Staying too long at the party

November 1, 2007

Medicine is a field in which the demands and stresses on practitioners can be considerable and the stakes (life or death, sight or blindness, etc.) even higher than the outcome of sporting events. Physicians and athletes need a way to determine when the time has come to enter a different phase of life and to stop doing certain things at which they no longer excel, whether that is performing LASIK or hitting a 98-mph fastball.

Key Points

Diminishing skills

"The best mirror is an old friend."

-George Herbert, 1651

-Lao-Tzu. 6th century B.C., The Way of Life

"A man's got to know his limitations."

-Clint Eastwood (as Dirty Harry)

Growing up, I loved watching Johnny Unitas lead the Baltimore Colts. The time came when he no longer could excel, however, and his last year in the league (as a San Diego Charger) was painful to watch.

Apparently, the same thing occurred with the legendary Jim Thorpe. And how many former heavyweight champions of the world have we seen trying to hang on in boxing, only to be brutally pummeled by younger opponents?

Sometimes legendary football coaches become ineffective, perhaps because they are unable to adapt to changes in the game (as with the advent of the forward pass) or lose the ability to motivate young athletes. In my opinion, clearly, the best time to go is at the top, à la Michael Jordan and Larry Bird in basketball.

Sports is not the only profession in which people can stay after their skills have abandoned them. Medicine is a field in which the demands and stresses on practitioners can be considerable and the stakes (life or death, sight or blindness, etc.) even higher than the outcome of sporting events. Physicians and athletes need a way to determine when the time has come to enter a different phase of life and to stop doing certain things at which they no longer excel, whether that is performing LASIK or hitting a 98-mph fastball.

My dad was a general surgeon, and he worked almost all the time. I have vivid memories, from when I was a little boy, of strangers coming up to me to tell me that my father had saved their lives or the life of a loved one with some late-night surgical procedure, that they were grateful to him, and that I was lucky to be his son. I imagined that this type of compliment would make it difficult for my father to retire. However, he always told me that once he observed his skills waning, he immediately would stop performing surgery. And despite being asked to stay on at the time, he did exactly that.

Eventually that time will come for all of us-but will we recognize it?

I was intrigued to see the results of a recent Business Week poll of executives and middle managers. In that survey, 90% of respondents ranked themselves as being in the top 10% of performers. Almost nobody, it seems, considered himself or herself to be average, let alone below average, although 49% of people must be. The poll suggests to me that smart, driven, and hardworking people have difficulty seeing that they no longer may be the stars they once were-or never were but aspired to be. Our egos may prevent us from seeing in ourselves what is readily apparent to others.

How can we make sure that when the time has come to stop doing certain things, we know it? Department chairpersons have deans to tell them if they are not doing well, academicians have their colleagues and chairpersons, and senior community practitioners have their junior partners and colleagues. But sometimes it can be difficult to accept the well-intentioned critiques and advice of others, for one reason or another, especially when we are used to the grateful comments of appreciative patients over decades of practice.