World’s oldest practicing physician reflects on the changes he’s witnessed over the course of his long career.
When Medical Economics began planning our 100th anniversary celebration last year, we were thrilled to discover that we had a 100-year-old practicing physician—the world’s oldest, according to the Guinness Book of World Records—in our own backyard: Howard Tucker, M.D.
Born in July 1922 in Cleveland, Ohio, Tucker obtained undergraduate and medical degrees from Ohio State University. After training in neurology at Columbia University in New York, he returned to Cleveland to practice in the early 1950s. He continued until November 2022, when the hospital where he worked stopped offering in-patient services. Now he’s looking for another job.
In recent years, with the help of his grandson Austin, Tucker has become something of a social media star. More than 31 million people have viewed his posts on TikTok, while 13 million have seen his reels on Facebook and Instagram. Meanwhile Austin is collaborating with family friend Taylor Taglianetti on a documentary about Tucker’s life and career that’s scheduled for release in the fall of 2023.
In December 2022, Medical Economics visited Tucker at his spacious home in Cleveland Heights to talk about how medical practice has changed over the course of his long career. Austin Tucker attended the interview via speakerphone. The interview transcript has been edited for length and clarity.
ME: You started practicing in 1947?
HT: I finished medical school in ’47 and began an internship then.
ME: So what year did you actually start practicing?
HT: Well, for my training I went to the Cleveland Clinic for two years, and I was lucky. They told me, “You are capable of learning more than we can teach you. You should apply to the Neurological Institute of New York.”
So I spent a couple years there. Then I went into the Navy. I was made chief of neurology for the Atlantic fleet. So it was like a training service. I was doing clinical rounds, attending conferences, learning from professors at Temple [University], Jefferson, [Thomas Jefferson Research University] and the University of Pennsylvania. I couldn’t have asked for anything better.
ME: How old were you then?
HT: About 30
ME: That’s a pretty high-ranking position to have at such a young age.
HT: I was very lucky. Then I went back to New York and was a Research Fellow. I could’ve stayed at Columbia, but I thought, “My parents are in Cleveland. I know Cleveland.” So I came to Western Reserve Medical School. Then I went into private practice for a while, where I was chief at Hillcrest [Hospital] for about 20 years. Then I joined the Cleveland Clinic.
I left there, but I couldn’t stay at home. I wanted to work with patients. So I got a job at St. Vincent’s [St. Vincent Charity Medical Center]. I was about 93 years old and they took me, until they closed November 15 . And now I’m looking for another job.
ME: What led you to pursue a career in medicine?
HT: I think I always felt I’d become a professional man rather than a businessman. And medicine seemed a place where you could get a lot of gratification from treating patients.
ME: Was there anything about neurology in particular that attracted you?
HT: It’s a fascinating branch of medicine. Particularly in the old days. Now you have CT scans and MRIs. And some of the intrigue and challenges we had is gone.
I remember a patient who was being treated [for a neurological problem] in another city. They told her she didn’t have multiple sclerosis. And the Cleveland Clinic said she didn’t have it. But I thought there couldn’t be any other diagnosis. Her MRI was normal, and 95% of patients with MS have an abnormal MRI. I kept explaining to her insurance company that somebody has to make up that other 5%. But they said she doesn’t have MS and we’re not going to pay for any medicine.
A year later I ordered a wheelchair for her. And the same insurance company said we’re not going to pay for a wheelchair because she has MS and pretty soon she wouldn’t be able to use it. So I suggested that she tell them she was going to call the state commission on insurance. As soon as they heard that they allowed me to treat her. And she’s done spectacularly well. And her response makes me feel I was right. So that’s gratification.
ME: What have been the biggest changes in medicine, and medical practice, since you started in the profession?
MT: The development of sulfas, then penicillin. I can remember one of my professors at Ohio State saying, “This is the end of infectious diseases.” And of course since then it’s become a specialty. And it’s a busy specialty and a complicated one.
ME: What else?
HT: Antibiotics. They treat so many things. Cigarette smoking. Doctors used to urge patients to light up. They said it’ll help quiet your nerves and curb your appetite. And they’d say it with a cigarette dangling from their mouth.
Then when I was in third year of medical school Alton Ochsner from the Ochsner Clinic in New Orleans came and gave a talk. Before my generation women didn’t smoke. And Ochsner came and showed how until that time lung disease was considered a disease of men. And he showed the incidence of women smoking and the incidence of lung cancer in women. They paralleled. So I was convinced this was not going to be good.
ME: I think it’s one of the great public health accomplishments in our history to convince people to stop smoking
ME: I’m glad to say it’s one vice I never took up.
HT: Do you drink at all?
ME: Very little.
HT: Me neither, but I love my martinis. Do you know of Dorothy Parker? She belonged to the Algonquin Club. She came in with a poem one day:
“I like to have a martini,
two at the very most.
After three I’m under the table.
After four I’m under my host.”
ME: That's very funny.
I know primary care isn’t your field, but presumably you get referrals from primary care doctors. Have you observed any changes in that field?
HT: Yes, I have. In the old days medicine was collegial. Doctors would sit in the lounge and chat. Now that’s gone. Doctors are too concerned about volume. When I call them about one of their patients I can tell they don’t want to hear about it. They want to do volume.
ME: Have your patients changed in terms of their expectations of you or their attitudes toward medicine?
HT: There’s less respect for the physician than there used to be. But doctors have contributed to that too. Some of them wear t-shirts to see patients. I always felt the bow tie I wear and shirts were important.
ME: When you were working did you try to keep to a regular schedule in your work and your life?
HT: I did. I used to make rounds at five in the morning. It’s the best time.
ME: Were patients awake?
HT: That’s not the important thing. You look at their chart. You see all the lab work. The nurse will tell you the meat and potatoes information, but they want to get off duty so they’re not going to talk too much. And the few other doctors who make rounds, they talk in monosyllables and short sentences. They want to finish their rounds and get to their offices. And the patients didn’t complain about the nurses at that hour of the morning.So it’s a wonderfully efficient time to make rounds.
In the early days I’d have up to 35 patients in the hospital, so morning rounds were pretty full. Then I always made it a point to come home because the kids were little and I could read to them at bed time. Then I’d go back to the hospital to finish rounds until 10 or 11 p.m.
ME: 5 a.m. to 11 p.m. is a long day.
HT: Yeah, but I guess I had good energy levels.
ME: Has it been difficult keeping up with new technologies? Do you use an electronic health record?
HT: I do. Many doctors quit when they were challenged by their electronics, but I decided I couldn’t do that. I had to master it. My grandson helps me with it and slowly I learned more and more.
ME: What publications do you read?
HT: I always get the Journal of Neurology. In the old days I’d read the New England Journal of Medicine, Journal of the American Medical Association, a lot of internal medicine publications, because they may have articles relevant to neurology.
ME: As you look back on your career are there any cases that particularly stand out in your memory?
HT: The first one is the sleeping beauties. It was a three-year-old who first came to the hospital because she had swallowed hair tonic. The doctors called the pharmaceutical house. They told them it was just mineral oil, like what you put on your hair. So they sent her home.
But then she became comatose so her family brought her back. And this continued on and off. Then it started happening to her sister. The mother would sit in the room with them with her rosary beads, praying.
And the pediatrician called me and said, “I’m seeing something and I don’t know what it is.” Well, I didn’t either. So finally I decided to send her to Columbia. By this time, it was international news. It made the cover of Life or Time, I forget which.
Anyhow, they couldn’t make a diagnosis. They presented her to the chiefs of neurology, internal medicine, and pediatrics. And after all that she came back (to Cleveland) without a diagnosis. And a friend of mine and I went back to basics. We knew if you see a comatose patient with no lateralizing sign, and you did a spinal tap, and it’s coma with normal spinal fluid it’s either drug intoxication or diabetic coma.
Well, she didn’t have diabetic coma. So we decided it had to be drugs, because nothing else fit. So we set a trap for the mother. We took blood from the child before visiting hour and after visiting hour. And it came back positive. So the mother was doing all this.
ME: What was the mother giving her?
HT: A drug called litocit. It’s a barbiturate. She worked in a drug store and had access to it.
ME: Why did you get a law degree?
HT: The first time I became an expert witness was to show a jury an EEG. The plaintiff’s attorney said it would take 10 minutes. I wasn’t supposed to give an opinion, just read the EEG to them.
Well, one of the finest defense lawyers was cross examining me and it took all day. But this man never asked me what I thought was the critical question in the case. And I thought, “I could do this.”
So I went to law school. And when they found out I was a physician with an active practice they never bothered me for daily recitations. I took my midterms and finals, and that’s all they expected of me. I was 67 when I passed the bar. After that I started getting more cases because the lawyers liked the way I testified. And I enjoyed it.
ME: Did you ever encounter concerns about your age from colleagues or patients?
HT: Colleagues no, because they hear me talk and know I haven’t lost it. But my referral base disappeared because of retirements and deaths.
As for patients, I’ve always told residents, “Don’t be upset when you get into practice and a patient says, “Do you mind if I see a doctor who’s a little older?’” Because before long you’ll hear, “Do you mind if I get a second opinion from someone a little younger who’s up on the latest things?”
ME: As I’m sure you know, burnout is a big problem in medicine now. Have you ever felt symptoms of it?
ME: Why do you think you haven’t?
HT: I continue to be intrigued, and enjoy the cerebral excitement of figuring out a problem. And I enjoy talking to patients.
ME: How, if at all, do you think doctors entering medicine today differed from you and your cohorts when you were starting practice?
HT: They’re more likely to get jobs not in private practice, but with a hospital system. And they don’t expect to become millionaires because they know they’re going to work on a salary.
ME: Do you think they’re as committed to patients as you and your colleagues were?
HT: Well, they can’t follow them as closely. There are doctors who stay out of the hospital, and those who stay in the hospital. And they don’t cross the divide. And I can’t understand it. It takes so much fun out of being a doctor to just be in the office all the time.
Your personal doctor may not see you at all when you’re in the hospital. Sometimes you won’t see a doctor at all. You’re seen by a PA or NP. They’re the ones who take care of you.
ME: When you were working, what kind of hobbies, activities did you do outside of work?
HT: Jogging. Spending time with family. Reading.
ME: Looking back on your career, would you have done anything differently?
ME: Do you have any advice for doctors starting out today?
HT: Just to be enthusiastic and dedicated to studying. And be cordial. Make eye-to-eye contact with your patients. Many doctors now will sit at the computer typing, ask the patient a question and return to looking at the computer. I don’t think that’s right.
Cleveland Clinic once sent me to take a course on how to speak to patients so I could teach it to other doctors. The course consisted of things like, “Knock on the door before you walk in, say hi, shake their hand.”
ME: You need a course to learn that? It seems like common courtesy.
HT: That’s exactly right. But that’s what they had to teach, because some people aren’t cordial. Some doctors are anxious when talking to patients. And I said then and I say now, you’re either comfortable talking to people or you’re not.
ME: Why is looking in the eye important?
HT: Because it gives the patient confidence and creates a sense of intimacy. They recognize they have a relationship with you. But when doctors just sit there and type into the computer it doesn’t lead to confidence, or cordiality. And it’s disrespectful.
ME: It seems like you’re everywhere now on social media
HT: I can’t believe it! I can’t understand how I’m that newsworthy. But I know it’s been published in Vietnam, Ireland, France, all over the U.S. I don’t get it.
Austin Tucker: It’s been fascinating to see how much the younger generation is inspired by him and wanting to hear more about what he’s seen over the years and how he still has this sense of motivation and his desire to continue learning.
ME: Do you use any platforms besides TikTok?
AT: Yeah, he’s gotten a few millions on Instagram and Facebook. The social media aspect was never supposed to be this big. We wanted to tell the story mainly through the documentary. TikTok was supposed to be like the behind-the-scenes footageAnd it’s really taken on a life of its own.
ME: Thank you for your time. It was a pleasure meeting you.
HT: Thank you. I enjoyed it.