Clinicians Are Talking About Aging Surgeons

Gordon H. Sun, MD, MS

Disclosures

July 21, 2014

In This Article

The "Chain of Command" in Reporting Concerns About Aging Surgeons

There are no widely published best-practice guidelines on how to report potential concerns with the performance of aging surgeons or other providers. As such, hospitals and practice groups have had to develop internal mechanisms, reflected in the wide and often conflicting variety of reader suggestions and personal anecdotes about similar situations.

Two issues are pertinent with respect to the chain of command. Several readers criticized the OR nurse for even bringing the issue up. Readers implied that the nurse was not being respectful ("Any change in [the surgeon's] ability must be dealt with using a higher degree of respect and appreciation") or was unqualified to pass judgment ("From what I've seen, there usually is an assistant/resident next to the surgeon who [in my opinion] is more knowledgeable and who could/should notice mistakes better than a nurse.") The comments we reviewed suggested that regardless of the approach taken by the nurse, there will certainly be opposition, either in terms of the qualifications of the complainant or the methods used to report concerns.

The OR nurse's original inquiry stated that the working relationship with the surgeon has lasted 30 years. Several readers believed that this long and presumably stable relationship represented an adequate foundation upon which the nurse might consider talking with the surgeon directly, either alone or with other colleagues. Despite this, a significant number of other readers were concerned that the surgeon might not be approachable and could "shoot the messenger," allowing internal hospital politics to quickly end the nurse's career. As one nursing administrator commented, "I have never seen this type of confrontation, even if it is well stated, result in a satisfactory solution for the nurse, and it infuriates the physician." Another reader commented, "You can't be an effective patient advocate if you're out of a job."

Many readers wrote about quality assurance protocols and specific personnel who should be approached when concerns about potentially suboptimal care are raised. The phrase "chain of command" recurred throughout readers' comments. As an example, a physician at a tertiary care center stated that at his hospital, the sequence of individuals to contact would be "the charge nurse, OR supervisor, chief of surgery, chief of staff, and then to the medical staff leadership, credentials committee, and eventually the board of the hospital." Other readers countered that many hospitals lack such mechanisms. One nurse, who reported complications following her botched surgery by an older urologist, wrote that at 8 hospitals where she had previously worked, "no such 'system' is even vaguely in place." Another reader wrote that even with a protocol in place, the process "does not always result in what we feel are professionally responsible actions."

Unfortunately, the OR nurse in question stated only that concerns were reported to the "powers that be," without specifying who they were. Lacking this information, a large number of readers suggested contacting the chief of surgery first; additional recommendations included notifying other surgical colleagues, nursing supervisors, and anesthesia staff. There was essentially universal agreement with Ms. Buppert that the state medical board should be an option of last resort once all other internal mechanisms have been exhausted; as one commenter wrote, "the board takes so much time."

A final note of interest is the fact that the OR nurse chose to highlight the surgeon's advanced age. Several readers suggested that using this as the sole basis of complaint would be an inappropriate tactic. One reader pointed out that the complainant should be "objective and report the skill deterioration without mentioning age, as this opens the OR nurse up to age discrimination." Others commented that the complainant could also be considered "aging," with 42 years of experience as a surgical technician and registered nurse, and broaching the aging issue could result in accusations of hypocrisy. One physician asked whether it was "possible that the nurse's faculties have also changed over that period of time," whereas another physician in India said that the nurse's age also would have been grounds for retirement.

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