mashing makes the glycemic index skyrocket, and cooking with salt increases the salt content).
Baking either is great (consider stuffing them with delicious well-seasoned beans and/or tomatoes; if you make it yourself, pesto can be a great option too, as can cheese if you’re so-inclined and judicious with choice and quantity) and preserves almost all of their nutrients. Remember that nearly 100% of the fiber is in the skin, so you do want to eat that.
The deciding factor is: sweet potatoes are good sources of a couple more valuable nutrients that white potatoes aren’t, and come out as the overall healthiest for that reason.
Enjoy!
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The “Five Tibetan Rites” & Why To Do Them!
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Spinning Around
In Tuesday’s newsletter, we asked you for your opinion of the “Five Tibetan Rites”, and got the above-depicted, below-described, set of responses:
- About 41% said “I have never heard of these before”
- About 27% said “they restore youth by adjusting internal vortexes”
- About 22% said “they are basically yoga, by a different name”
- About 11% said “they are a pseudoscience popular in the US”
So what does the science say?
The Five Tibetan Rites are five Tibetan rites: True or False?
False, though this is more question of social science than of health science, so we’ll not count it against them for having a misleading name.
The first known mentioning of the “Five Tibetan Rites” is by an American named Peter Kelder, who in 1939 published, through a small LA occult-specialized publishing house, a booklet called “The Eye of Revelation”. This work was then varyingly republished, repackaged, and occasionally expanded upon by Kelder or other American authors, including Chris Kilham’s popular 1994 book “The Five Tibetans”.
The “Five Tibetan Rites” are unknown as such in Tibet, except for what awareness of them has been raised by people asking about them in the context of the American phenomenon.
Here’s a good history book, for those interested:
The author didn’t originally set out to “debunk” anything, and is himself a keen spiritualist (and practitioner of the five rites), but he was curious about the origins of the rites, and ultimately found them—as a collection of five rites, and the other assorted advices given by Kelder—to be an American synthesis in the whole, each part inspired by various different physical practices (some of them hatha yoga, some from the then-popular German gymnastics movement, some purely American spiritualism, all available in books that were popular in California in the early 1900s).
You may be wondering: why didn’t Kelder just say that, then, instead of telling stories of an ancient Tibetan tradition that empirically does not exist? The answer to this lies again in social science not health science, but it’s been argued that it’s common for Westerners to “pick ‘n’ mix” ideas from the East, champion them as inscrutably mystical, and (since they are inscrutable) then simply decide how to interpret and represent them. Here’s an excellent book on this, if you’re interested:
(in Kelder’s case, this meant that “there’s a Tibetan tradition, trust me” was thus more marketable in the West than “I read these books in LA”)
They are at least five rites: True or False?
True! If we use the broad definition of “rite” as “something done repeatedly in a solemn fashion”. And there are indeed five of them:
- Spinning around (good for balance)
- Leg raises (this one’s from German gymnastics)
- Kneeling back bend (various possible sources)
- Tabletop (hatha yoga, amongst others)
- Pendulum (hatha yoga, amongst others) ← you may recognize this one from the Sun Salutation
You can see them demonstrated here:
Click Here If The Embedded Video Doesn’t Load Automatically
Kelder also advocated for what was basically the Hay Diet (named not for the substance but for William Hay; it involved separating foods into acid and alkali, not necessarily according to the actual pH of the foods, and combining only “acid” foods or only “alkali” foods at a time), which was popular at the time, but has since been rejected as without scientific merit. Kelder referred to this as “the sixth rite”.
The Five Rites restore youth by adjusting internal vortexes: True or False?
False, in any scientific sense of that statement. Scientifically speaking, the body does not have vortexes to adjust, therefore that is not the mechanism of action.
Spiritually speaking, who knows? Not us, a humble health science publication.
The Five Rites are a pseudoscience popular in the US: True or False?
True, if 27% of those who responded of our mostly North American readership can be considered as representative of what is popular.
However…
“Pseudoscience” gets thrown around a lot as a bad word; it’s often used as a criticism, but it doesn’t have to be. Consider:
A small child who hears about “eating the rainbow” and mistakenly understands that we are all fuelled by internal rainbows that need powering-up by eating fruits and vegetables of different colors, and then does so…
…does not hold a remotely scientific view of how things are happening, but is nevertheless doing the correct thing as recommended by our best current science.
It’s thus a little similar with the five rites. Because…
The Five Rites are at least good for our health: True or False?
True! They are great for the health.
The first one (spinning around) is good for balance. Science would recommend doing it both ways rather than just one way, but one is not bad. It trains balance, trains our stabilizing muscles, and confuses our heart a bit (in a good way).
See also: Fall Special (How To Not Fall, And Not Get Injured If You Do)
The second one (leg raises) is excellent for core strength, which in turn helps keep our organs where they are supposed to be (this is a bigger health issue than most people realise, because “out of sight, out of mind”), which is beneficial for many aspects of our health!
See also: Visceral Belly Fat & How To Lose It ← visceral fat is the fat that surrounds your internal organs; too much there becomes a problem!
The third, fourth, and fifth ones stretch our spine (healthily), strengthen our back, and in the cases of the fourth and fifth ones, are good full-body exercises for building strength, and maintaining muscle mass and mobility.
See also: Building & Maintaining Mobility
So in short…
If you’ve been enjoying the Five Rites, by all means keep on doing them; they might not be Tibetan (or an ancient practice, as presented), and any mystical aspect is beyond the scope of our health science publication, but they are great for the health in science-based ways!
Take care!
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Brussels Sprouts vs Spirulina – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing Brussels sprouts to spirulina, we picked the sprouts.
Why?
Pitting these two well-known superfoods against each other, we get the following:
Looking at the macros first, spirulina has a little more protein, while sprouts have more carbs and nearly 10x the fiber. So, we call this a win for sprouts.
In terms of vitamins, sprouts have a lot more of vitamins A, B6, B9, C, E, K, and choline, while spirulina has a little more of vitamins B1, B2, and B3. An easy win for sprouts.
In the category of minerals, sprouts have more calcium, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while spirulina has more copper and iron. Another clear win for sprouts.
Adding up the sections makes the winner very clear: Brussels sprouts enjoy a well-earned victory.
Want to learn more?
You might like to read:
Take care!
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Coffee & Your Gut
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Coffee, in moderation, is generally considered a healthful drink—speaking for the drink itself, at least! Because the same cannot be said for added sugar, various sorts of creamers, or iced caramelatte mocha frappucino dessert-style drinks:
The Bitter Truth About Coffee (or is it?)
Caffeine, too, broadly has more pros than cons (again, in moderation):
Caffeine: Cognitive Enhancer Or Brain-Wrecker?
Some people will be concerned about coffee and the heart. Assuming you don’t have a caffeine sensitivity (or you do but you drink decaf), it is heart-neutral in moderation, though there are some ways of preparing it that are better than others:
Make Your Coffee Heart-Healthier!
So, what about coffee and the gut?
The bacteria who enjoy a good coffee
Amongst our trillions of tiny friends, allies, associates, and enemies-on-the-inside, which ones like coffee, and what kind of coffee do they prefer?
A big (n=35,214) international multicohort analysis examined the associations between coffee consumption and very many different gut microbial species, and found:
115 species were positively associated with coffee consumption, mostly of the kind considered “friendly”, including ones often included in probiotic supplements, such as various Bifidobacterium and Lactobacillus species.
The kind that was most strongly associated with coffee consumption, however, was Lawsonibacter asaccharolyticus, a helpful little beast who converts chlorogenic acid (one of the main polyphenols in coffee) into caffeic acid, quinic acid, and various other metabolites that we can use.
More specifically: moderate coffee-drinkers, defined as drinking 1–3 cups per day, enjoyed a 300–400% increase in L. asaccharolyticus, while high coffee-drinkers (no, not that kind of high), defined as drinking 4 or more cups of coffee per day, enjoyed a 400–800% increase, compared to “never/rarely” coffee-drinkers (defined as drinking 2 or fewer cups per month).
Click here to see more data from the study, in a helpful infographic
Things that did not affect the outcome:
- The coffee-making method—it seems the bacteria are not fussy in this regard, as espresso or brewed, and even instant, yielded the same gut microbiome benefits
- The caffeine content—as both caffeinated and decaffeinated yielded the same gut microbiome benefits
You can read the paper itself in full for here:
Want to enjoy coffee, but not keen on the effects of caffeine or the taste of decaffeinated?
Taking l-theanine alongside coffee flattens the curve of caffeine metabolism, and means one can get the benefits without unwanted jitteriness:
Enjoy!
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Dates vs Figs – Which is Healthier?
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Our Verdict
When comparing dates to figs, we picked the dates.
Why?
Dates are higher in sugar, but also have a lower glycemic index than figs, which makes the sugar content much healthier. On the flipside, figs do have around 3x more fiber.
So far, so balanced.
When it comes to micronutrients though, dates take the prize much more clearly.
Dates have slightly more of most vitamins, and a lot more of most minerals.
In particular, dates are several times higher in copper, iron, magnesium, manganese, phosphorus, selenium, and zinc.
As for other phytochemical benefits going on:
- both are good against diabetes for reasons beyond the macros
- both have anti-inflammatory properties
- dates have anticancer properties
- dates have kidney-protecting properties
So in this last case, another win for dates.
Both are still great though, so do enjoy both!
Want to learn more?
You might like to read:
Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Pelvic Floor Exercises (Not Kegels!) To Prevent Urinary Incontinence
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It’s a common threat, and if you think it couldn’t happen to you, then well, just wait. Happily, Dr. Christine Pieton, PT, DPT, a sport & women’s health physical therapist, has advice:
On the ball!
Or rather, we’re going to be doing ball-squeezing here, if you’ll pardon the expression. You will need a soccer-ball sized ball to squeeze.
Ball-squeeze breathing: lie on your back, ball between your knees, and inhale deeply, expanding your torso. Exhale, pressing your knees into the ball, engaging your abdominal muscles from lower to upper. Try to keep your spine long and avoid your pelvis tucking under during the exhalation.
Ball-squeeze bridge: lie on your back, ball between your knees, inhale to prepare, and then exhale, pressing up into a bridge, maintaining a firm pressure on the ball. Inhale as you lower yourself back down.
Ball-squeeze side plank: lie on your side this time, ball between your knees, supporting forearm under your shoulder, as in the video thumbnail. Inhale to prepare, and then exhale, lifting your hip a few inches off the mat. Inhale as you lower yourself back down.
Ball-squeeze bear plank: get on your hands and knees, ball between your thighs. Lengthen your spine, inhale to prepare, and exhale as you bring your knees just a little off the floor. Inhale as you lower yourself back down.
For more details and tips on each of these, plus a visual demonstration, plus an optional part 2 video with more exercises that aren’t ball-squeezes this time, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Psst… A Word To The Wise About UTIs
Take care!
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