It’s Thursday afternoon and I’m on my feet.  But late Tuesday into Wednesday I was flat out with a debilitating stomach virus.  Late Wednesday I entered into high level negotiations with my office staff.  What to do about my Thursday scopes?  I had a full day of procedures on the last Thursday of the year – it was the end-the-year rush for young families who had met their deductibles.  Rescheduling would be difficult.  I felt myself recovering but I wasn’t sure I’d be 100% by morning.  Actually I knew I wouldn’t be 100% but knew I’d be good enough to do what I’d done 15,000 times before.

In the end I chose to look for a substitute.  Dr Doug Fishman, a close colleague and Director of the Texas Children’s Hospital Endoscopy unit stepped in to assure that my kids were taken care of.

Then between sips of Gatorade in the early morning hours I stumbled on this post by KevinMD which made me think.  It centers on a recent New England Journal of Medicine Perspective piece which suggests that surgeons should be mandated to disclose to patients how much sleep they’ve had.  Kevin does a nice job with both sides of the debate.

But when we open the door to legislating sleep disclosure where do we draw the line?  How much sleep is too little and who’s to decide?  How do we measure the quality of sleep in a surgeon?  And what about nutrition and its impact on cognition?  How much coffee is too much coffee for a neurosurgeon? And what about the physician recovering from a severe gastrointestinal illness?

Kevin asks why we should stop at surgeons.  What about intensivists or even pediatricians or pediatric endoscopists?

But this issue of my own physical competency has been the subject of internal dialog in the past.  I struggle with three herniated discs which sometimes create problems.  And just like everyone else I go through periods of stress and turmoil with my own life.  All of these things make me less than 100%.  But in each instance I weigh my level of compromise and make what I think is the right decision.

It would be impossible for patients to make truly informed decisions about what constitutes compromise on my part.  My decision yesterday to look for help was based on an internal dialog and the help of trusted staff and colleagues who know me.  There isn’t a metric in the world that could have made that decision any better.