significant objections. Because there were no data in the literature to
support (or refute, for that matter) the use of cognitive screening to
gauge a physician's ability to practice safely, we dropped that require-
ment. Instead we increased the number of peer reviews from 3 to 10,
an approach that does have support in the literature, which demon-
strates that peer review is an accurate and fair way to determine if
physicians are practicing safely and effectively. We ask the chief of sur-
gery for names of 10 peers who are in a position to honestly and fairly
judge a physician's ability to practice and include them in the peer
review process.
• Physical assessments. Physical exams are performed by individu-
als' primary care physicians, and focus on determining whether sur-
geons have the physical skills needed to perform the procedures for
which they're privileged.
• Respect. The screenings are intended to uncover possible prob-
lems; they're not used as pass/fail assessments. For example, a sur-
geon who needs to be on her feet for hours during a busy day of sur-
gery might have a physical ailment that impairs her ability to operate.
Instead of looking for ways to get rid of her, we'll think of ways to
accommodate her needs. That's the respect piece of our policy. Not
everyone sees it that way — some feel threatened by the process —
but our goal is to help physicians practice as long as possible in a safe
way. Although some disagree with the policy, the majority of our med-
ical staff offered their support when it was put to a vote.
Before it's too late
Reaching a certain age does not mean a surgeon is impaired, and our
program is designed to identify opportunities to help aging physicians
maintain the respect and admiration they deserve, not force them to
retire. Sadly, I'm aware of a nationally known physician at another
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