Knowing — or not knowing — when to stop: cognitive decline in ageing doctors

To the Editor: Adler and Constantinou raised a concern about the ageing doctor1 that also worried me when I was practising as an anaesthetist. The same concern was raised recently in the Australian and New Zealand College of Anaesthetists Bulletin.2 In anaesthesia, decisions and actions have to be made in seconds and minutes, rather than days and weeks, and maintenance of standards is very important. Doctors practise largely in isolation, and may not be aware of their standard failing against the general standard. Operating theatres offer both an opportunity to observe the practice of others and a conduit for information on colleagues — nursing and medical.

I used this opportunity in private and public practice by asking younger colleagues, one in each, to be my “buddy”, as in diving safety. They were asked to keep watch for any rumour of my declining standards and to report it to me. We would then discuss what to do: retrain or retire. The latter became more of an option the older I grew.

This strategy opened up pathways. One was that the buddy was given the authority to approach me on the topic. Another was that I was open to the idea that my ability could diminish, while a third was that the hostility, so often seen in this setting, was abolished. I would rather be tapped on the shoulder by a sympathetic colleague than a medical board, a hostile coroner or a vindictive prosecution lawyer.

In the end, there was no tap on the shoulder, and I went because I had had an enjoyable and rewarding career and could afford to retire. This allowed succession planning in both areas, public and private, and a younger colleague could embark on a similar path.