The following is a response to a letter from Howard Spiro, M.D., that appeared in the Autumn 2003 issue of Yale Medicine.

Dear Howard,

That you should respond to my essay with a letter half again as long as that to which you responded [“Knowing When It’s Time to Quit,” Summer 2003] brings to mind G.B. Shaw’s coda to a letter, “Forgive me for writing a long letter but I did not have time to write a short one.” My response to you will be shorter.

My two main reasons for retiring are relevance to my medical community and lack of an adequate intellectual schema in which to incorporate new knowledge. I was bothered by the impending irrelevance that I had seen afflict older physicians. Friends of mine, particularly doctors and attorneys, concur in the recognition. Does being troubled by that prospect reveal inadequate ego strength or simply an accurate perception of reality? Choose one!

The problems of understanding and incorporating new knowledge and its effect on how I wanted to practice are linked to your statements about continuing to practice in a changed capacity and the wisdom that comes to some with age. All the kindness and wisdom in the world are not, in my opinion, worth much if not backed by up-to-date knowledge. I suspect that doctors who practice part time in clinics after retiring are not offering first-rate medicine.

You take me to task for not being a “mid-1930s liberal.” I plead guilty. The implication that somehow it was immoral to retire and deprive the world of my (supposed) talents is a bit harder to take. Perhaps I should have spelled out my thoughts more clearly. For me to continue to practice and encounter the loss of respect of my colleagues—and your colleagues know you better than you know—and be unable to use new information properly would have been to practice under false pretenses.

Do I think everyone should retire at a specific age? Of course not. With rare exceptions, however, there comes a time when older physicians should make way for younger ones. I chose what I chose. I make no apologies. I loved medicine but do not miss it. I am very happy in my current state.

Your longtime friend and student,

Herbert J. Kaufmann, M.D. ’59
Bedford, N.Y.

For more on this topic, see the online Yale Journal for Humanities in Medicine at info.med.yale.edu/intmed/hummed/yjhm/.