Wednesday, May 23, 2007

Time to Stop "Cutting & Suturing"?

There was an article in USA Today recently highlighting the increasing problem of older drivers. It is not something most of like to think about. I do not like even being without my car for a day while it is being serviced. It is difficult to think about giving up the freedom and independance and self-reliance that comes from being able to drive. But that's the real point, isn't it? Being able.

As difficult as that is to fathom, I find it as difficult, maybe more, to imagine not being able to operate. Yet for me, patient safety is the major issue. Patient safety is first. Not my ego, not my self-worth as defined by my profession. Still, I am human and those things do raise their heads when making choices, don't they? So when is the right time for a surgeon to call it quits?

Harvey Cushing, MD wrote this:

  • Why not put the surgical age of retirement for the attending surgeon at sixty and the physician at sixty-three or sixty-five, as you think best? I have an idea that the surgeon’s fingers are apt to get a little stiff and thus make him less competent before the physicians cerebral vessels do. However, as I told you, I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work. Then, of course, many of us may get vascularly speaking, a little inelastic well on this side of sixty, or may remain in this respect as youthful at seventy as are others at fifty. This is all a lottery of inheritance and habits, and I shall be very glad, for one, to have legislated to stop active work at sixty.»Letter to Dr. Henry Christian, November 20, 1911.


Robert M. Goldwyn, M.D wrote the following in an Editorial published in JPRS [Volume 114(1)July 2004pp 256-257 ]:

  • I once asked a friend of the family, an ophthalmologist in his 80s who had retired, how one decides to stop operating. He said simply, You will know it if you listen to yourself. And that is the key. Listen to yourself. The decision is ultimately yours to make. One should not be afraid to do something for oneself. It is hard to accept that fact because for decades our role as physician has been to exert ourselves for others even though, of course, we benefit. Retirement, furthermore, does not mean the end of being altruistic. There are many opportunities to make the world a better place and not just for oneself or one's family.
  • Another fact, unpleasant to mention, is that some surgeons, as they age, lose their manual skills, their surgical judgment, and their will to learn new things, to keep up with the times. When an opera singer is over the hill, it is apparent to everyone. A surgeon can hide it longer, even though the patient may be the first to experience the consequences of that surgeon's diminishing skills; nurses and colleagues may know it but fear telling the surgeon, although they may stop sending patients and family to him or her. Remember: a tenor who sings off-key harms nobody but not so the surgeon who functions suboptimally.

  • My former chief, Dr. Francis D. Moore, once remarked: Nobody over 70 should be sticking a knife into anybody else. While one might disagree with the specific age, it does make a point (no pun intended). Furthermore, there are some surgeons who should have stopped many years before they ever reached 70.

So just like I hope I give up my car keys before becoming one of those elderly driver/accident statics, I hope I give up my scapel before I harm anyone. I hope I will know when that time comes.

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