012 外科医生年迈不胜任我要向上级报告吗？ - 医护前沿 - 奥医教育-奥医资讯-厦门奥医教育咨询有限公司

工作中常常有的医生年龄太大，已经无法胜任其所承担的职业，屡屡出现工作差错，这时，作为患者代言人的护士是否该向上级报告？该如何报告？

How Should I Report an 'Aging' Surgeon?
Carolyn Buppert, MSN, JD

Question
I work in the OR with a 75-year-old surgeon. Over the past 1-2 years, it has become obvious that his skills are greatly diminishing. I have reported this to the "powers that be" many times in a variety of ways. I'm told that they will look into it, but I don't see anything happening. I have been told that my hands are basically tied because I am making a medical judgment about his treatment and technique. I am depressed and super-stressed. Please help me be the patient's advocate that I was trained to be!

An operating room (OR) nurse wrote in to request advice on how to handle the following situation:

I work in the OR with a 75-year-old surgeon, with whom I have worked for 30 years. Over the past 1-2 years, it has become obvious that his skills are greatly diminishing. He is not concerned with adequate hemostasis at the end of the procedure, therefore, many of his patients return to the OR in critical condition with hemoglobin levels of 8.0 g/dL or less. After being informed of patient allergies during the timeout, he proceeds to write prescriptions for those exact medications. His hands shake to the point that he has to hold one hand with the other to load a needle holder. His history and physicals are generic and more concerned with the patient's social life than the reason for their visit. In the past 6-12 months, during pelvic laparoscopies, when obvious pathology is present (dermoid cyst, endometriosis, ovarian torsion), he claims that there is nothing there and does nothing!

I have reported this to the "powers that be" many times in a variety of ways. I'm told that they will look into it, but I don't see anything happening. I dread working with him, but because he is on my service, we are together every week. I have been told that my hands are basically tied because I am making a medical judgment about his treatment and technique. I was a certified surgical technician for 10 years before getting my RN and have worked in the OR for 32 years. I know what is right and wrong! I don't know what to do. I am depressed and super-stressed. I dread going to work on his surgery days. Please help me be the patient's advocate that I was trained to be!

We may be seeing more of this, as both the physician and nurse "baby boomer" populations age. We don't see ourselves objectively, and it can be hard to know when to give up clinical practice, for the sake of the patients.

My first thought is to discuss your observations with the surgeon. If I were in his position, I would be very grateful in the long run (although probably embarrassed and peeved in the present) if someone close to me pointed out that my performance was diminishing. I think you should write down specific instances, providing specific dates, where you felt that he was not practicing according to the standard of care; when you have at least 3 examples, make an appointment and sit down with him. Perhaps you could start with how much you have enjoyed working with him over the years. Tell him something is bothering you of late. Then give him the data, if there are data, and if not, give him your impressions and observations, with names and dates. Be gentle, but also be very sure of your facts and confident of your observations. Tell him what you fear, for each patient that you mention. Tell him you are afraid that he will be sued.

Having worked with him for 30 years, you are probably the best person to notice whether he is slipping. However, if he doesn't believe that you are qualified to pass judgment on his fitness to perform surgery, ask him to consider getting a qualified surgeon in to observe and advise. I wonder about the anesthesia providers; have they noted any breaches of standards of care? If you are seeing a decline, there are probably others who are seeing it as well.

You have already tried going over his head, and haven't seen a change. Did you speak with nursing administrators, or did you speak with the head of surgery? Obviously, you could report him to the medical board, but I don't think that is the way to go, at least until you have tried the direct approach. It may take a while to sink in, but I think if he hears from his usual OR nurse that he needs to retire from cutting, that should carry significant weight. And, surely he will understand that if he does nothing after speaking with you, you may file a complaint with the medical board. He has to appreciate that it will be so much better for him if he is the one to take the step to dial back. If he still has lots to give professionally, he could consult, advise, write, organize, manage, or teach.

If after you have had a conversation with him and, if necessary, a follow-up conversation, you see no change and you feel obligated to escalate the process, then you need to do a few things to protect your employment situation. First, ascertain that the anesthesiologists and any other clinicians who have been with you in surgery don't disagree with your assessment. If they concur, or at least don't disagree, make an appointment with the head of surgery. Relate what you have observed and what you have done about it. The department head is going to understand that you can file a complaint with the medical board; however, you want to exhaust all of the internal processes for dealing with fitness to practice before going to an outside agency.

If you start by going to the medical board, without going through the steps I provided above, you may find yourself out on a limb. The last thing you want is for others who have seen the surgeon in action to contradict you. You may be right, and they may be wrong, but without support and corroboration, your complaint isn't likely to be taken seriously. You may be both "right" and fired. You don't need to be "the judge" in this matter. If you have discussed your concerns with the surgeon and with those in a position to take action, then you are the patient's advocate you were trained to be.

原文链接：http://www.medscape.com/viewarticle/820783

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