The recent quarterly report of actions taken by the state medical license commission noted the license revocation for a doctor under whose care a mother and her twin babies all died from complications of preeclampsia (the same condition that led to the death of Lady Whatshername in Downton Abbey). License numbers are issued sequentially so seeing that his license number is lower than mine, I can assume that his license was first issued well before 1982 when I first became licensed in this state.
Cut to the chase: did his age (60 or more) contribute to the mistakes he made in not preventing this tragedy, or did he just not know what to do (seems unlikely, this not being a rare condition) or was it unavoidable? The commission did not go into details but clearly thought it was time for him to move on.
At a recent meeting, a 64 yr old colleague expressed uncertainty with a chart note, "patient needs TOC for CT." Everyone else in the room knew that it meant Test Of Cure for Chlamdyia Trachomatis, i.e., the patient needs a follow-up test to see if her chlamydia infection was adequately treated. I think this guy focussed on "CT" as in the xray procedure computerized tomography and was trying to figure out why someone need to be retested for an xray.
Does this cognitive inflexibility suggest an aging process, or just an off moment? When I forget a scheduled meeting, I think, is this early dementia? When a younger colleague doesn't show, we say, oh that's just Bob again.
How do I know when it will be time to stop working, time to move on? Hopefully before I tell a woman carrying twins, oh, your blood pressure's a little high, rest more and see me back in a week.
Worried about an after-coming entrapped head, we generally don't recommend breech (butt or feet first) deliveries. The head can be the biggest part of the newborn, and if it gets stuck with legs and trunk already outside, the results can be catastrophic.
Sandy is near term with breech presentation, being seen by a lay midwife (which means a home or other non-hospital delivery). The latter recommended that she see us to discuss possible version (trying to turn the baby around before labor) and/or a CS.
She failed to answer our attempts to call to make an appointment, and when I called the midwife to find out her current status, was informed that Sandy now may be seeing an unlicensed lay midwife known to attempt home breech deliveries. The new lay midwife once had a license, but it was withdrawn after a couple of deliveries with negative outcomes and serious questions about her ability to provide appropriate care.
