Dr. Fiaz Maqbool Fazili
A Troubling Sight: Recently, I watched a senior colleague, a surgeon of stature and long-standing repute, being gently supported by another person as he attempted to climb a few steps. His body seemed frail, dependent, unsteady. And yet, hours later, I heard he was scheduled to perform surgery. The image would not leave me. It forced me to reflect: have we reduced surgery to mere cutting and cautery, forgetting the immense physical stamina, mental sharpness, and reflexive integration that are its real foundation? Surgery is not carpentry of flesh. It is not the mechanical act of holding a scalpel. It is a symphony of decisions—assessing anatomy, predicting complications, responding instantly to the unforeseen. It demands mental clarity, physical steadiness, and emotional balance every moment. Can these qualities remain intact in a surgeon whose body is already failing him outside the operating theatre?
Surgery Beyond The Scalpel: For the outsider, the spectacle of surgery may appear technical: the surgeon cuts, removes, repairs, sutures, and leaves the rest to healing. But for the insider, it is an unending dialogue with uncertainty.
• A bleeding vessel, invisible on scans, suddenly bursts.
• A tumour clings to structures thought free on imaging.
• A patient’s airway collapses in seconds.
Will Reality Bite Me ?.. As a Surgeon at these moments, survival rests on a surgeon’s alertness and reflexes. To feel tissue planes, to recognise unusual patterns, to predict mishaps, to call for help before disaster—this is surgery. Hands may hold the scalpel, but it is the mind that saves the life. That is why physical and mental health are non-negotiable in surgical practice. Just as a trembling pilot cannot fly, a faltering surgeon cannot guarantee safety.
The Ethical Question: Here lies the dilemma: senior doctors possess decades of judgment, hard-won wisdom, and experience that younger surgeons desperately need. They are mentors, pioneers, and repositories of tradition. Yet experience is not always equal to ability. The ethical question becomes:
• Should a surgeon whose mobility is impaired still be in the operating theatre?
• Should a doctor whose vision, hearing, or reflexes have dulled be performing high-risk procedures?
• Should patients, unknowingly, place their lives in the hands of someone whose personal frailty is hidden behind reputation?.
*Can a doctor or paramedic who is on medication that impairs physical strength, mental alertness, or decision-making capacity ethically continue to practice while handling human lives? This remains a critical and debatable question.”
The Hippocratic Oath Reminds Us Me First : “First, do no harm.” Continuing to operate when one’s faculties are compromised violates this spirit. Patients are not experimental subjects to test whether age and infirmity can withstand surgical stress.
The Last Incision -Guidelines And Grey Zones: Globally, professional bodies have recognised this problem. In the UK’s NHS, pilots and surgeons alike undergo periodic health checks to ensure fitness. In the US, some hospitals mandate retirement ages or restrict privileges after a certain threshold, unless competence is proven. In India, however, the National Medical Commission (NMC) has not laid down a uniform policy for retirement age or post-retirement practice in private settings. Doctors retire from government service at 58 or 60, yet many continue to operate in private hospitals well into their 70s or 80s. Is this an extension of service to society, or a dangerous paradox where scarcity of doctors allows safety concerns to be brushed aside? The lack of mandatory annual fitness assessments for practicing doctors creates a troubling gap. While we debate the finer points of healthcare policy, the patient lying on the table is exposed to avoidable risks.
The Pilot Analogy: Society rightly insists that pilots undergo rigorous medical checks before flying. Even a momentary lapse in alertness could risk hundreds of lives. Why, then, do we not apply the same vigilance to surgeons? A surgeon may not carry 200 passengers in a plane, but in every operation, the stakes are absolute: one life, one family, one irreplaceable human being. Should we allow a surgeon whose reflexes are compromised to gamble with that? The analogy is simple: if pilots must prove their fitness, surgeons must too.
“A surgeon’s true legacy isn’t about how many operations they perform later in life, but the safety and well-being of their patients. The text emphasizes that the wisdom and ethical choice for a surgeon is to step away from practice when their physical capabilities diminish, viewing this act as the ultimate, honorable “operation” of conquering ego and accepting the truth.”
Between Experience And Ego: It is not only systems but also individuals who must reflect. Many senior surgeons continue to operate not because they must, but because ego and identity are tied to the scalpel. For decades, surgery has been their signature, their introduction at every gathering, their purpose in life. To hang up the gown feels like erasing themselves. But true greatness lies in knowing when to step back. A senior surgeon’s wisdom can illuminate teaching, mentoring, and supervision. They can be the guardians of standards, the conscience of the profession, the guiding presence for juniors in difficult decisions—without holding the knife themselves. Respect for experience must never blind us to the reality of decline. In fact, stepping back gracefully may be the greatest service a senior surgeon can render—preserving patient safety while passing on their legacy.
Patients’ Right To Safety: This debate is not about doctors alone. It is about patients, who deserve the highest standard of care. A patient entering an operating theatre assumes their surgeon is fit—physically, mentally, emotionally. They rarely know if the surgeon is battling tremors, memory lapses, or visual deficits. Transparency demands we place patient rights above professional pride. A frail surgeon may insist they are still capable. But capability cannot be self-certified. Independent assessment—whether medical, cognitive, or procedural—is essential. Patients cannot and should not bear the cost of misplaced confidence.
Cultural Silence, Complicity: In our society, questioning seniors is often seen as disrespect. Younger doctors, nurses, and staff may observe decline in an older surgeon, but they remain silent out of fear or misplaced reverence. Families of patients hesitate to ask, lest they appear ungrateful. Institutions avoid confrontation, lest reputations be bruised. This cultural silence enables risk. By shielding frailty, we place vulnerable patients in danger. Reverence should never outweigh responsibility.
A Call To Policy Makers: The time has come for India, and Kashmir in particular, to address this issue with courage:
1. Mandatory Health Checks: Annual physical and cognitive fitness tests for surgeons above a certain age.
2. Role Redefinition: Encourage senior surgeons to focus on teaching, supervision, and mentoring rather than active operative work.
3. Transparent Policies: Hospitals must disclose age and health-related guidelines for surgical practice.
4. Respectful Transition: Create honorary roles and dignified positions for retired surgeons, so stepping back does not mean invisibility.
Saftey is not an option in mefical care butvan” ESR – essential safety requirement. Any compromise even 99.9 % to QPS experts is NC- Non compliance , failure by JCI standards . This is not punishment—it is protection. Not dismissal, but dignity.
The Final Incision- Dignified Good bye, When And Where? Watching that frail surgeon being helped up the stairs, I could not help but ask: what happens if his hands falter while holding a scalpel? What if his mind drifts for a moment during an unpredicted mishap? What if his fatigue delays the response by mere seconds? Surgery is not about cutting and cautery. It is about judgment under pressure, reflexes in crisis, the ability to turn unpredictability into survival. And for that, a surgeon must be as fit as their patient deserves. It is time we, as a profession and as a society, accepted this truth. A surgeon’s true legacy is not measured in the number of operations performed in old age, but in the safety of the patients whose lives they touched. To step back when the body demands is not weakness. It is wisdom, it is ethics, it is honour. And perhaps, it is the last and greatest operation—cutting away ego, cauterising pride, and suturing the wounds of denial with the thread of truth.
(The author is a freelancer is a surgeon by profession. The views, opinions and conclusions expressed in this article are those of the author and aren’t necessarily in accord with the views of “Kashmir Horizon”)
Dr. Fiaz Maqbool Fazili
