If I had $100 for every time I walked into a patient’s room, introduced myself as the doctor, and was immediately asked, “Hey, how old are you?” I might be able to retire right now — at the age of 28. Of course, I am exaggerating, and yet this question echoes for my baby-faced colleagues and me constantly. Whether it’s simple curiosity or blatant reverse-ageism, I find this question erodes trust before it is built. I haven’t yet found an agreeable way to bypass it. I usually just state my age before quickly moving on. Rarely, some congratulate me on my accomplishments given “such a young age.” But these felicitations are like writing in the sand, which quickly wash away in the waves of emotions I begin to feel the moment they ask me that question. Why this question hits too close to home Even though I am the oldest child in my extended family, my traditional Indian (specifically Gujarati) family considers me to be a kid. I keep hitting milestones — 16 to start driving, 18 to start voting, 21 to drink alcohol, 25 to rent a car — but I am still seated at the kids’ table at home. During holidays or celebrations, I often feel left out. Too old to play with the kids and too young to gain entry into adult conversations. I attempt to walk up to a group of aunties and uncles hunched over in a hushed conversation — abridging their conversation, they turn toward me and ask, “Aren’t you getting too old not to be married?” So, I am officially too young and too old at the same time. I commiserate being in age-limbo with my brother, who shares similar sentiments. Nonetheless, there is a deep hurt that comes with never feeling trustworthy enough to hear family secrets. And, as I learned on my psychiatry rotation as a third-year student, I am using the mature coping mechanism of suppression to hide that hurt. Similarly, I start to feel untrustworthy during patient encounters where my age is brought up — no matter how knowledgeably or confidently I began that interaction. When your competency is questioned As new physicians, we are required to start making decisions and to start practicing medicine. Even residents who haven’t had my cultural experiences know the feeling of doubting oneself for even minor decisions. We hold the precious privilege of caring for someone’s life, and mistakes can be grave. Knowing this, we double and triple-check our work. Despite this, patients and colleagues continue to question us. When we are interns, they want the opinions of our seniors. When we are seniors, they want the opinions of our attendings. Even as an attending (my first time as a chief resident), a patient’s wife asked whether there was “someone above me” who could confirm my clinical judgment. Unlike our patients, members of our interdisciplinary team might not blatantly ask our age, but there are undercurrents of skepticism. For example, nurses will look surreptitiously toward the critical care fellow lurking behind the senior resident who is running a code before acting on the resident’s requests. Pharmacists will congratulate interns for finally placing that antibiotic order correctly. We fall victim to the experienced physicians’ “back in my day” comments. How we can grow together There are times when I simply want to reference this article about physician age and patient outcomes — no difference! But, I choose to remember that three years of residency barely surpasses the 10,000-hour rule popularized by Malcolm Gladwell. And I am thankful for the talented and experienced health care providers that surround me. Countless times, an ICU nurse has whispered in my ear about which pressor to start. Pharmacists have alerted me on near-misses and helped me write the correct medication order. Nurse care managers took the time to explain the difference between Medicaid and Medicare. And, experienced physicians have taught me how to hold a patient’s hand and be a guide through the toughest time in his or her life. But, currently, we lack robust evidence about how physician age affects patient outcomes. Thus, we, “young physicians,” will continue to double-check our work, and those around us will wonder if we have done so. Illuminating the lengthy path it takes to become a physician, a colleague jokingly replies, when asked the age question: “Let’s see … four years of college, four years of medical school, and three years of residency, so I’m at least 11 years old.” I pose the following question for our readers: How often, when boarding a plane, do we demand that the cockpit doors be opened so we can inquire about the pilots’ age? We don’t. We trust that they have enough knowledge and experience to competently fly hundreds of people to their destination. Isn’t it time we afford the same trust to all of our physicians, regardless of their age? Sneha Shah is an internal medicine chief resident who blogs at Insights on Residency Training, a part of NEJM Journal Watch Source
