Age-Related Cognitive Decline in Physicians : Evaluation and Intervention
By Andy Baer , MD , MagMutual Chief Medical Officer
Many of us have aging family members and friends who suff er from cognitive impairment and its impact on memory , language , thinking and judgment . The American Academy of Neurology estimates that mild impairment is present in about 8 % of people age 65 to 69 and in 15 % of 75- to 79-year-olds . And current research indicates that for many people , mild cognitive impairment precedes the development of full-blown dementia . 1
No group is immune from cognitive decline , not even physicians . However , given their responsibility for the care of others , such impairment can create serious issues .
Physicians who are impaired due to age-related cognitive decline are less likely to adhere to the appropriate standards of care and are more likely to have an increase in poor patient outcomes . Allowing impaired physicians to continue their medical practice can compromise patient safety and the integrity of the medical profession .
That ’ s why , if a physician believes a colleague may be impaired due to cognitive decline , it ’ s important to evaluate the situation and intervene in a timely manner , even though recognizing impairment and confronting a colleague about it can be diff icult . Here is information that can help .
Recognizing Impairment According to the American Medical Association , 2 an impaired physician is one who has a physical or mental health condition that interferes with the ability to engage safely in professional activities . In the case of cognitive decline , a physician is less likely to follow standards of care , less likely to consider and adopt new therapies , and may have poorer patient outcomes . As a result , the physician compromises professional relationships , puts patients at risk and undermines trust in medicine .
Little guidance exists on identifying impaired physicians before an adverse event . Sometimes the warning signs are obvious :
• Increased patient complaints
• Poor patient outcomes
• Decreased quality of care and careless medical decisions
• Increased irritability or forgetfulness
• Decreased productivity or eff iciency
• Depression , anxiety and mood instability .
The Federation of State Medical Boards Policy on Physician Illness and Impairment 3 is an excellent resource for identifying a potentially impaired physician and guiding rehabilitation .
However , all too often , signs of cognitive impairment aren ’ t clear . In those cases , the physician should be referred to a third party who is trained and credentialed to evaluate and confirm impairment .
When Should You Intervene ? Some impaired physicians may be reluctant to seek help or admit their impairment because they fear the potential consequences . If a physician denies cognitive impairment or is unwilling to discuss their mental or physical health , a more formal intervention with other medical professionals may be required to help the physician recognize impairment and the risks it poses .
Physicians may not feel comfortable confronting an impaired colleague . In general , there is a duty to respect the autonomy of physicians , and an intervention may feel intrusive . But if there is suspicion about a physician ’ s mental or physical health , that duty can be waived . Physicians have an ethical and legal duty to report behavior that puts patients at risk . Failure to monitor themselves and their colleagues can compromise their reputation and the medical profession itself .
AMA Principles of Medical Ethics state that patient well-being must always be the primary consideration . Keeping the ethics guidance and applicable law in mind , physicians should confront and , if necessary , report impaired colleagues in a timely manner .
The first step in an intervention can be as simple as expressing collegial concern . A genuine “ How are you ?” can open the door to a more meaningful conversation . Five steps to an eff ective intervention are : 1 . Express concern to the physician . 2 . Arrange a meeting with the physician either one-on-one or with other healthcare professionals .
3 . If patient safety isn ’ t at risk , present options such as reducing hours or taking a break from work . If patient safety is a concern even under reduced or restricted practice , recommend that the physician cease practice .
4 . If the physician stays in denial , communicate consequences such as the suspension of privileges or being reported . 5 . If the physician still refuses to comply , it may be necessary to contact the licensing board .
Patient Safety Is Primary Physicians who fail to file reports concerning impaired colleagues generally aren ’ t placing themselves at risk unless reporting is required by a state board . But failing to address an impaired physician means that patients will continue to be at risk for poor outcomes .
After an impaired physician has been identified and confronted , healthcare organizations should make sure the physician modifies their practice , or ceases it altogether , to ensure that quality patient care continues to be provided safely . And to reduce the risk of impaired physicians and compromised patient care on an ongoing basis , organizations should establish mechanisms to promote health and wellness among physicians — a move that will benefit doctors and patients alike .
1 Cleveland Clinic , https :// my . clevelandclinic . org / health / diseases / 17990-mild-cognitive-impairment 2 https :// www . ama-assn . org / sites / ama-assn . org / files / corp / media-browser / code-of-medical-ethicschapter-9 . pdf 3 https :// www . fsmb . org / siteassets / advocacy / policies / policy-on-physician-impairment . pdf
Disclaimer : The information provided in this article does not constitute legal , medical or any other professional advice . No attorney-client relationship is created and you should not act or refrain from acting on the basis of any content included in this article without seeking legal or other professional advice .