To the Editor

The recent letter by Dr. Kenneth Travis (APSF Newsletter Summer 1993) asked ‘What to do with the older anesthesiologist?”

The immediate implication is that of a problem, but what is the supporting documentation? Absent a scientific foundation, the argument must survive the presumption to age discrimination. Age versus youth is not a new debate in the continuum of human experience. Callow youth has always arrogated unto itself such conceits as it could fashion from a world of limited experience and unbridled optimism.

The central issue is not age (or youth), but determining fitness for duty. Is the older anesthesiologist who carries the patina of experience really a greater risk than the recently fledged tyro who grabs every night of call in order to support a mortgage on Xanadu? Is the sum of anesthesiology really only the capacity to successfully process multiple simultaneous signals? That sounds more like the description of a stereo receiver than a skilled clinician.

Even the analogy to the aviation industry, so popular in anesthesiology, fails here. It is only commercial transport aviation that requires the older pilot to retire at age 60; this same pilot may continue, however, to fly a cargo version of the identical plane until such time as the aviator can no longer pass the semi-annual physical exam. General aviation pilots also may continue to fly until no longer able to demonstrate fitness for duty. The Federal Aviation Administration has re-examined its extant policy for air transport pilots in the past and will no doubt do so again in the future. The European Community has recently raised its disqualification ceiling from 60 to 65 years of age for pilots engaged in commercial transportation.

If indeed the specialty can develop methods of detecting decrements in performance, can we not use all our wondrous technology and knowledge then to aid the practitioner who is beset by ill health, age or emotional distress? Humility gained through life experience causes Wordsworth to echo: ‘I have learned to look on nature, not as in the hour of thoughtless youth; but hearing oftentimes the still, sad music of humanity.’ In a less introspective view, I take solace in the modern aphorism that

‘Old age and treachery will always overcome youth and inexperience.’

David Eric Lees, M.D.

Professor and Chairman, Department of Anesthesia Georgetown University Medical Center Washington, D.C.