Guy Maddern, professor of surgery at the University of Adelaide, records the life of a clinical director at St Anywhere. St Anywhere is fictitious, but the events and issues are real:

Every hospital has its senior surgeon, someone who has been part of the institution for almost 40 years and was even a medical student in the hospital during his training. His contribution to the organisation and patients has been unstinting. Everybody admires and respects his service, dedication and skill. The hospital and his patients are his life.

In Australia now there is no retirement age. Government is encouraging us to work longer, but as the clock ticks on, ageing reduces many of the faculties enjoyed by younger colleagues: response to stress, technical abilities, eyesight, the ability to cope with late-night surgery and still function effectively in clinic or the operating theatre the next day.

Steven was no exception. At 66 he showed no sign of wanting to retire from surgical practice. In recent years, some of the more complex cases had been handled by junior colleagues, but still his operating lists rarely finished on time. He no longer wanted to be on the emergency roster, increasing the workload for the remaining surgeons.

No disaster had occurred to any patient, but a sense of foreboding existed about his surgery. For Steven retirement was not an option. But to continue his surgical practice tempted fate. A discussion about pursuing outside interests was futile and finished with considerable resentment.

A solution was needed that used Steven’s talents gainfully, protected patients and offered satisfying work experience. Fortunately Steven possessed insight into the issue and a way forward was devised. Outpatient clinics would be increased, some undergraduate teaching commitments were moved from more junior colleagues and Steven’s surgical experience was harnessed to assist junior consultants in more difficult cases, providing wisdom without the stress of ultimate responsibility. The transfer was achieved quietly and without announcement, providing a valuable resource to the hospital and another four years of satisfying employment and service for a skilled but aging surgeon.

Unfortunately not all surgeons have such insight or wish to follow such a change of their career. Some refuse to be counselled and marshal their union or lawyer to counter such moves. It is very difficult to prove a surgeon is failing to perform adequately. A Head of Unit cannot wait for a clinical disaster to occur to prove the point, but without such events it is almost impossible to prove that change has to happen. Many lifetime friendships have been destroyed as colleagues have sought to encourage cessation of active practice.

We need methods to demonstrate declining technical skills and support efforts to encourage retirement or change duties. Until the dichotomy of working longer and declining physical faculties is resolved, clinical directors and the country will be faced with an almost impossible task of terminating outstanding careers with resentment, anger and disappointment.

View the Diary of a Surgeon archives

Peter Fray

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