He struggled to hear when people talked to him. He asked the same questions over and over. He fell asleep when really important conversations were going on around him.

But it wasn’t until he missed an emergency call that I knew I had to act.

I spoke to a higher-up about this elderly doctor out of concern for patient safety, and for several weeks the guilt tested my dual loyalties — one, to the people in my profession, and two, to my patients.

On one hand, it didn’t feel right throwing another doctor, especially one of color, under the bus. After all, we are few and far between and need to support each other. But on the other hand, I was seriously concerned that his ability to care for patients properly was compromised.

The doctor was a locum tenens, a traveling physician who covers for other colleagues when they go on vacation or maternity leave. Parachuting into a hospital setting is challenging for the most acute-sensed doctor, but for this man, who struggled with electronic medical records, whose hearing aids barely worked, who would write discharge notes for patients I’d already sent home, I’m sure it was worse.

I was a resident. I was supposed to be learning from him. Instead, I felt like I was cleaning up after him, which I had no business trying to do.

The night after I spoke about my concerns, I couldn’t sleep.

“I just feel really bad about what I did,” I explained to my husband. I could feel the tears pooling in my eyes.

I, the resident, was the only doctor who responded to that emergency. The patient was a complicated case, and I was frustrated that the more experienced doctor wasn’t there. My frustration fueled my complaint, but after the adrenaline died down, I wondered, had I done the right thing?

“That’s your snitch guilt,” he replied.

I was looking for reassurance, which I got from some fellow residents, but my husband was right. I didn’t want to do it, but I really felt like patients would suffer.

While the older doctor was working with me, two patients pulled me aside and asked me why was he so rude, why he didn’t listen, and why he was so unprofessional. I didn’t want to undermine this attending physician or the trust that should have developed between him and our patients. I defended him, offering flimsy excuses — maybe his hearing aids weren’t properly adjusted — to convince our patients he was a good doctor, even as I knew these were terrible justifications.

Did his decades of experience matter if he couldn’t communicate well? What if he actually wasn’t a good doctor? I hated being in this position.

I wasn’t the only one — a social worker and another medical student pitched in to try and keep the ship afloat. But we were ancillary and less experienced. This was about authority, but it was also about trust. I didn’t trust him.

This was a complicated situation, but perhaps not uncommon.

In his book, Complications: A Surgeon’s Notes on an Imperfect Science, Dr. Atul Gawande wrote that whether due to age, or substance abuse, or even plain incompetence, “3 to 5 percent of practicing physicians are actually unfit to see patients.” And to further complicate matters, he wrote, the people “in the best position to see how dangerous” these doctors have become, are often in “the worst position to do anything about it.”

So the typically danger looms, until somebody gets hurt.

To be fair, there are plenty of elderly doctors who are really on top of their game — I work with many every day. But could my concerns about this one doctor be part of something that might become more common?

According to the the Federation of State Medical Boards, the number of actively licensed doctors age 70 and older grew from 75,627 in 2010 to 94,969 last year — it’s unclear how many still practice day to day.

What’s challenging is that doctors can’t always tell when their skills are declining. One article described an elderly surgeon who could not find his own office after a day of surgery. Another article in Annals of Surgery told of a surgeon who fell asleep during surgery and another who operated on the wrong side of a patient’s brain.

Some hospitals are considering policies requiring cognitive testing for doctors over a certain age. While this could make a difference, I wonder if these policies are fair? Or perhaps discriminatory?

My guilt was also driven by the idea that I might be negatively impacting someone’s career, that my words carried weight.

In grade school, we complained about an English teacher who seemed to be fixated on one lesson for weeks and weeks. The school didn’t invite her back to teach the following year, and I saw her dressed as an elf at a Santa display at the mall. My words derailed her career.

I wonder what will happen to this elderly doctor — I doubt he’ll be invited back to my hospital, but if he does the same at another hospital, will a patient there get hurt? Either way, my guilt haunts me.

Jennifer Adaeze Okwerekwu is a psychiatry resident and can be reached on Twitter @JenniferAdaeze.  She writes the Off the Charts column in STAT News, where this article originally appeared.

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