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“I’ll Die Operating!”

May 26, 2014

Apparently all doctors must practice medicine until the day they die.  Or so says Gordon Marino in the Opinionator section of the New York Times in a piece called “A Life Beyond Do What You Love”.  This article caught my eye, since I am currently trying to do “what I love”, having already lived a couple of lives doing “what I think I should love”.  I didn’t agree with everything the piece said about doing what you love, although I will agree that the phrase “do what you love and the money will follow” is pure malarkey.

Mr. Marino gives several examples of people who have changed their lives to do what they love, and one of these is Dr. John Kitchin, aka “Slomo”.  Dr. Kitchin is a neurologist who worked for 30 years, realized it wasn’t any fun anymore, quit and moved to Pacific Beach, CA, where he rollerblades on the boardwalk all day every day.  The regulars there call him “Slomo” because he rollerblades in slow motion.  Now he’s totally happy.  Somebody did a short documentary on him, you should check it out.  Of course the reason he can do this is because he worked as a doctor for 30 years.  But that’s not my point.

Of this doctor Mr. Marino says the following:  “But is it ethical for the doctor to put away his stethoscope and lace up his skates?”  Which also caught my eye for obvious reasons.  I’m not sure when retiring from medicine became an ethical issue.

I decided to write a Letter to the Editor about this sentence, but I got no love from the Op-Ed overlords.  So I’m giving it to you, dear reader, so that at least one person other than the parsimonious loser that reads Letters to the Editor at the NYT will read it.

To the Editor:

In the Opinionator section on May 17th you published a piece by Gordon Marino entitled “A Life Beyond ‘Do What You Love’ “.  In it Mr. Marino uses as an example Dr. John Kitchin, aka Slomo, who quit his work as a medical doctor and spends his days rollerblading in California.  Of this doctor Mr. Marino says the following:  “But is it ethical for the doctor to put away his stethoscope and lace up his skates?”  I’m not sure when retiring from medicine became an ethical issue.

The definition of the word “ethical” has two elements.  The first is that the word indicates an issue pertaining to or dealing with morals or the principles of morality; pertaining to right and wrong in conduct.  To say that it is unethical for a doctor to quit his job is to say that it is morally wrong.  Is it because we’ve invested so much time and money in our training that we are morally obligated to keep at it?  It takes at least as long to train an astronaut or a PhD.  Are they obligated to work forever also?  Perhaps if this were another country, such as France, where medical school and malpractice insurance are heavily subsidized by the government, one could argue that it would be wrong to take all that public money and throw it away.  But here in the US we pay for our own education.  Perhaps it’s because we’re trained to take care of others, a sacred trust.  Sure, but so are nurses and physical therapists.  Are we morally obligated to take care of others because we can?  By that metric all of humanity is so obligated.

The second definition of the word “ethical” says that being ethical means being in accordance with the rules or standards for right conduct or practice, especially the standards of a profession.  Nowhere in The Hippocratic Oath does it say “Thou shalt never quit.”  The American Medical Association Declaration of Professional Responsibility doesn’t mention retirement.

Doctors are held to many ethical standards, as they should be.  Working as a doctor forever is not one of those standards.

Shirie Leng, MD

Anesthesiologist, recently retired

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9 Comments
  1. In some cases, some need to stop practicing since they (we?) may no longer be able to practice safely. If only our minds can keep up with our desires!

  2. Dana Seidl, MD permalink

    Excellent reply to the Op-Ed! There’s no law that states we have to do our profession for the rest of our lives. This could well lead to detrimental care to patients as our skills and knowledge start to fade and lag behind those more recently trained and more enthusiastic about their craft.

    Burn out is real and does nobody a favor — patients, family and loved ones, and most of all yourself. Changing your life to do something you indeed “love” is itself a loving act.

    You’ve retired?! Congratulations! (Two more years for me, residency class of ’84).

  3. I’m sure about to “retire,” I still love the job, but I’m afraid that it’s like Ronald Reagan said about the Democratic Party – “I didn’t leave them, they left me.”
    I’m a great Internist – but survey says that we can dig into the “quality harvest” – that means, trade quality points for dollars. Quality harvesting is tricky – a 5% reduction in dollars doesn’t necessarily mean a 5% reduction in quality. I can’t do cheaper, low-quality work. Mom told me not to.
    Everybody want some – have all you wish! Everyone drive the bus – I just won’t sit in it anymore.

  4. kidkidneydoc permalink

    I think the answer to his question of whether it was ethical that he hang up his stethoscope, (which also made me snicker a little because Mr. Marino clearly has no concept of the different fields of practice in medicine because seriously.. when was the last time you saw a neurologist/pyschiatrist with a stethoscope! I’m being half facetious of course, but I don’t think Mr. Marino has the right to pass judgement or even advise about starting careers in medicine when he has not gone through the process himself, but I digress..) is a resounding yes. His heart and mind were no longer into what he was doing. We all know that if we’re not on our A-game as physicians, we make mistakes. Those mistakes are not ones that will just affect us, but our entire patient population and their families. So, was it proper conduct for Dr. Kitchin to “hang up his stethoscope” and remove himself from a situation that he knew could do harm to others? Or in other words, did Dr.Kitchin uphold the Hippocratic Oath by doing what he wanted? hell yea.

  5. Everybody’s driving the show, except the people who know what they’re doing. I note with some concern the following comment from some “cutting-edge entrepreneur-business-model-reformulators” in medicine. Here’s their example how to save on costs….
    Mandate a formula for chargemaster rates and severely limit deviation from those rates.Publish the chargemaster and let patients price shop as part of their hospital selection.
    (example) One of these leaders inquired about the charges for circumcision of newborn infants. The hospital charge was $1149, the insurance company rate was $886, and if the procedure was performed the next day at the pediatrician’s office it was $298.

    What do neurologists charge for circ’s? I’d never heard of pediatricians doing it in the office. $300 including tip. (old joke).

  6. kidkidneydoc permalink

    Nowadays newborns do get circs done by the PCP after discharge because some hospitals, due to the lack of reimbursement for inpatient circs, will ask parents to pay out of pocket before they leave. This is usually the case in a small community hospital. The charge was $200 where I was.

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