ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Age of Surgeons May Raise Ethical Concerns over Memory Lapses

by G. Richard Holt, MD, MSE, MPH, MABE, D BE • August 11, 2015

  • Tweet
  • Email
Print-Friendly Version

Clinical Scenario

Archibald Fitch, MD, is a senior, highly respected, experienced, and innovative head and neck surgeon at your medical center. Tall and lean, with a full head of white hair and a robust disposition, he has a commanding presence. He was the first otolaryngologist in your community to practice the full scope of head and neck oncologic and reconstructive surgery, adding a number of innovations of his own to the field, including several textbooks and a host of journal publications. Beyond those credentials, he is considered a compassionate and meticulous surgeon with keen judgment and discernment, serving as a role model to many in the community and beyond.

You Might Also Like

  • Disruptive Behavior by Patients Raises Ethical Concerns for Otolaryngologists
  • Letters: Surgeons’ Zone of Focus May Not Signal Cognitive Decline
  • Ethical Implications of Burnout in Residents
  • Unprofessional Physician Behavior Raises Discipline Dilemma, Patient Care Concerns
Explore This Issue
August 2015

Dr. Fitch, now in his mid-70s, has continued to practice head and neck surgery and is always willing to give formal or informal counsel when consulted regarding a colleague’s patient. His general health appears good, and he is an avid golfer and tennis player. His attendance at committee meetings and participation in medical center affairs is consistent and admirable. He is very active in several national charities of his passion.

On one hand, he shows no deterioration of dexterity and motor skills. On the other hand, your observations raise the concern that subtle cognitive deterioration might be present that could worsen over an unknown period of time.

Because of his prominence in the medical community, as well as his experience and expertise, there are often observers in his operating rooms, including yourself. On a recent occasion, you stopped by Dr. Fitch’s operating room to observe a few minutes of him performing bilateral modified neck dissections. You were close enough to hear this verbal exchange between Dr. Fitch and the scrub technician:

Dr. Fitch: “Sandra, may I have … uh… you know, that long instrument with the blunt tips that you cut tissue with … it’s a pair of scissors, I just can’t think of its name, right now. But you know what it is.”

Sandra: “Dr. Fitch, are you thinking of the Metzenbaum scissors?”

Dr. Fitch: “Of course, Sandra, thank you. How could I forget that old friend?”

A few minutes later, the same scenario was played out with an automatic clip applier and a Penrose drain. At other times, you noted that Dr. Fitch preferred to find an instrument himself on the instrument tray rather than ask for it. His technical performance of the procedures was flawless, however, and the blood loss was minimal. You were impressed, as usual.

Verification

These brief memory lapses concern you, and you feel you should verify your observations with other colleagues—discreetly. Over coffee in your office, you describe your observations to two fellow otolaryngologists whose opinions—and discretion—you trust. Both colleagues did remember recent incidences when they were either observing or assisting Dr. Fitch and he experienced such memory lapses, but these involved names of medications and names of personnel. Neither had observed any breach of technique or of patient safety.

As chief of otolaryngology-head and neck surgery at the medical center, a position previously held for many years by Dr. Fitch, along with his tenure as chief of the medical staff, you feel a professional obligation to monitor the capabilities of every otolaryngologist in the department. You have, in the past, dealt with issues such as disruptive behavior and other unprofessional activities. In this particular situation, your concerns involve a highly regarded senior surgeon who continues to practice within the standards of technical capability, but with a possible early deterioration of memory.

Again, in confidence, you request a separate meeting with Dr. Fitch’s regular anesthesiologist and his circulating nurse. Both are initially wary of where you might be headed with this line of inquiry, but after you assure them that you are interested only in the welfare of both Dr. Fitch and his patients, they do acknowledge having observed an increasing frequency of memory lapses, although he compensates cleverly using his sense of humor and warm personality. As a model of professional propriety and decorum, Dr. Fitch simply does not get flustered or act inappropriately in the healthcare setting.

You review Dr. Fitch’s medical staff privileges and the letters of recommendation and support for their renewal; there is no evidence of concern being passed on by those endorsing his continued staff privileges. There are no documented complaints about his behavior or interactions with colleagues, staff, or patients. In short, he is what everyone feels he is—a consummate professional. In more than 40 years of surgical practice, he has had no medical liability suits, and there have been no complaints filed with the state medical board.

You feel very conflicted about raising this issue with Dr. Fitch—on one hand, he shows no deterioration of dexterity and motor skills, and his clinical judgment appears intact. On the other hand, your observations and those of others raise the concern that subtle cognitive deterioration might be present that could worsen over an unknown period of time. This surgeon has devoted his professional career to excellence and innovation in patient care, medical education, and community service and, at age 75, continues his dedication to clinical work. You are aware that, over the past several years, there has been increasing national discussion regarding the issue of the “aging surgeon,” a topic previously side-stepped in many regards with respect to a surgeon’s prerogative to decide when is the proper time to retire.


Is it time to initiate this discussion at your medical center, and should you be the one to initiate it? What should you do?

Click here for a discussion of this topic.

Pages: 1 2 | Single Page

Filed Under: Departments, Everyday Ethics, Home Slider Tagged With: EthicsIssue: August 2015

You Might Also Like:

  • Disruptive Behavior by Patients Raises Ethical Concerns for Otolaryngologists
  • Letters: Surgeons’ Zone of Focus May Not Signal Cognitive Decline
  • Ethical Implications of Burnout in Residents
  • Unprofessional Physician Behavior Raises Discipline Dilemma, Patient Care Concerns

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Weaning Patients Off of PPIs
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Did You Receive COVID-19 Relief? Here Are Reporting Considerations for 2021
    • Otolaryngology Experts Share Best Practices in Five Areas
    • How Climate Change May Be Affecting Sleep Patterns for Adults and Children
    • Laryngologists Discuss Tough Tracheostomy Choices During COVID-19 Era
    • Head and Neck Cancer: Experts Discuss How to Improve Surgery Quality and Value

Polls

Did you receive funding from the CARES Act or Paycheck Protection Program?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.