
The Problem of the Aging Surgeon (2009) - JabavuAdams
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628499/
======
zomg
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
Agree. Robotics hasn’t even really penetrated the market for treatment or
diagnostics yet. There are many opportunities.

~~~
swiley
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
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.

------
bubblewrap
"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.

~~~
melling
Simpson’s Paradox

[https://www.lesswrong.com/posts/7FJRnxbRtT7Sbzizs/simpson-s-...](https://www.lesswrong.com/posts/7FJRnxbRtT7Sbzizs/simpson-
s-paradox)

------
Ensorceled
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.

------
eternalban
"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
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?

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

~~~
zomg
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
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-
assoc...](https://www.healthcareers.nhs.uk/explore-roles/medical-associate-
professions/roles-medical-associate-professions/surgical-care-practitioner)

~~~
jessriedel
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.

------
spark28
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.

------
transcranial
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-...](https://www.telegraph.co.uk/news/obituaries/2403698/Michael-
DeBakey.html)

[2]
[https://www.nytimes.com/2006/12/25/health/25surgeon.html](https://www.nytimes.com/2006/12/25/health/25surgeon.html)

------
js8
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
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-
ame...](https://www.smithsonianmag.com/smart-news/there-are-more-americans-
over-age-100-now-and-they-are-living-longer-180957914/)

~~~
chosenbreed37
> And spend the next 20-40 years hanging out?

I think this is a great point. I don't think it detracts from the post in
question. But it highlights the observation that many do not seem to have
anything meaningful to do outside work. Anecdotally, I've heard of people
coming out of retirement because they were bored stiff. I'm wondering whether
or not we should develop a broad range of interest and possibly
hobbies/vocations that we could transition to in "retirement". Alternatively
not retire altogether but transition to a different role more in line with our
capabilities as we age.

~~~
js8
Yes, that's what I was thinking. Just say, when you're 60, and you feel at the
peak, now I am going to do something else as a hobby.

But again, this goes against our tradition where we celebrate "real work" and
not doing something for fun or as a hobby.

------
epmaybe
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
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
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.

------
aetherspawn
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
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.

~~~
dang
" _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)

