In addition to a requirement for in-house practitioners to undergo testing at age 75 and older to be credentialed or re-credentialed, Sinai Hospital in Baltimore also has developed a comprehensive two-day program for surgeons who are referred to them by any facility for more extensive testing of cognitive and physical skills or capabilities.
“Many experienced OR nurses or surgical residents or surgical assistants have occasionally noticed an older surgeon is not quite on their game,” says Mark R. Katlic, MD, MMM, FACS, chairman of the Department of Surgery and surgeon-in-chief at Sinai Hospital and director of the Sinai Center for Geriatric Surgery, also in Baltimore. “Either it’s in operations, or they’re forgetting things, or it’s their appearance. They might not be as well-dressed or shaven or well-kept as before, or something else may not be quite right.”
If concerns are raised with the chief of surgery or president of the organization, then he or she needs to respond, Katlic says. “They can’t rely on hearsay,” he says. “This person’s career is at stake.”
Some surgeons have retired when their facilities have threatened to send them for evaluation, Katlic says. For those who do go for the evaluation, they stay at a hotel near the hospital. They come to the hospital for a physical exam and general neurology exam, followed by physical and occupational therapy testing. Those tests include examination of hand-eye coordination and fine motor skills in which they’re timed. These tests are followed by neuropsychological testing, which includes memory, attention span, frustration level, emotions, and some visual/spacial ability.
The second day includes more neurocognitive testing, more occupational therapy testing, and an eye exam. A comprehensive report follows that compares the surgeon’s results to those of the general public.
The cost is $17,000, which Katlic acknowledged is high, but he says that amount covers the cost of the PhD neuropsychologists and specialist physicians who are involved in the testing. “It’s cheaper than a malpractice case or even defending one,” he says. “It’s almost the only thing that exists that gives the hospital some objective evidence of whether a person’s faculties are good or not.”
When testing aging surgeons, look at both sides of the issue, Katlick says.
“I say all the time, the goals of this program are to balance patient safety on one side with the dignity of this committed surgeon on the other side.”
RESOURCE
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The Aging Surgeon Program, Sinai Hospital, Baltimore. Contact JoAnn Coleman, DNP, ACNP, ANP, AOCN, GCN, Program Coordinator for The Aging Surgeon Program, Clinical Program Coordinator for the Sinai Center for Geriatric Surgery. Email: [email protected].
