Stop cutting

Published March 17, 2019, 12:41 AM

by Charissa Luci-Atienza & Bernie Cahiles-Magkilat

IF SYMPTOMS PERSIST

By DR. JOSE PUJALTE JR.

“Bear with my weakness. My old brain is troubled. Be not disturbed with my infirmity.”
– William Shakespeare (1564-1616) English playwright and poet, “The Tempest” (1610-1611)

Dr. Jose Pujalte Jr.
Dr. Jose Pujalte Jr.

Surgeons are your typical alpha males (or females). The bravura is demonstrated mostly in the operating room where he/she is expected to call the shots and own up to mistakes – sometimes even by those in the surgical team. But for the most part though, the technical prowess combined with nerves of steel and a sense of mission results in a good, reliable surgeon. The long years of training and practice almost always pays off.  The skills are honed, the hands become perfect extensions of a thinking, analyzing brain. This cerebro-manual activity peaks and in time, however, slowly begins to deteriorate.

When is it time to stop operating? Paula Span, writing last month in the New York Times, said that some US hospitals have required screening of their medical professionals over 70 – this, of course, includes surgeons. She writes about an 80-year-old vascular surgeon who on board a plane, saw an “older-looking captain.” The surgeon thought, “I hope this guy’s still OK,” at which point “it hit me like a hammer — this is what other people think when they look at me.” In the US, the mandatory retirement age for airline pilots is 65. Even their FBI agents must retire at 57. Our own policemen’s (Philippine National Police) mandatory retirement age is 60 or 35 years of service, which ever comes later.

Aging Surgeon Program. At Sinai Hospital in Baltimore, Maryland, an aging surgeon program exists because “safeguards are needed to not only protect patients from unsafe surgeons, but to protect surgeons and hospitals from liability risks.” So, they developed a “comprehensive, multidisciplinary, objective, and confidential evaluation of physical and cognitive function of surgeons.”  The briefer further mentions only US Supreme Court justices, the Pope, and surgeons have no mandatory retirement age (!).

Counterview. Paula Span writes in the same article, “Whether older surgeons have poorer outcomes than younger ones also remain debatable, because decades of experience and judgment can compensate for modest physical or cognitive declines.” Indeed, in a records review of 900,000 US Medicare patients, there was lower mortality in operations done by older surgeons compared to younger ones. According to the American Medical Association (AMA), almost one fourth of practicing physicians in the US are over 65. In 2017, more than 122,000 of them still engaged in patient care. My father (an orthopedic surgeon), stopped cutting at 85. But even then, he would have brandished that scalpel if he wanted to – his hands didn’t shake, his vision remained sharp, his strength did not waver. He just knew he wanted to stop – just like a champion boxer who was undefeated. I also remember how he was assisting his mentor, Dr. Benjamin V. Tamesis – with sadness and pity. Dr. Tamesis was already dying of prostatic cancer, had a Foley catheter on – and he was still operating! But I understand Dr. Tamesis: it was like asking a chef to stop cooking or an artist to stop painting. Something dies when you stop doing what you love most.

My Advice to Aging Surgeons. If you have early Parkinson’s or Alzheimer’s: stop now. Quit while you’re not yet a danger to patients or an embarrassment to yourself and your colleagues. You can continue to attend hospital conferences and be the senior surgeon to teach, guide in research, and do other worthwhile non-surgical activities. You will remain a respected member of the faculty or the department. Do not wait to be reprimanded or banned from the operating theatre outright. No matter how invincible you still feel, get good surgical fellows or residents to assist you. As for Sinai Hospital’s aging surgeon program, it is now thankfully on its fifth year and has screened a grand total of eight surgeons.

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