Harold C. Pillsbury III, MD, Thomas J. Dark Distinguished Professor and emeritus chair of otolaryngology/head and neck surgery, University of North Carolina (UNC), and executive director, The Children’s Cochlear Implant Center at UNC, Chapel Hill, said that surgeons need to be honest with themselves and evaluate their comfort level with resolving complications if they arise. “If they are confident and their results have been fabulous, then they should continue operating,” he said. “If not, then they shouldn’t do it.”
Explore this issue:August 2018
“A surgeon must be willing to admit to shortcomings and take steps to mitigate against putting their patients at risk for an untoward outcome,” Dr. Daspit said.
Colleagues Play an Important Role
Colleagues and coworkers are a valuable resource for identifying surgeons who display initial signs of professional deterioration, the ACS says.
Dr. Pillsbury agreed with ACS, noting that colleagues are intimately aware of a surgeon’s limitations in ways that consultants might not be. Noting his belief that mandatory assessments should begin at age 70, Dr. Pillsbury said, “Colleagues should look at what surgeons are doing and talk to them about how they’re faring with patient cases.”
Although Dr. Pillsbury would welcome such an assessment, he doubts that all surgeons would want to oblige. “I think the word ‘mandatory’ may make some surgeons feel as if they are being criticized,” he said. “But individuals in leadership positions have an obligation to protect the public.”
Dr. Babu is also a proponent of having colleagues police their aging colleagues. “They should look at their surgical outcomes,” she said. When studying the question of whether or not neurosurgeons should have a mandatory retirement age, she said she found that the majority of respondents wanted to use case logs and outcomes data to make assessments (Mayo Clin Proc. 2017;92:1746–1752).
Dr. Daspit concurred. “In most surgical specialties, the quality and outcomes of inpatient care [are] the ultimate measure[s] of ongoing competence and safety for surgeons of all ages,” he said. “However, several surgical specialties such as otology are not performed in ways that mistakes can easily be detected. Both are highly technical, and are performed alone under a microscope with limited knowledge of what is transpiring by observers. Bad results usually don’t reveal their occurrence until after the outpatient procedure is completed and the patient has been discharged.”
In addition to identifying problems, colleagues and staff must be able to express concerns to the appropriate committees regarding perceived problems, Dr. Daspit said.