Doctors spend a long time training to be doctors. It takes at least 10-15 years to complete our training, which means we are usually in our thirties, at least, by the time we are ready to practise independently. Most of us love being doctors, and continue practising until quite late in life. I often wonder whether this is because we have spent so much time and energy training to be doctors that we don’t know what else to do! It is not uncommon to see doctors practising into their 70s and continuing to love their work. In a profession that advances with astonishing rapidity, it is a challenge to keep up to date with the vast amounts of information we need to know, about diseases, investigations and treatments, which continue to change and grow. So how do we deal with the challenges of being a doctor as we age?
I am 57 now, and have been a doctor for 35 years, and an eye surgeon for over 25 years. Even though my speciality involves a tiny part of the body, the practice of it has changed enormously in my lifetime, and keeping up with best practice is a continuing challenge.
I trained in extracapsular cataract surgery, and the phaco-emulsification technique came in at the end of my training, so I had to learn it in private practice when I was heavily pregnant with my first child.
When I trained, there was no treatment for macular degeneration, which is now one of the fastest-growing areas in our field in terms of treatment and research. Anti-VEGF injections have revolutionised our practice, and our outcomes for people with wet macular degeneration.
We had three drops and a tablet to treat glaucoma and when all else failed, there was trabeculectomy surgery. Now we have a plethora of drops and combination drops, different lasers, minimally invasive glaucoma surgery with tiny stents, and many variations on drainage surgery, with and without implants and anti-metabolites.
Structural corneal disease could be treated with full thickness corneal grafts from a dead donor and that was pretty much it. Now we have all manner of treatments, including laser and various surgical techniques, that offer treatment with increasing sophistication and success.
How do we keep abreast of all these changes so that we can continue to offer our patients best practice based on all the available evidence?
This is one of the reasons why medicine is more a calling than a career. As well as our workloads, we devote a great deal of our time out of paid working hours to reading journals, attending meetings, liaising with colleagues, and keeping up with continuing professional development in all its various forms. It is a vital part of being a good doctor.
We cannot just rest on the laurels of our training, extensive and rigorous as it was, as medicine is always expanding and moving on. If we stay where we are, we will be left behind. We have to be willing to move with medicine as it expands.
One of the things I love about training registrars is that they help to keep me up to date with best and current practice. They are always keen to offer new and exciting ways of treating a problem and a fresh perspective on things that helps to keep my eyes open.
They also keep us honest … we have to truly understand something ourselves to be able to explain it clearly and simply to others! And they keep us fresh and enthusiastic and optimistic about the future of our profession.
As a solo practitioner in the country, registrars have been a key part of me staying connected and up-to-date with the changes in my own profession over the years. I love teaching them and having them around and am very grateful to be part of the training programme.
As I approach 60, I have been reflecting on how I will practise medicine as I grow older, and here are some tips:
How to care for yourself as you are ageing
- Be open to change and growth.
No matter how many years we have lived, we can always be open to new things and to growing with the times and expanding with what is on offer.
If we shut down and try and stay in our comfortable groove, we may not be offering our patients the best service that they deserve.
- Be willing to let things go.
There does come a point where we may have to let things go. If there is another major change in the way we do cataract surgery, or some other procedure, I will have to consider whether I go through the process of learning it, or whether I let it go and refer to one of my younger colleagues.
- Ask for help
If you are not sure what to do, ask for help. Refer to a colleague or a specialist in the field for a second opinion. Don’t just say you don’t know and leave it at that. There may be someone who does know.
- Don’t isolate yourself
This is especially important if you are a solo practitioner, and can be a challenge if you live in a rural or remote area.
Go and spend time with colleagues, socially, at conferences, or go and spend a day with them in their office or operating theatre.
It can be lovely to have company as a solo practitioner, and watching someone else at work and chatting about what they do and why, can help confirm what you do know, and expand your own knowledge and expertise.
- Keep up with continuing professional development
CPD is not a punishment, it is a vital part of being a good and up-to-date doctor. It is also a great opportunity to socialise with colleagues and friends, and to keep up to date formally and informally. Knowing you are abreast of current developments in your field helps to build your confidence that you are offering your patients the best service that you can. And building networks of colleagues helps ensure you are in touch with people who can offer support if you or your patients need it.
- Allow yourself to wind down
It may be that you are not ready to retire yet, but you are starting to feel tired and perhaps a little burnt out.
Allow yourself to wind down, to work shorter days, fewer days each week, take longer holidays, so that the transition to retirement is a gradual and gentle one, and you have time to build a life outside of medicine with friends and activities so that you have some purpose in life outside of medicine when you finally do retire!
- Be honest when the time has come
The day will come when it is time to retire. It may be precipitated by ill health in yourself or a loved one, or you may just know that you have had enough.
Be honest when that day comes. Don’t push past it – that will hurt you and your family and your patients.
Surrender to the knowing that you have had a long and rewarding career and the time has come for it to end.
Celebrate all that you have offered your community, your family, and how much you have enjoyed the practice of this noble profession.
- Appreciate yourself, just as you are
It can be challenging, growing older. Where once we may have been the one that others looked up to, and turned to for advice and help, we may now be seen as being ‘past it’ and no longer as relevant or important. It is vital that we appreciate ourselves, just as we are, so that we are not so invested in being appreciated by others for what we do.
- Let go, but don’t let yourself go
Take care of yourself physically, mentally, emotionally. Your body has to carry you through your entire life … take care of it! And consider opening up to the greater dimensions of your being, and of life, and exploring them, now that you have time and space to do so.
- Enjoy being an elder
Enjoy being an elder in the community and being able to speak and act freely.
Now that you cannot be censured, deregistered or otherwise disciplined as a doctor, make the most of it!
Speak out against social injustice. Speak up about the need for reform in the medical profession and society in general.
Be an advocate for people, using your lived wisdom, power and authority to speak for them when they are unable or unwilling to speak for themselves.
Write your life story, or articles for this website. Reflect on all you have learned in life and share it with all of us.
Retirement can be a very active phase of life – enjoy it!
We can grow old gracefully. Ageing does not have to be something to be shunned or feared or avoided by artificial means. It is happening to all of us, every day. The key is how we do it, whether we surrender to the process and allow ourselves to be supported as we grow older, or whether we fight it all the way. When we surrender, they are just years, numbers, for we are forever young in our hearts, if we stay open to life and love. And ageing brings with it an enormous amount of lived wisdom, for us to share with the world.