Deciding when to stop performing surgery can be tough for many physicians. Some have difficulty stepping down even when they’ve experienced signs that they should stop operating. Richard A. Chole, MD, PhD, professor in the department of otolaryngology at Washington University School of Medicine, St. Louis, Mo., said it’s time to put down your scalpel if you have mental challenges that cause forgetfulness or result in you getting things mixed up. “It’s well documented that individuals don’t have great insight into their deteriorating cognitive abilities,” he said. “Many don’t realize what’s occurring.”
Explore this issue:August 2018
Another confounding factor in the aging physician is the deterioration of situational awareness, decreasing their ability to quickly make decisions during surgery. “If something isn’t going as they anticipated, surgeons might have to make decisions on the fly,” Dr. Chole said.
Otolaryngologists perform many elective surgeries that require complex decision making. “They rely on their judgment in advising patients on whether or not to have a surgery and the type of surgery; it’s not as black and white as doing a surgery to fix a broken bone,” Dr. Chole said. “Providing guidance on when to have a surgery can be difficult and demanding for surgeons because data changes yearly regarding certain types of surgeries and when they should be performed.”
Some physical problems that impair a surgeon’s prowess include hand tremors; diminished ability to stand for a long period of time due to knee, ankle, or leg problems; impaired dexterity due to arthritis; loss of the ability to use a microscope because bending over results in neck and back problems; and declines in vision, said Maya Babu, MD, MBA, a neurosurgeon in Miami, Fla., who contributed to a position paper published by the American College of Surgeons about aging surgeons.
Other potential warning signs, according to ACS’ paper, include unusual tardiness, evidence of poor clinical judgment, major changes in referral patterns, unexplained absences, confusion, change in personality, disruptiveness, drastic change in appearance, and unusually late and incoherent documentation.
In addition to their declining abilities, some may argue that older surgeons are less familiar with newer technologies. “I don’t know of any data that says that’s true,” Dr. Chole said. “I don’t think that’s the case in an academic environment because older surgeons are constantly exposed to trainees and younger doctors, who create an environment that leads to the adoption of newer technologies, but it’s possible and worthy of study.”