Viewpoint: 5 strategies to address cognitive impairment among aging physicians

Aging physicians have a higher risk of cognitive impairment than their younger counterparts, and as more physicians work into later years, safeguards are needed to protect both patient safety and physician careers, according to a commentary published in the April issue of Neurology Clinical Practice.

Among U.S. physicians aged 70 and older with active licenses, the estimated prevalence of those with mild cognitive impairment and dementia may be as high as 28 percent, the authors wrote. 

In turn, strategies are needed to thoughtfully address the risk of cognitive impairment in aging physicians. 

Here are five of the strategies outlined in the commentary: 

1. Reactive assessment: In this approach, currently the norm in medicine, a physician is evaluated after an error has occurred or when reported by a patient, colleague, or institution. 

  • Advantages: This approach is unlikely to provoke strong, negative responses among physicians.
  • Disadvantages: It's not proactive, potentially leaving many impaired physicians unrecognized.

2. Sounding the alarm/peer reporting: This approach relies on physicians "sounding the alarm" about potentially impaired colleagues.

  • Advantages: It's minimally invasive.
  • Disadvantages: Physicians are often reluctant when it comes to reporting colleagues, and the hierarchical apprenticeship model in medicine discourages physicians from reporting senior colleagues.

3. Physician self-assessment and self report: This involves physicians reporting their own potential compromising condition when they become aware of it.

  • Advantages: Physicians have a professional obligation to disclose concerning conditions. On-line assessment tools for self-reporting could easily be made available.
  • Disadvantages: It relies on self-awareness, but in some cases, loss of insight itself may be part of a person's impairment. Financial and personal-self interest may also serve as barriers here.

4. Mandatory retirement requirement: This strategy would require practicing physicians to retire at a certain age. 

  • Advantages: This would be consistent with other professions, such as pilots, who are required to retire after 65 given their job performance affects public safety, and most high court justices, among others. public safety.
  • Disadvantages: It's a broad approach and ignores performance. Cognitive capacity varies greatly among individuals, with some older physicians performing on par with their younger counterparts. 

5. Age-based cognitive screening tool: This approach involves a brief neurocognitive screening protocol, which the authors suggest start at age 65, that aims to identify physicians with levels of impairment that would likely increase the risk of serious harm to their patients.

  • Advantages: It's designed to identify physicians with a high likelihood of cognitive impairment who require additional evaluations.
  • Disadvantages: False-positives could lead to unnecessary follow-up evaluations, which could stir up anxiety among physicians. False-negatives could allow potentially impaired physicians to continue practicing medicine. It's also challenging to reach a consensus on the specifics of such testing, such as what age it should begin and how often.

"If significant cognitive impairment is found after appropriate evaluation, precautions to confidentially support physicians practicing safely for as long as possible should be instituted," the authors said. 

To view the full commentary, click here.

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