Some patients find reassurance in gray hair, or so it seems.
Years ago, when I was a sandy-haired faculty member in my mid-30s, I was making hospital rounds with two of our young resident physicians. Although they were both still in training, they each had a full head of very prematurely gray hair. We entered the room and one of the residents began the introductions. “Mr. Smith, This is Dr. Campbell. He is our professor.”
The patient looked back and forth between the gray-haired residents and me.
“Yeah, right!” the man said. “Your professor. Sure. Who is he, really?” At the time, Doogie Howser, MD, was still on television. More than once, I had been told that I looked a bit like the 16-year-old title character. Everybody in the room – but me – had a good laugh.
I knew, of course, that my days of looking too-young-to-be-a-doctor were numbered. I don’t remember when I last heard the comment, but it has been decades since anyone was confused about whether I was old enough to do what I do.
Recently, I have been thinking more about the other end of the career. When is a physician too old to continue?
I recently read an article about Dr. Ferdinand Sauerbruch, an inventor of medical devices and a giant of surgical innovation, that brought the topic into focus for me. Dr. Sauerbruch began his remarkable career after graduating medical school in 1902, developing innovative limb prostheses for World War I soldiers and revolutionizing European surgery. He was a medical leader in Germany, and frequently operated on the rich and famous because of his technical prowess.
Dr. Sauerbruch is also known for his horrific decline. Toward the end of his career, he was forgetful, moody, and technically inept. As he approached his mid-70s in the late 1940s, he was causing immeasurable harm during even simple procedures. Despite being encouraged to retire by colleagues he had trusted when he was younger, he refused to do so. His hospital finally stopped letting him operate in 1948 after a famous actor died during a routine procedure. Amazingly, he continued to perform surgery in his home until his own death in 1951.
Older surgeons are subject to aging issues like everyone else. We experience declining sensory functions, a loss of habitual and controlled analytic memory, and decreased visual-spatial abilities. Despite this, surveys show that many older surgeons do not believe that they are in decline. As Dr. Sauerbruch’s story confirms, aging and an absence of insight are a dangerous combination. Of course, there is enormous variability, but this is why there are mandatory retirement ages for commercial airline pilots at 65, FBI agents at 57, and air traffic controllers at 55. No such requirements exist for physicians.
Before I went to medical school, I worked as a nurse’s aide in a private hospital where some of the doctors had been on the staff for decades. At the time, we viewed the oldest of the physicians as either “cantankerous,” “doddering,” or “harmless.” During my own residency, my fellow trainees and I christened various surgeons cranky, wise, rigid, steady, or timid. In our view, some of the older doctors “still had it” while others did not. Doing the math, I know that a few of those older doctors were younger than I am now.
I recently turned sixty. My sandy hair long ago turned gray. I experience a twinge every time I can’t recall someone’s name or it takes longer than it should to remember where I left a notebook. I understand that my wonderful opportunities to perform and teach surgery will not last forever.
Surgeons hear a lot of great things about themselves from patients and family members. Co-workers, I realize, tend to be positive or to keep quiet. Now that I have read about Dr. Sauerbruch, I am more committed than ever to step aside while I am still safe. I only hope that when my colleagues notice the faintest hint of a decline, they will tell me.
And – equally important – that I will believe them and gracefully pass the mantle to the next generation.