Knowing when it’s time to quit

“My second fixed idea is the uselessness of men over the age of sixty.” —William Osler, 1905

Osler spoke those words in his last address at Johns Hopkins before he left to become Regius Professor at Oxford. He then went on to cite Trollope’s novel The Fixed Period, in which an idea is advanced that men should retire at 60, spend a year in contemplation and then be chloroformed. Newspapers of the time missed Osler’s jesting tone and took him seriously. A great brouhaha ensued, which caused Osler both considerable distress and some amusement.

To read Osler today is to experience some of the best aspects of humane and medical thought of the Victorian era. Much of that thought is not outmoded.

I retired in 2000. When I told people what I planned, they asked why. I was 67, apparently fit, enjoyed an interesting practice and my mind seemed not to be failing. Of course, there were and are lots of good reasons to leave practice: HMO intrusiveness, decreasing reimbursement, loss of collegiality in medical communities and suchlike. But these matters were not really at the root of my decision.

When they get to a certain age, doctors should retire. As they age, they become increasingly irrelevant to their medical communities. The generational difference that slowly develops makes communication less cordial. True, we all belong to the same fraternity, but the handshake changes. Doctors are usually happiest when they confer and refer within an age radius of 10 or 15 years. The tone of a medical community is usually set by doctors in their 40s and early 50s. I practiced in one community for over 30 years. Doctors who stood at the pinnacle of the profession when I arrived slowly became “Dr. Who?”

Usually they did not know that their knowledge was slipping. They probably did not know it because their loyal patients continued to love them. It was sad to see. I did not want it to happen to me. I could see it would have happened. There were many doctors in our area and some in my group who were younger than my children. Many of them could not bring themselves to call me by my first name. I gradually lost the intense desire to know everything in my field, and even if I had kept the desire, it would have been impossible to do so.

In order to use new knowledge one must have a schema, a sort of intellectual hat rack, on which to hang new concepts. I did not have an up-to-date intellectual schema to incorporate what I understand of genetics and molecular biology. Even many of the titles, much less the contents, of articles in my specialty journals were incomprehensible to me. It is in these new fields that basic knowledge is growing, and clinicians should have a grasp of their specialty’s basic science. And, as far as clinical information goes, in my field of gastroenterology, much of it seemed to me to be recycled knowledge arrived at by newer methods. It may have come with better statistics or larger patient populations or with MRIs and endosonography instead of barium and fiber optics, but it did not help an experienced physician take better care of his patients. At major meetings I increasingly found myself choosing between papers I had no background to understand and symposia that told me little, as I watched hordes of young men and women bustle past.

Medicine is a unique activity. It offers the opportunity to engage simultaneously in intellectual problem solving, humane ministering and, in some areas, technical expertise. I retired after 34 years of practice, 45 years after entering medical school—really, more than a generation ago. It has been a time of tremendous, awesome, unforeseen developments in medicine and I had a wonderfully satisfying career. I think what Osler had in mind when he gave The Fixed Period address was the relationship of physicians to their colleagues and to new knowledge. Doctors should not be chloroformed but they should retire.