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.

“Fart walks” have become a cultural phenomenon, after a woman named Mairlyn Smith posted online a now-viral video about how she and her husband go on walks about 60 minutes after dinner and release their gas.

Smith, known on TikTok as @mairlynthequeenoffibre and @mairlynsmith on Instagram, has since appeared on myriad TV and press interviews extolling the benefits of a fart walk. Countless TikTok and Instagram users and have now shared their own experiences of feeling better after taking up the #fartwalk habit.

So what’s the evidence behind the fart walk? And what’s the best way to do it?

Exercise can help get the gas out

We know exercise can help relieve bloating by getting gas moving and out of our bodies.

Researchers from Barcelona, Spain in 2006 asked eight patients complaining of bloating, seven of whom had irritable bowel syndrome, to avoid “gassy” foods such as beans for two days and to fast for eight hours before their study.

Each patient was asked to sit in an armchair, in order to avoid any effects of body position on the movement of gas. Gas was pumped directly into their small bowel via a thin plastic tube that went down their mouth, and the gas expelled from the body was collected into a bag via a tube placed in the rectum. This way, the researchers could determine how much gas was retained in the gut.

The patients were then asked to pedal on a modified exercise bike while remaining seated in their armchairs.

The researchers found that much less gas was retained in the patients’ gut when they exercised. They determined exercise probably helped the movement and release of intestinal gas.

Walking may have another bonus; it may trigger a nerve reflex that helps propel foods and gas contents through the gut.

Walking can also increase internal abdominal pressure as you use your abdominal muscles to stay upright and balance as you walk. This pressure on the colon helps to push intestinal gas out.

Proper fart walk technique

One study from Iran studied the effects of walking in 94 individuals with bloating.

They asked participants to carry out ten to 15 minutes of slow walking (about 1,000 steps) after eating lunch and dinner. They filled out gut symptom questionnaires before starting the program and again at the end of the four week program.

The researchers found walking after meals resulted in improvements to gut symptoms such as belching, farting, bloating and abdominal discomfort.

Now for the crucial part: in the Iranian study, there was a particular way in which participants were advised to walk. They were asked to clasp hands together behind their back and to flex their neck forward.

The clasped hands posture leads to more internal abdominal pressure and therefore more gentle squeezing out of gas from the colon. The flexed neck posture decreases the swallowing of air during walking.

This therefore is the proper fart walk technique, based on science.

What about constipation?

A fart walk can help with constipation.

One study involved middle aged inactive patients with chronic constipation, who did a 12 week program of brisk walking at least 30 minutes a day – combined with 11 minutes of strength and flexibility exercises.

This program, the researchers found, improved constipation symptoms through reduced straining, less hard stools and more complete evacuation.

It also appears that the more you walk the better the benefits for gut symptoms.

In patients with irritable bowel syndrome, one study increasing the daily step count to 9,500 steps from 4,000 steps led to a 50% reduction in the severity of their symptoms.

And just 30 minutes of a fart walk has been shown to improve blood sugar levels after eating.

What if I can’t get outside the house?

If getting outside the house after dinner is impossible, could you try walking slowly on a treadmill or around the house for 1,000 steps?

If not, perhaps you could borrow an idea from the Barcelona research: sit back in an armchair and pedal using a modified exercise bike. Any type of exercise is better than none.

Whatever you do, don’t be a couch potato! Research has found more leisure screen time is linked to a greater risk of developing gut diseases.

We also know physical inactivity during leisure time and eating irregular meals are linked to a higher risk of abdominal pain, bloating and altered bowel motions.

Try the fart walk today

It may not be for everyone but this simple physical activity does have good evidence behind it. A fart walk can improve common symptoms such as bloating, abdominal discomfort and constipation.

It can even help lower blood sugar levels after eating.

Will you be trying a fart walk today?

Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.