How to tell an older surgeon: It's time to give up the scalpel.

Observers say regulatory standards are needed

Addressing a surgeon whose clinical skills are perceived to be declining—and potentially putting patients at risk—is a delicate subject matter. Here's how to carefully approach the conversation, Medscape's Gordon Sun explains.

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Medscape's story was sparked by an OR nurse who asked for advice on how to approach a 75-year-old surgeon who she believed was no longer at his clinical best and could compromise patient care. According to Carolyn Buppert, an NP and health care attorney, the nurse should:

  • First discuss her concerns with the surgeon in a "gentle, non-confrontational manner" and use specific examples to illustrate her point;
  • Recruit a peer of the surgeon's to "observe and pass judgment" and speak with nursing administrators or the chief of surgery; and
  • Avoid contacting the state medical board until all other possibilities have been tried. (Buppert says contacting the board prematurely could put the nurse in a "no-win" situation if no other clinician could corroborate her observations.)

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But not everyone agrees with Buppert; Medscape received 250 responses from readers who had their own advice on how to deal with the issue. Common themes included:

  • Regulatory standards are needed: Some readers called for regulatory guidelines that approach the issue of aging surgeons—which don't currently exist, but are increasingly in demand by members of the field. (For instance, attendees at the American Medical Association Senior Physicians Section debated this at their 2014 meeting.) One active surgeon with 40 years of clinical experience told Medscape that the World Health Organization or a similar group must come up with guidelines to protect the patient and to "save aging surgeons from embarrassment, continue to utilize their expertise, and be morally correct."
  • Create best practices for whom in the "chain of command" should address the issue: Many Medscape readers suggested implementing best practices for quality assurance protocols regarding the specific personnel.
  • Decide if there needs to be a mandatory age restriction: Readers split over whether it would be fair to implement an age restriction, given that some exist outside of the health care industry in situations where consumer safety is at risk. However, observers say that many hospitals and health systems—including University of Virginia Health System and Stanford University Medical Center—already voluntarily implement periodic screenings for older health care providers.

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  • Determine if age is a stand-alone factor in determining surgeon performance: Several readers said a surgeon's performance should be determined by "objective" measures, like hand tremors, that might not be related to age. Readers also warned that forcing surgeons to retire may lead many doctors—unable or unwilling to deal with life outside the OR—to become bored or depressed.

Sun notes that no reader raised the issue of workforce sustainability, even though the American College of Surgeons reported that there's likely to be a surgeon shortage as older doctors retire and the population grows (Sun, Medscape, 7/21).

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