Physician don't heal thyself: a descriptive study of impaired older doctors

Peisah, Carmelle; Wilhelm, Kay

doi:10.1017/s1041610207005431

Cited by 50 publications

(61 citation statements)

References 18 publications

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“…Cognitive impairment or dementia was found in 22 cases. 16 Another study performed by the California Medical Board (CMB) looked at 148 physicians referred for competency assessment secondary to performance concerns. 17 A number of tests of neuropsychological functioning were used; they found the physicians to be performing lower than expected on tests of intellectual and neuropsychological functioning.…”

Section: Discussionmentioning

confidence: 99%

“…1 Studies have shown that the commonly used screening test, Mini Mental State Examination (MMSE), shows poor sensitivity in detecting mild cognitive impairment. 4,7,16 There are several cognitive domains that are insufficiently examined by this screen, frontal-executive, visuospatial skills and semantic memory. 4 However, intelligent individuals can score well in MMSE in the presence of moderate dementia.…”

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confidence: 99%

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A retrospective study of cognitive function in doctors and dentists with suspected performance problems: an unsuspected but significant concern

Kataria¹,

Brown²,

McAvoy³

et al. 2014

JRSM Open

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SummaryObjectiveTo examine the performance assessments and cognitive function of practitioners referred to the National Clinical Assessment Service (NCAS).DesignRetrospective observational study.SettingPractitioners referred to NCAS for performance assessment due to suspected performance problems.ParticipantsOne hundred and nine practitioners over the age of 45 years referred to NCAS between 1 September 2008 and 30 June 2012.Main outcome measuresReasons for referral of practitioners and their characteristics; details of their assessments including screening for cognition using Addenbrooke's Cognitive Examination Revised (ACE-R); outcome of the process.ResultsReasons for referral included ‘clinical difficulties’ and ‘governance or safety issues’. Eighty-seven practitioners scored above 88 on ACE-R. Twenty-two were found to have an ACE-R score of ≤88. On further assessment, 14 of these 22 practitioners were found to have cognitive impairment. The majority of all practitioners were found to be performing below the expected level of practice for someone at their grade and specialty. Of those scoring ≤88 on the screening, only seven continued in clinical practice.ConclusionsA high proportion of practitioners scoring poorly on ACE-R were found to have cognitive impairment following detailed neuropsychological testing, the youngest aged 46 years. Many were working in isolation. Nearly all practitioners scoring poorly on ACE-R were international medical graduates; reasons for this are unclear. Performance assessment results showed persisting failings in the practitioners' record keeping and in their assessment of patients. Our findings highlight the need for increased vigilance and training of responsible officers to recognise performance problems and emphasise the importance of comprehensive assessment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A retrospective study of cognitive function in doctors and dentists with suspected performance problems: an unsuspected but significant concern

Kataria¹,

Brown²,

McAvoy³

et al. 2014

JRSM Open

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“…The older, male solo or isolated practitioner has been identified as being at higher risk of impairment. 6 The performance of procedural work, engagement in continuing medical education, the opportunities for supervision, and the extent of retirement planning are also important to note.…”

Section: A Physical or Mental Condition Or Disorder (Including Substamentioning

confidence: 99%

“…A higher chronic disease burden has been associated with impairment in LCPs. 6 There is a relatively long list of common physical diseases, in particular vascular risk factors, that increase vulnerability to cognitive impairment.…”

Section: Physical Illnessmentioning

confidence: 99%

Clinical assessment of the late-career medical practitioner

Wijeratne

2016

Australas Psychiatry

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Late career is a specific developmental stage in medical practitioners, a time of transition towards retirement. The treating psychiatrist should be mindful of the welfare of the practitioner, the public and the profession during the assessment, which is conducted from a complex therapeutic and regulatory viewpoint. It is important to assess the physical, psychological and cognitive health of the LCP. Although rates of burnout, depression and suicidal ideation are lowest in Australian doctors over 60, only a small minority of LCPs over 75 are likely to perform at a cognitive level similar to that of younger colleagues. There are a number of therapeutic challenges, including the practitioner's acceptance of their own ageing.

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“…7,11,12 Physician retirement, without transition planning for suitable replacements, can lead to shortages and raise concerns about patient continuity of care. [13][14][15] Although there are numerous benefits to patients that come from having an experienced physician, 16 concerns have been raised with regard to the personal health burdens experienced by older physicians 17 and for patient safety, 7,18,19 particularly in procedural specialties such as surgery. 20 Therefore, successful physician retirement requires planning for the financial demands, physical changes and psychosocial dynamics that are associated with aging and later life transitions.…”

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confidence: 99%

Planning for retirement from medicine: a mixed-methods study

Silver

Easty

2017

CMAJ Open

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Background: Evidence suggests there are important personal and social consequences associated with inadequate retirement planning for physicians. We evaluated whether academic physicians felt satisfied with their retirement planning, and identified obstacles to retirement planning and a set of factors to facilitate retirement planning. Methods:We applied a sequential mixed-methods research design to explore and examine factors that facilitate academic physician retirement planning using data collected from multiple sources (including 7 focus groups, an internet-based survey and 23 in-depth interviews). We examined survey results regarding retirement planning satisfaction and preferences for complete versus gradual retirement. We used thematic analysis to examine verbatim transcripts and notes from the focus groups and interviews.Results: Survey data (response rate 51%) indicated that 10% of respondents were very satisfied with their retirement planning and 89.5% would prefer to retire gradually rather than stop work completely. Key barriers to retirement planning that emerged included poor personal financial management, rigid institutional structures and professional norms. Facilitators included financial planning resources for physicians at multiple career stages, opportunities and resources for later-career transitions and later-career mentorship support for intergenerational collaboration, and recognition of retirees.Interpretation: Key findings highlight perceived barriers to retirement planning at various career stages in addition to factors that can enhance physicians' retirement planning, including creating gradual and flexible retirement options, supporting ongoing discussions about financial planning and later career transitions, and fostering a culture that continues to honour and involve retirees. Medical institutions could foster innovative models for later-career transitions from medicine in ways that address physicians' needs at various career stages, support gradual transitions from practice and recognize the value of experienced, capable later-career physicians and retirees. Abstract ResearchResearch CMAJ OPEN E124CMAJ OPEN, 5(1)

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Physician don't heal thyself: a descriptive study of impaired older doctors

Cited by 50 publications

References 18 publications

A retrospective study of cognitive function in doctors and dentists with suspected performance problems: an unsuspected but significant concern

A retrospective study of cognitive function in doctors and dentists with suspected performance problems: an unsuspected but significant concern

Clinical assessment of the late-career medical practitioner

Planning for retirement from medicine: a mixed-methods study

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