7 ms·

The Problem of the Aging Surgeon (2009)

75 points by JabavuAdams 7y ago

aetherspawn 7y ago
Discussion point: Uni is not the only way to be educated about something. In fact, I have found industry experience to be more effective learning
- dusted 7y ago
  You didn't read the article did you? This is not about experience, it's about getting old enough that you've got lapses in attention no longer are fully aware of what you're doing. It's about being good at A, but times change, and since you're good at A, you're assumed to be good at B too, but you are not. It's about systems evolving around highly esteemed people, that make detecting life-threatening situations hard or impossible.
  - aetherspawn 7y ago
    A large portion of the article mentions specifically that students who graduate uni more recently are educated in more modern surgical techniques .. but the premise assumes the surgeon basically doesn’t learn on the job which I’m not sure is a strong argument
  - gdy 7y ago
    "You didn't read the article did you?" Firstly, don't be an ass. Secondly, the article mentioned many factors, including specifically "quantity of education, remoteness of education", which are arguably are not an issue if an old dog keeps learning new tricks. "When contemplating the effect of age on surgeons, quantity of education, remoteness of education, and obsolescence of the content of the education are all at least theoretical concerns."
  - dang 7y ago
    "Please don't comment on whether someone read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that."" https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
WalterBright 7y ago
Instead of forcing them to retire, perhaps assign them to less demanding surgeries.
- sametmax 7y ago
  Or just much less surgeries, or only in support of newbies. Fatigue and speed of execution seem central.
- zomg 7y ago
  That's not how it works -- most surgeons aren't "assigned" surgeries. They run a practice, focused on a particular disease state, and perform surgeries on their patients to address health issues with respect to that disease state. With that said, the kind of surgery being performed does have an impact on the body of the surgeon in terms of their posture.
  - jdietrich 7y ago
    It can work like that. Here in the UK, we increasingly rely on Surgical Care Practitioners - nurses who can independently perform a specific set of routine surgical procedures. Medicine stands to benefit greatly from the division of labour and economies of scale; a large surgical unit with a diverse range of skillsets can perform more surgeries with better outcomes at lower cost. https://www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/surgical-care-practitioner https://www.healthcareers.nhs.uk/explore-roles/medical-assoc...
    - jessriedel 7y ago
      You seem to be confusing the nature of the doctor-patient relationship (i.e., whether the patient contracts with the doctor or contracts with the hospital who employs a doctor) with the use of surgical assistants (generally a type of physician's assistant). Private practices routinely use PAs in the US to do less demanding procedures, just like the UK. Obviously, the nature of the doctor-patient relationship will influence the degree to which PAs are used -- patients generally want full surgeons, while 3rd party payers like the government want to save costs -- but that doesn't undermine zomg's correction of WalterBright's comment.
bubblewrap 7y ago
"In the end, the study group consisted of 291 patients (330 knees). Younger surgeon age was correlated with fewer complications" There is a danger in such statistics in that for example older surgeons may have been assigned the more difficult cases.
- mft_ 7y ago
  You're right; it's probably a bell-shaped curve.
- melling 7y ago
  Simpson’s Paradox https://www.lesswrong.com/posts/7FJRnxbRtT7Sbzizs/simpson-s-paradox https://www.lesswrong.com/posts/7FJRnxbRtT7Sbzizs/simpson-s-...
js8 7y ago
This is a very difficult problem. Aging is emotionally painful. I think it is insane that in our societies (Western, I am not American) we prolong the age of retirement. I believe it should be 60, tops. And we should have culture that would celebrate moving to retirement, to make sure that people do not feel useless all of sudden. But it is often hard for, especially really good, people to go into retirement, because you still have a (usually wrong) feeling that you can continue as if they were younger, and they see all the young hacks doing the same mistakes.. So if the society could support these people in giving up, I think it would be helpful for everybody. As the Czech saying goes - stop at the best time. We should do that even if it is a small economic loss.
- melling 7y ago
  And spend the next 20-40 years hanging out? Hopefully, over the next couple of decades more people reach a healthy 100. https://www.smithsonianmag.com/smart-news/there-are-more-americans-over-age-100-now-and-they-are-living-longer-180957914/ https://www.smithsonianmag.com/smart-news/there-are-more-ame...
  - sharmi 7y ago
    Some people enjoy retirement. We have a retired army major attending our local python meetup without feel. He learns Python with great enthusiasm. He is now trying to understand cyber security. Having said that, that level of enthusiasm is a rare mindset and signs of indefatigable spirit.
  - jackvalentine 7y ago
    As we said to one of the old guys at work who didn't really want to be there anymore, didn't need the money and just hung around for the routine... Join Rotary and volunteer or something. There are loads of things you can do that would make the world better.
    - melling 7y ago
      ...or you could pick a different/another career: Writer, director, fund manager, ... Warren Buffet is still managing a lot of money at 88. https://en.m.wikipedia.org/wiki/David_McCullough https://en.m.wikipedia.org/wiki/David_McCullough https://en.m.wikipedia.org/wiki/Warren_Buffett https://en.m.wikipedia.org/wiki/Warren_Buffett https://en.m.wikipedia.org/wiki/Carl_Icahn https://en.m.wikipedia.org/wiki/Carl_Icahn https://en.m.wikipedia.org/wiki/Donald_Knuth https://en.m.wikipedia.org/wiki/Donald_Knuth https://en.m.wikipedia.org/wiki/Woody_Allen https://en.m.wikipedia.org/wiki/Woody_Allen https://en.m.wikipedia.org/wiki/Martin_Scorsese https://en.m.wikipedia.org/wiki/Martin_Scorsese https://en.m.wikipedia.org/wiki/Bill_Belichick https://en.m.wikipedia.org/wiki/Bill_Belichick
eternalban 7y ago
"Only wine and cheese improve with age". Fair warning, future fellow robotic workers.. More seriously, the issue of lack of formal training in emerging techniques (note the -40- year olds who have missed the latest hip surgery technique) has nothing to do with 'degraded cognitive abilities due to aging', and really should be discussed in context of a 'continuity of education and certification' regime. It is not an issue of age, rather the time it takes to produce skilled worker in a domain, and the frequency of significant breakthroughs/changes in that domain. [edited]
- magduf 7y ago
  This really disturbs me. Why wouldn't surgeons be constantly retrained on newer surgical techniques? Shouldn't this be standard procedure? Why should any patient have to suffer with the scars and complications from an old-style surgery instead of a newer less-invasive technique just because some surgeon hasn't bothered getting trained on the newer technique?
Ensorceled 7y ago
My father-in-law was an ophthalmic surgeon who "retired" in his 60's. In his case, he had a clear "line in the sand", where his fine motor control became reduced and he could no longer do the kind of delicate work his profession required. This means other surgeons are also compromised but are "getting away with it" and also giving poorer results.
zomg 7y ago
I work in the medical device industry and one major dynamic that's improving surgical capabilities for aging surgeons is the increase in surgical robots. I was in a lab testing a new product on the da Vinci Robot and one of the surgeons commented to me that "this robot will add another 10 years to my career" -- he was probably in his early 60's already! It will be very interesting to see how robotic technology changes surgical outcomes as robotic surgery becomes the standard of care.
- godzillabrennus 7y ago
  Agree. Robotics hasn’t even really penetrated the market for treatment or diagnostics yet. There are many opportunities.
  - swiley 7y ago
    I'm really not sure it will any time soon. I think robot enthusiasts sometimes underestimate what hands attached to a brain full of knowledge really are capable of. There's a problem software developers have to solve if they really want robots to be a full replacement for a human physically performing a task and that's a way for the trained humans to communicate their knowledge to the robot. The problem with this is that most people really aren't great at communicating precisely. They have a hard time teaching each other and are often hopeless when it comes to giving precise and complete instructions for something to a robot. forget complex tasks like surgery even gardening and washing dishes is hard. Even something as simple as "grab the thing" is a pretty big project. Maybe in the future as robots become more common speaking with the level of precision required will also become common (kind of like what happened to culture with the web and email.)
    - philips 7y ago
      I think you are thinking of robotics in the sense of replacing surgeons or being an autonomous partner. While OP is talking of robotics as an assitive tool to help a surgeon make finer or less invasive movements.
  - canada_dry 7y ago
spark28 7y ago
I think it's more a question of ability than age. For surgeons in particular, it seems there needs to be a clear line drawn when it comes to factors like fine motor control or vision being compromised. Perhaps it's on the medical field to determine these diagnostics and actively regulate/test for them.
epmaybe 7y ago
Off topic, but every time I see the domain in parentheses on links from pubmed, it shows up as nih.gov. I know that the NIH/NLM runs pubmed, but I feel like I get misled thinking that this is an official NIH publication before I click on the link.
- jessriedel 7y ago
  The important thing is that the NIH domain hosts the PubMed website, not that the NIH runs PubMed from an administrative standpoint. The domain in parentheses tells you the URL domain for the link, nothing more, and shouldn't be interpreted as endorsement. It would be infeasible for HN to automatically determine who the authoring/endorsing institution is.
  - epmaybe 7y ago
    I know, I guess my brain has been trained to think of it as an endorsement even though I can infer that it likely isn't.
transcranial 7y ago
DeBakey performed his last surgery at age 90 [1], pioneered numerous procedures -- including one performed on himself at age 97 [2], and continued to practice medicine until his death at age 99. Remarkable person, but obviously an outlier. Just thought it would be interesting to bring him up in this thread. [1] https://www.telegraph.co.uk/news/obituaries/2403698/Michael-DeBakey.html https://www.telegraph.co.uk/news/obituaries/2403698/Michael-... [2] https://www.nytimes.com/2006/12/25/health/25surgeon.html https://www.nytimes.com/2006/12/25/health/25surgeon.html

75 points by JabavuAdams 7y ago

Discussion point: Uni is not the only way to be educated about something. In fact, I have found industry experience to be more effective learning

dusted 7y ago
You didn't read the article did you? This is not about experience, it's about getting old enough that you've got lapses in attention no longer are fully aware of what you're doing. It's about being good at A, but times change, and since you're good at A, you're assumed to be good at B too, but you are not. It's about systems evolving around highly esteemed people, that make detecting life-threatening situations hard or impossible.
- aetherspawn 7y ago
  A large portion of the article mentions specifically that students who graduate uni more recently are educated in more modern surgical techniques .. but the premise assumes the surgeon basically doesn’t learn on the job which I’m not sure is a strong argument
- gdy 7y ago
  "You didn't read the article did you?" Firstly, don't be an ass. Secondly, the article mentioned many factors, including specifically "quantity of education, remoteness of education", which are arguably are not an issue if an old dog keeps learning new tricks. "When contemplating the effect of age on surgeons, quantity of education, remoteness of education, and obsolescence of the content of the education are all at least theoretical concerns."
- dang 7y ago
  "Please don't comment on whether someone read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that."" https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

WalterBright 7y ago

Instead of forcing them to retire, perhaps assign them to less demanding surgeries.

sametmax 7y ago
Or just much less surgeries, or only in support of newbies. Fatigue and speed of execution seem central.
zomg 7y ago
That's not how it works -- most surgeons aren't "assigned" surgeries. They run a practice, focused on a particular disease state, and perform surgeries on their patients to address health issues with respect to that disease state. With that said, the kind of surgery being performed does have an impact on the body of the surgeon in terms of their posture.
- jdietrich 7y ago
  It can work like that. Here in the UK, we increasingly rely on Surgical Care Practitioners - nurses who can independently perform a specific set of routine surgical procedures. Medicine stands to benefit greatly from the division of labour and economies of scale; a large surgical unit with a diverse range of skillsets can perform more surgeries with better outcomes at lower cost. https://www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/surgical-care-practitioner https://www.healthcareers.nhs.uk/explore-roles/medical-assoc...
  - jessriedel 7y ago
    You seem to be confusing the nature of the doctor-patient relationship (i.e., whether the patient contracts with the doctor or contracts with the hospital who employs a doctor) with the use of surgical assistants (generally a type of physician's assistant). Private practices routinely use PAs in the US to do less demanding procedures, just like the UK. Obviously, the nature of the doctor-patient relationship will influence the degree to which PAs are used -- patients generally want full surgeons, while 3rd party payers like the government want to save costs -- but that doesn't undermine zomg's correction of WalterBright's comment.

bubblewrap 7y ago

"In the end, the study group consisted of 291 patients (330 knees). Younger surgeon age was correlated with fewer complications" There is a danger in such statistics in that for example older surgeons may have been assigned the more difficult cases.

mft_ 7y ago
You're right; it's probably a bell-shaped curve.
melling 7y ago
Simpson’s Paradox https://www.lesswrong.com/posts/7FJRnxbRtT7Sbzizs/simpson-s-paradox https://www.lesswrong.com/posts/7FJRnxbRtT7Sbzizs/simpson-s-...

js8 7y ago

This is a very difficult problem. Aging is emotionally painful. I think it is insane that in our societies (Western, I am not American) we prolong the age of retirement. I believe it should be 60, tops. And we should have culture that would celebrate moving to retirement, to make sure that people do not feel useless all of sudden. But it is often hard for, especially really good, people to go into retirement, because you still have a (usually wrong) feeling that you can continue as if they were younger, and they see all the young hacks doing the same mistakes.. So if the society could support these people in giving up, I think it would be helpful for everybody. As the Czech saying goes - stop at the best time. We should do that even if it is a small economic loss.

melling 7y ago
And spend the next 20-40 years hanging out? Hopefully, over the next couple of decades more people reach a healthy 100. https://www.smithsonianmag.com/smart-news/there-are-more-americans-over-age-100-now-and-they-are-living-longer-180957914/ https://www.smithsonianmag.com/smart-news/there-are-more-ame...
- sharmi 7y ago
  Some people enjoy retirement. We have a retired army major attending our local python meetup without feel. He learns Python with great enthusiasm. He is now trying to understand cyber security. Having said that, that level of enthusiasm is a rare mindset and signs of indefatigable spirit.
- jackvalentine 7y ago
  As we said to one of the old guys at work who didn't really want to be there anymore, didn't need the money and just hung around for the routine... Join Rotary and volunteer or something. There are loads of things you can do that would make the world better.
  - melling 7y ago
    ...or you could pick a different/another career: Writer, director, fund manager, ... Warren Buffet is still managing a lot of money at 88. https://en.m.wikipedia.org/wiki/David_McCullough https://en.m.wikipedia.org/wiki/David_McCullough https://en.m.wikipedia.org/wiki/Warren_Buffett https://en.m.wikipedia.org/wiki/Warren_Buffett https://en.m.wikipedia.org/wiki/Carl_Icahn https://en.m.wikipedia.org/wiki/Carl_Icahn https://en.m.wikipedia.org/wiki/Donald_Knuth https://en.m.wikipedia.org/wiki/Donald_Knuth https://en.m.wikipedia.org/wiki/Woody_Allen https://en.m.wikipedia.org/wiki/Woody_Allen https://en.m.wikipedia.org/wiki/Martin_Scorsese https://en.m.wikipedia.org/wiki/Martin_Scorsese https://en.m.wikipedia.org/wiki/Bill_Belichick https://en.m.wikipedia.org/wiki/Bill_Belichick

eternalban 7y ago

"Only wine and cheese improve with age". Fair warning, future fellow robotic workers.. More seriously, the issue of lack of formal training in emerging techniques (note the -40- year olds who have missed the latest hip surgery technique) has nothing to do with 'degraded cognitive abilities due to aging', and really should be discussed in context of a 'continuity of education and certification' regime. It is not an issue of age, rather the time it takes to produce skilled worker in a domain, and the frequency of significant breakthroughs/changes in that domain. [edited]

magduf 7y ago
This really disturbs me. Why wouldn't surgeons be constantly retrained on newer surgical techniques? Shouldn't this be standard procedure? Why should any patient have to suffer with the scars and complications from an old-style surgery instead of a newer less-invasive technique just because some surgeon hasn't bothered getting trained on the newer technique?

Ensorceled 7y ago

My father-in-law was an ophthalmic surgeon who "retired" in his 60's. In his case, he had a clear "line in the sand", where his fine motor control became reduced and he could no longer do the kind of delicate work his profession required. This means other surgeons are also compromised but are "getting away with it" and also giving poorer results.

zomg 7y ago

I work in the medical device industry and one major dynamic that's improving surgical capabilities for aging surgeons is the increase in surgical robots. I was in a lab testing a new product on the da Vinci Robot and one of the surgeons commented to me that "this robot will add another 10 years to my career" -- he was probably in his early 60's already! It will be very interesting to see how robotic technology changes surgical outcomes as robotic surgery becomes the standard of care.

godzillabrennus 7y ago
Agree. Robotics hasn’t even really penetrated the market for treatment or diagnostics yet. There are many opportunities.
- swiley 7y ago
  I'm really not sure it will any time soon. I think robot enthusiasts sometimes underestimate what hands attached to a brain full of knowledge really are capable of. There's a problem software developers have to solve if they really want robots to be a full replacement for a human physically performing a task and that's a way for the trained humans to communicate their knowledge to the robot. The problem with this is that most people really aren't great at communicating precisely. They have a hard time teaching each other and are often hopeless when it comes to giving precise and complete instructions for something to a robot. forget complex tasks like surgery even gardening and washing dishes is hard. Even something as simple as "grab the thing" is a pretty big project. Maybe in the future as robots become more common speaking with the level of precision required will also become common (kind of like what happened to culture with the web and email.)
  - philips 7y ago
    I think you are thinking of robotics in the sense of replacing surgeons or being an autonomous partner. While OP is talking of robotics as an assitive tool to help a surgeon make finer or less invasive movements.
- canada_dry 7y ago

spark28 7y ago

I think it's more a question of ability than age. For surgeons in particular, it seems there needs to be a clear line drawn when it comes to factors like fine motor control or vision being compromised. Perhaps it's on the medical field to determine these diagnostics and actively regulate/test for them.

epmaybe 7y ago

Off topic, but every time I see the domain in parentheses on links from pubmed, it shows up as nih.gov. I know that the NIH/NLM runs pubmed, but I feel like I get misled thinking that this is an official NIH publication before I click on the link.

jessriedel 7y ago
The important thing is that the NIH domain hosts the PubMed website, not that the NIH runs PubMed from an administrative standpoint. The domain in parentheses tells you the URL domain for the link, nothing more, and shouldn't be interpreted as endorsement. It would be infeasible for HN to automatically determine who the authoring/endorsing institution is.
- epmaybe 7y ago
  I know, I guess my brain has been trained to think of it as an endorsement even though I can infer that it likely isn't.

transcranial 7y ago

DeBakey performed his last surgery at age 90 [1], pioneered numerous procedures -- including one performed on himself at age 97 [2], and continued to practice medicine until his death at age 99. Remarkable person, but obviously an outlier. Just thought it would be interesting to bring him up in this thread. [1] https://www.telegraph.co.uk/news/obituaries/2403698/Michael-DeBakey.html https://www.telegraph.co.uk/news/obituaries/2403698/Michael-... [2] https://www.nytimes.com/2006/12/25/health/25surgeon.html https://www.nytimes.com/2006/12/25/health/25surgeon.html