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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Are Brain Chips Safe?
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Ready For Cyborgization?
In yesterday’s newsletter, we asked you for your views on Brain-Computer Interfaces (BCIs), such as the Utah Array and Neuralink’s chips on/in brains that allow direct communication between brains and computers, so that (for example) a paralysed person can use a device to communicate, or manipulate a prosthetic limb or two.
We didn’t get as many votes as usual; it’s possible that yesterday’s newsletter ended up in a lot of spam filters due to repeated use of a word in “extra ______ olive oil” in its main feature!
However, of the answers we did get…
- About 54% said “It’s bad enough that our phones spy on us, without BCI monitoring our thoughts as well!”
- About 23% said “Sounds great in principle, but I don’t think we’re there yet safetywise”
- About 19% said “Sign me up for technological telepathy! I am ready for assimilation”
- One (1) person said “Electrode outside the skull are good; chips on the brain are bad”
But what does the science say?
We’re not there yet safetywise: True or False?
True, in our opinion, when it comes to the latest implants, anyway. While it’s very difficult to prove a negative (it could be that everything goes perfectly in human trials), “extraordinary claims require extraordinary evidence”, and so far this seems to be lacking.
The stage before human trials is usually animal trials, starting with small creatures and working up to non-human primates if appropriate, before finally humans.
- Good news: the latest hot-topic BCI device (Neuralink) was tested on animals!
- Bad news: to say it did not go well would be an understatement
The Gruesome Story of How Neuralink’s Monkeys Actually Died
The above is a Wired article, and we tend to go for more objective sources, however we chose this one because it links to very many objective sources, including an open letter from the Physicians’ Committee for Responsible Medicine, which basically confirms everything in the Wired article. There are lots of links to primary (medical and legal) sources, too.
Electrodes outside the skull are good; chips on/in the brain are bad: True or False?
True or False depending on how they’re done. The Utah Array (an older BCI implant, now 20 years old, though it’s been updated many times since) has had a good safety record, after being used by a few dozen people with paralysis to control devices:
How the Utah Array is advancing BCI science
The Utah Array works on the same general principle as Neuralink, but the mechanics of its implementation are very different:
- The Utah Array involves a tiny bundle of microelectrodes (held together by a rigid structure that looks a bit like a nanoscale hairbrush) put in place by a brain surgeon, and that’s that.
- The Neuralink has a dynamic web of electrodes, implanted by a little robot that acts like a tiny sewing machine to implant many polymer threads, each containing its own a bunch of electrodes.
In theory, the latter is much more advanced. In practice, so far, the former has a much better safety record.
I am right to be a little worried about giving companies access to my brain: True or False?
True or False, depending on the nature of your concern.
For privacy: current BCI devices have quite simple switches operated consciously by the user. So while technically any such device that then runs its data through Bluetooth or WiFi could be hacked, this risk is no greater than using a wireless mouse and/or keyboard, because it has access to about the same amount of information.
For safety: yes, probably there is cause to be worried. Likely the first waves of commercial users of any given BCI device will be severely disabled people who are more likely to waive their rights in the hope of a life-changing assistance device, and likely some of those will suffer if things go wrong.
Which on the one hand, is their gamble to make. And on the other hand, makes rushing to human trials, for companies that do that, a little more predatory.
Take care!
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Pistachios vs Peanuts – Which is Healthier?
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Our Verdict
When comparing pistachios to peanuts, we picked the peanuts.
Why?
The choice might be surprising; after all, peanuts are usually the cheapest and most readily available nuts, popularly associated with calories and not much else. However! This one was super-close, and peanuts won very marginally, as you’ll see.
In terms of macros, pistachios have slightly more fiber and nearly 2x the carbs, while peanuts have slightly more protein and fats. What we all as individuals might prioritize more there is subjective, but this could arguably be considered a tie. About the fiber and carbs: peanuts have the lower glycemic index, but not by much. And about those fats: yes, they are healthy, and the fat breakdown for each is almost identical: pistachios have 53% monounsaturated, 33% polyunsaturated, and 14% saturated, while peanuts have 53% monounsaturated, 34% polyunsaturated, and 14% saturated. Yes, that adds up to 101% in the case of peanuts, but that’s what happens with rounding things to integers. However, the point is clear: both of these nuts have almost identical fats.
In the category of vitamins, pistachios have more of vitamins A, B1, B2, B6, and C, while peanuts have more of vitamins B3, B5, B9, E, and choline, So, a 5:5 tie on vitamins.
When it comes to minerals, pistachios have more calcium, copper, phosphorus, and potassium, while peanuts have more iron, magnesium, manganese, selenium, and zinc. So, a marginal victory for peanuts (and yes, the margins of difference were similar in each case).
Adding up the tie, the other tie, and the marginal victory for peanuts, means a marginal victory for peanuts in total.
A quick note in closing though: this was comparing raw unsalted nuts in both cases, so do take that into account when buying nuts, and at the very least, skip the salted, unless you are deficient in sodium. Or if you’re using them for cooking, then buying salted nuts because they’re usually cheaper is fine; just soak and rinse them to remove the salt.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Eat Better, Feel Better – by Giada de Laurentis
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In yesterday’s edition of 10almonds, we reviewed Dr. Aujla’s “The Doctor’s Kitchen“; today we’re reviewing a different book about healing through food—in this case, with a special focus on maintaining energy and good health as we get older.
De Laurentis may not be a medical doctor, but she is a TV chef, and not only holds a lot of influence, but also has access to a lot of celebrity doctors and such; that’s reflected a lot in her style and approach here.
The recipes are clear and easy to follow; well-illustrated and nicely laid-out.
This cookbook’s style is less “enjoy this hearty dish of rice and beans with these herbs and spices” and more “you can serve your steak salad with white beans and sweet shallot dressing on a bed of organic quinoa if you haven’t already had your day’s serving of grains, of course”.
It’s a little fancier, in short, and more focused on what to cut out, than what to include. On account of that, this could make it a good contrast to yesterday’s book, which had the opposite focus.
She also recommends assorted adjuvant practices; some that are evidence-based, like intermittent fasting and meditation, and some that are not, like extreme detox-dieting, and acupuncture (which has no bearing on gut health).
Bottom line: if you like the idea of eating for good health, and prefer a touch of celebrity lifestyle to your meals, this one’s a good book for you.
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Behavioral Activation Against Depression & Anxiety
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Behavioral Activation Against Depression & Anxiety
Psychologists do love making fancy new names for things.
You thought you were merely “eating your breakfast”, but now it’s “Happiness-Oriented Basic Behavioral Intervention Therapy (HOBBIT)” or something.
This one’s quite simple, so we’ll keep it short for today, but it is one more tool for your toolbox:
What is Behavioral Activation?
Behavioral Activation is about improving our mood (something we can’t directly choose) by changing our behavior (something we usually can directly choose).
An oversimplified (and insufficient, as we will explain, but we’ll use this one to get us started) example would be “whistle a happy tune and you will be happy”.
Behavioral Activation is not a silver bullet
Or if it is, then it’s the kind you have to keep shooting, because one shot is not enough. However, this becomes easier than you might think, because Behavioral Activation works by…
Creating a Positive Feedback Loop
A lot of internal problems in depression and anxiety are created by the fact that necessary and otherwise desirable activities are being written off by the brain as:
- Pointless (depression)
- Dangerous (anxiety)
The inaction that results from these aversions creates a negative feedback loop as one’s life gradually declines (as does one’s energy, and interest in life), or as the outside world seems more and more unwelcoming/scary.
Instead, Behavioral Activation plans activities (usually with the help of a therapist, as depressed/anxious people are not the most inclined to plan activities) that will be:
- attainable
- rewarding
The first part is important, because the maximum of what is “attainable” to a depressed/anxious person can often be quite a small thing. So, small goals are ideal at first.
The second part is important, because there needs to be some way of jump-starting a healthier dopamine cycle. It also has to feel rewarding during/after doing it, not next year, so short term plans are ideal at first.
So, what behavior should we do?
That depends on you. Behavioral Activation calls for keeping track of our activities (bullet-journaling is fine, and there are apps* that can help you, too) and corresponding moods.
*This writer uses the pragmatic Daylio for its nice statistical analyses of bullet-journaling data-points, and the very cute Finch for more keyword-oriented insights and suggestions. Whatever works for you, works for you, though! It could even be paper and pen.
Sometimes the very thought of an activity fills us with dread, but the actual execution of it brings us relief. Bullet-journaling can track that sort of thing, and inform decisions about “what we should do” going forwards.
Want a ready-made brainstorm to jump-start your creativity?
Here’s list of activities suggested by TherapistAid (a resource hub for therapists)
Want to know more?
You might like:
- How To Use Behavioral Activation (guide for end users)
- Treatment Guide: Behavioral Activation (guide for clinicians)
Take care!
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The Diet Compass – by Bas Kast
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Facts about nutrition and health can be hard to memorize. There’s just so much! And often there are so many studies, and while the science is not usually contradictory, pop-science headlines sure can be. What to believe?
Bas Kast brings us a very comprehensive and easily digestible solution.
A science journalist himself, he has gone through the studies so that you don’t have to, and—citing them along the way—draws out the salient points and conclusions.
But, he’s not just handing out directions (though he does that too); he’s arranged and formatted the information in a very readable and logical fashion. Chapter by chapter, we learn the foundations of important principles for “this is better than that” choices in diet.
Most importantly, he lays out for us his “12 simple rules for healthy eating“, and they are indeed as simple as they are well-grounded in good science.
Bottom line: if you want “one easy-reading book” to just tell you how to make decisions about your diet, simply follow those rules and enjoy the benefits… Then this book is exactly that.
Click here to check out The Diet Compass and get your diet on the right track!
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How to Read a Book – by Mortimer J. Adler and Charles Van Doren
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Are you a cover-to-cover person, or a dip-in-and-out person?
Mortimer Adler and Charles van Doren have made a science out of getting the most from reading books.
They help you find what you’re looking for (Maybe you want to find a better understanding of PCOS… maybe you want to find the definition of “heuristics”… maybe you want to find a new business strategy… maybe you want to find a romantic escape… maybe you want to find a deeper appreciation of 19th century poetry, maybe you want to find… etc).
They then help you retain what you read, and make sure that you don’t miss a trick.
Whether you read books so often that optimizing this is of huge value for you, or so rarely that when you do, you want to make it count, this book could make a real difference to your reading experience forever after.
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