Abstract
I recently wrote to a fellow editor, who replied by telling me he had retired. I asked him what he intended to do next, imaging that he had many years of productivity left in him? I’m still waiting for a response. Perhaps I’m wrong. He may be burnt out, finished, unable to contemplate reading another research paper or writing to a peer reviewer. Perhaps he did his job less well in his latter years than he once did? We imagine that we reach a peak of professional brilliance that only slowly declines. Even better if that peak is a plateau of exceptional service. The consequences of misjudging the worth of a research paper or annoying a peer reviewer tend to be few. Editors, at least those who might have a thick enough skin to make a career of it, tend not to lie awake at night regretting a decision not to publish an article.
I can still, however, still think of clinical scenarios from almost 20 years ago in which I wish I had acted differently. Experience, I imagined, would improve my decision making and skills. It must do mustn’t it? A consultant-led service implies that we put faith in those who are most experienced. Almost any patient would rather be assessed by a consultant, the head of the team, rather than a less senior doctor. Given the choice between a cardiac surgeon of 30 years’ experience and a less experienced colleague, you’d take the longer serving specialist wouldn’t you?
Hickey et al. 1 attempt to answer this difficult question and find a surprising answer. After adjusting for case-mix, inevitably more experienced cardiac surgeons tackle more complex cases, there is an increased risk of mortality in patients operated on by longer serving surgeons. This is an uncomfortable finding, which challenges preconceptions about length of service and patient outcomes. The authors caution that the size of the association is modest and may not be clinically significant on average, and it is sensitive to the choice of statistical model. Yet it still raises important questions about increasing the retirement age in technically demanding surgical specialities.
Elsewhere, cardiac surgeons feature in the story of Benjamin Britten, the greatest English composer of opera since Handel. Britten died from heart failure, three years after aortic valve surgery. The cause of Britten’s heart valve disease has been disputed. Petch 2 puts the record straight.