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An interdisciplinary task force of physicians and neuropsychologists with advanced training in impairment and disability assessment provided a review of the literature on malingering in chronic pain, medical disorders, and mental/cognitive disorders. Our review suggests that treating health care providers often do not consider malingering, even in cases of delayed recovery involving work injuries or other personal injuries, where there may be a significant incentive to feign or embellish symptoms or delay recovery. This report discusses the implications of this issue and offers recommendations to evaluating physicians and other health care professionals.

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This article briefly describes the phenomenological reports of individuals who have survived a near-death experience (NDE) and summarizes the methodological problems of assessing and defining their experience, specifically the out-of-the-body (OBE) experience associated with an NDE. The authors, using a single-person research design, offer one approach to quantifying the OBE associated with an NDE. They administered the Phenomenology of Consciousness Inventory (PCr) and the Dimensions of Attention Questionnaire (DAQ) to one participant across several stimulus conditions including: hypnosis, resting with eyes closed, recollection of an out-of-thebody experience, and recollection of the out-of-the-body experience during hypnotic regression. Similarities and differences among the participant's experiences associated with these stimulus conditions are discussed. BACKGROUND The Near-Death Experience (NDE)The occurrence of near-death experiences have been recorded since antiquity. Locke and Shontz [l] reported that the earliest descriptive accounts of NDEs to appear in scfentific journals originated with the work of Noyes and Kletti [2] in 199 0 1991, Baywood Publishing Co., Inc.

Background: As the population of aging physicians increases, methods of assessing physicians’ cognitive function and predicting clinically significant changes in clinical performance become increasingly important. Although several approaches have been suggested, no evaluation system is accepted or utilized widely. Study Design: Literature was reviewed using Medline, PubMed and other sources. Articles discussing the problems of geriatric physicians were summarized, stressing publications that proposed methods of evaluation. Selected literature on evaluating aging pilots also was reviewed, and potential applications for physician evaluation were proposed. Neuropsychological cognitive test protocols were reviewed, and a reduced evaluation protocol was proposed for interdisciplinary longitudinal research. Results: Although there are several articles evaluating cognitive function in aging physicians and aging pilots, and although a few institutions have instituted cognitive evaluation, there are no longitudinal data assessing cognitive function in physicians over time, and correlating them with performance. Conclusion: Valid, reliable testing of cognitive function of physicians is needed. In order to understand its predictive value, physicians should be tested over time starting when they are young, and results should be correlated with physician performance. Early testing is needed to determine whether cognitive deficits are age-related or longstanding. A multi-institutional study over many years is proposed. Additional assessments of other factors, such as manual dexterity (perhaps using simulators) and physician frailty are recommended, but detailed discussion of these issues is beyond the scope of this article.