Dr. Fiaz Maqbool Fazili
Introducting A Question That Refuses to Die-
When should a doctor—or any paramedic entrusted with human life—stop practicing? This is not merely a technical question of licensing or retirement. It is a moral, ethical, and deeply human dilemma. Unlike an accountant who miscalculates or a teacher who forgets a formula, a doctor’s lapse—be it from tremor, clouded judgment, or untreated illness—can mean a lost life.
In India, and particularly in Jammu & Kashmir, the debate has become sharper. We see retired doctors re-emerging in private practice, often well past the age of state service retirement, with no annual fitness check or competency assessment. Meanwhile, younger doctors remain under-employed. The National Medical Commission (NMC) offers guidelines, but they are patchy and lack enforcement teeth. The question then becomes: are we failing to protect patients by allowing unchecked continuation of practice, or are we wasting valuable expertise by imposing premature retirement?
An Introspective Question: Am I truly fit to treat patients? Before anything else, I must ask this of myself. As care providers, we all carry the responsibility of ongoing self-assessment. But what does ‘fitness’ really mean in this context? For the patient, it may imply safety, trust, and compassion. For the caregiver, it may mean physical stamina, mental clarity, ethical soundness, and moral integrity. The answers may differ, yet they converge in the realm of medical ethics and professional morality, where self-reflection becomes the foundation of safe and noble practice.”
The Moral and Ethical Lens-
Medicine has always been more than a job—it is a moral calling. Hippocrates framed it as a sacred covenant. Islam calls the healer a custodian of Allah’s trust. Modern codes of ethics—from the GMC in the UK to the AMA in the US—demand competence, honesty, and self-limitation.
At its heart, the moral question is simple: can you continue to provide safe care? If the answer is yes, age is secondary. But if the answer is no—whether due to memory lapses, erratic behavior, or physical incapacity—then continuing practice becomes not just unethical, but dangerous.
Here lies the contradiction. Society often reveres senior doctors, calling them “legends,” and patients sometimes prefer them, mistaking experience for eternal competence. Yet legends, too, can falter. Wisdom cannot compensate for a hand that trembles in surgery or a mind that confuses drug dosages.
The Medical Reality of Aging Practitioners-
Doctors, like their patients, are not immune to the realities of human biology. With advancing age, the following risks loom large:
Neurological disorders: Alzheimer’s, dementia, or even mild cognitive impairment can cloud judgment.
Psychiatric vulnerabilities: depression, bipolar swings, or dependence on psychotropic drugs.
Physical limitations: tremors, stiff shoulders, vision problems, hearing loss.
Chronic diseases: diabetes, epilepsy, cardiovascular issues, often requiring medication with side effects that dull reflexes.
Substance abuse: alcoholism or anxiolytic overuse—unspoken yet widespread in high-stress professions.
Each of these conditions chips away at the razor-sharp edge medicine demands. An airline pilot undergoes mandatory health checks to ensure passenger safety. Why not the same for doctors, who deal not with machines but with fragile human lives?
The Indian Policy Vacuum-
The NMC is the country’s supreme regulator. It mandates professional conduct, lays out codes, and insists on Continuous Medical Education (CME). Yet nowhere does it require annual health or fitness certifications for practitioners. This is a gaping hole.
Compare this to the aviation industry, where even a minor ailment can ground a pilot. In Singapore, physicians above 65 undergo mandatory peer reviews and competency checks. In the UK, revalidation by the GMC requires evidence of fitness to practice every five years.
India, meanwhile, retires doctors from government service at 58 or 60 or 65 , only to allow them unfettered continuation in private practice until death or disability forces them to stop. This is not regulation—it is abdication.
What’s the real age limit to become a senior citizen? Some say 60, some 65 .
Retirement and the Double Standard-
Why does this dichotomy exist?
Government retirement is administrative, not medical. Doctors retire because the state enforces age limits, not because they are unfit.
Private practice thrives on demand. Patients often flock to older doctors, trusting their experience.
Scarcity of jobs. Young doctors face unemployment or underemployment. Retired doctors continue, partly because the system has not absorbed the next generation.
Financial necessity. Many doctors lack pensions or face family responsibilities that push them to keep working.
Thus emerges a contradiction: the same state that retires doctors at 60 65 tacitly encourages them to open private clinics the very next day. Patients remain unaware whether their doctor has any recent health clearance or ongoing competency validation.
The Ethical Tightrope-
A retired doctor may argue: “My patients still need me, and I am fit.” Indeed, there are surgeons in their 70s who are sharper than juniors in their 30s. But ethics demands humility and self-awareness. Continuing out of ego, prestige, or financial greed is indefensible.
At the same time, society must avoid ageism. Not every gray hair is a liability. If periodic independent assessments show competence, why should age alone disqualify a healer? The key is systemic checks and balances—not blind trust, nor blanket bans.
The Patient’s Right to Safety-
Ultimately, the patient must be at the center of this debate. A patient walking into a consultation has the right to assume that the doctor is:
Clinically competent.
Physically fit.
Mentally sound.
Without annual checks, this assumption becomes a gamble. A tremor may be hidden under a confident smile. A memory lapse may be explained away as “stress.” But medicine cannot be left to guesswork.
Towards a Framework of Reform-The way forward lies in balancing respect for senior doctors with uncompromising patient safety. Here are concrete steps India—and suggestions from doctors body’, consultations and inputs from former faculty forum in particular—must adopt a consensus on :
Mandatory Annual Health Fitness Certificate:
At what age does rational thinking and decision-making precision begin to decline? Is the medical field exempt from this? Prioritise safety for both yourself and your patients.
Every doctor at least above that x years ( varies from country to country and Medical councils) must undergo a comprehensive medical and psychological check, certified by an independent panel.
Peer Competency Review: Senior doctors also should demonstrate updated knowledge, continued competence through CME credits, skill assessments, or supervised evaluations.
Public Registry of Fitness to Practice: Patients must be able to verify if their doctor is certified as fit. Transparency builds trust.
Gradual Role Transition: Instead of clinical duties, senior doctors may mentor, teach, or consult—roles that value experience without compromising patient safety.
Post-Retirement Engagement Programs: Government and medical colleges should create structured avenues for retired doctors to contribute without direct patient care—research, policy, tele-medicine guidance ,advisory boards, statutory bodies .
NMC Guidelines with Teeth: A clear, enforceable framework that goes beyond words to action, with penalties for malpractice rooted in unfitness.
The Human Face of the Problem-
Consider Dr. X, a brilliant surgeon who saved thousands of lives in his prime. Now in his seventies, he suffers from diabetes, mild tremors, and occasional memory lapses on medication. His patients still line up, out of loyalty and nostalgia. But one day, a dosage mistake leads to a preventable complication. Who is responsible? The doctor who failed to step aside, or the system that allowed him to continue unchecked?Both share the blame.
When: Courage to Step Aside-
Doctors are trained to do no harm. That oath does not expire at retirement; it becomes even more sacred with age. True greatness is not in clinging to the scalpel until it drops from a trembling hand. It is in knowing when to lay it down, and when to pass the torch.
The NMC, policymakers, and society must rise above murkiness and set clear ethical guardrails. Senior doctors must embrace dignity in transition. And patients must demand transparency and accountability.
In the end, medicine is not about the doctor’s pride—it is about the patient’s life. And life, as we know, allows no rehearsals.
The Author is a Surgeon at Mubarak hospital, Healthcare policy analyst, Certified Professional in Quality improvement in Hospitals can be reached at drfiazfazili@gmail.com
