Does your doctor’s age matter? [PODCAST]

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“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.”

Sneha Shah is an internal medicine chief resident who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

She shares her story and discusses her KevinMD article, “Does your doctor’s age matter?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Sneha Shah. She’s an internal medicine chief resident, and she wrote the KevinMD article “Does your doctor’s age matter?” Sneha, welcome to the show.

Sneha Shah: Kevin, thank you so much for having me on. I’m excited to be here with you.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Sneha Shah: Absolutely. So I was born in India and grew up there until I was 12 years old, when my family and I moved to Chicago. I have one brother. Both of us went to Marquette University in Milwaukee, Wisconsin, and then I stayed at the Medical College of Wisconsin for medical school. And then I decided I wanted to be an internal medicine doctor, applied to residencies essentially across the country, and really fell in love with the program here at the University of Colorado. And so that’s where I have been for residency for the last three years, and now I’m a chief resident there in internal medicine. My career plans are to be an academic hospitalist, so currently I’m looking for jobs.

Kevin Pho: All right, well, best wishes with everything. Now, as a chief resident, can you share any tips and advice you have for other house staff, especially during the pandemic?

Sneha Shah: The biggest advice I have for our house staff during the pandemic would be to really work on your wellness: Eat well, sleep well, and connect with family and friends as much as you can. Personally, during the pandemic, I felt a sense of isolation and occasionally felt lonely, and I really relied upon my significant other here in Denver and my co-chief residents, who really helped me feel the best that I can. And so I think personal wellness can feed into your resilience to get through what seems to be now a really prolonged process.

Kevin Pho: All right, so let’s transition into your KevinMD article, “Does your doctor’s age matter?” Now, for those who haven’t read that article, can you just share the story you told and maybe share why you decided to write it?

Sneha Shah: Yeah, absolutely. So the story I tell with this article, “Does your doctor’s age matter?”, was really founded on this idea that essentially throughout many, I would say pretty much 70 to 75, of my interactions with patients, my age was brought up, whether it was for them to compliment me on my successes at such a young age or simply asking my age. And over time, I think this sort of built up into the idea of, are patients doubting my abilities, or are they just genuinely curious?

And I think the point I was trying to get across is, even if it’s genuine, for a young physician to hear that over and over again can erode trust. And so I was encouraging not only patients but our colleagues to be mindful about why you’re asking that question and perhaps clarifying that.

Kevin Pho: And when patients, and maybe your colleagues for that matter, bring up your age, what goes through your mind?

Sneha Shah: I think the first thing that goes through my mind really is a sense of doubt, personal doubt about my abilities. And you may have heard from other younger physicians, especially female physicians, that we quite often feel imposter syndrome, feeling like you don’t belong, that you’re constantly questioned. And so when I get asked my age, those are the feelings that start to develop, and my focus, I think, is somewhat shifted to those feelings, as opposed to really taking care of the patient and putting the patient in the center of the situation. And I think that question tends to bring me into the center, and that’s not where I want to be when I’m taking care of somebody.

Kevin Pho: So when your age is brought up, how do you normally respond?

Sneha Shah: You know, I wrote this in the article, but thus far I tend to tell them my age and try and move on quickly. And I think a few people commented on it, and I’ve had colleagues comment to me about my article and encourage me to add humor into the situation. And so that’s what I’ll try to do, but actually during chief year I haven’t had many patient interactions, so we’ll see what happens once I become an attending.

Kevin Pho: You focus primarily on patients, but has this been an issue with colleagues as well, and perhaps older physicians? Do they ever comment on your age?

Sneha Shah: You know, I think older physicians are the people that have not usually brought up that issue, and I think it’s because they’ve likely gone through a similar situation when they were just becoming physicians. I do write in the article about sort of ancillary staff and our interdisciplinary team, and not that they bring the age up in a very overt sense, but there are some undercurrents of doubt, comments like, “Well, this intern finally put in the antibiotic order correctly.” And sort of emphasizing the word “finally” means they knew that the intern wouldn’t do that and were shocked that they were able to.

And because residency is a time of learning and growth, and you’re doing everything under supervision, I think everyone being conscientious of that and giving our younger physicians the benefit of the doubt, I think, is the side to err on.

Kevin Pho: So what kind of advice do you have for physicians, interns, and residents who face similar challenges when they get asked about their age?

Sneha Shah: First, developing your personal approach to address that question is the main thing, and using the same approach each time, so that you become comfortable in it with repetition. And then secondly, I think being humble is something that I’ve learned is really key, and not to be overconfident, and not to blow up a situation where you may not know the answer.

So what I’ve really found is, confidence means saying that you don’t know when you truly don’t know. And I think patients and your colleagues appreciate that, as opposed to lying or answering in a half-truth or making something up. Just say you don’t know, and I think that will build your confidence regardless of your age. Knowing what you don’t know, I think, really builds your confidence. And that’s the advice I have for younger physicians: Have an approach, find some repetition in how you address the age question, and then say when you don’t know. And I think that’ll help you grow tremendously.

Kevin Pho: We’re talking to Sneha Shah. She’s an internal medicine chief resident, and she wrote the KevinMD article “Does your doctor’s age matter?” Now, you’ve been in an academic program for four years, now as a chief resident. It’s been 20 years since I’ve been in an internal medicine program. Can you share some of the perhaps generational differences, and perhaps the evolution of the younger doctors, that you’ve seen during your three and a half years in the program?

Sneha Shah: I mean, that’s a fantastic question. We were in fact just talking about this among us chief residents here at Colorado. The biggest difference that I see between the generations has to do with, I think, the growth of medical knowledge itself, and just how much more we know about disease processes, how much new information comes out on essentially a monthly basis in internal medicine these days, but definitely every six months to a year, how much medicine changes.

Some of what I find is challenging is our patients are getting more complicated. There’s more information to know, and yet I think that our educational structures, and perhaps even our rounding structures, stem from the times when there wasn’t so much information to know. And I’m trying to figure out how we can bring our day-to-day, sort of logistical activities into the world of new medicine. Do we, with the advent of workstations on wheels, need to just start doing discovery rounds for all of our patients? I know that may be challenging for interns, but really for senior residents and attendings, who can formulate plans and advance treatments in moments with information, it may be the right way to do things. And so that’s what I’ve really been thinking about: How can we change our day-to-day structure in the hospital to match what’s going on with this information and data overload?

Kevin Pho: So you had mentioned mobile workstations. What are some of the other specific changes that you would like to see if you’re in charge of changing rounds?

Sneha Shah: I think one main change that I’ve seen, that we do here at our Rocky Mountain Regional VA, is interdisciplinary rounding. And so we’ll have our pharmacists and our care coordinators round with us, and that has really streamlined the process of communication later in the day. The pharmacist will, in real time, change your medication orders or approve any medications that you order on rounds. And our care coordinators have already rounded with the patient ahead of time, so they’re doing their own pre-rounding and then giving that input on rounds, which I think really expedites the day and taking care of that patient. And I think that’s something that we can incorporate throughout our sites, and I would like to see something happen across the field of internal medicine.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Sneha Shah: I think the take-home message that I would leave with the KevinMD audience is that residents work really hard, and I don’t think they get told thank you enough. And so if you see a resident, regardless of their subspecialty, thank them for their hard work and for being really the frontline providers in all areas of medicine. And so that would be my take.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Sneha Shah: Thanks for your time, Kevin.

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