Cognitively Impaired Physicians: How Do We Detect Them? How Do We Assist Them?

Soonsawat, Anothai; Tanaka, Gen; Lammando, Marcia A.; Ahmed, Iqbal Ike K.; Ellison, James M.

doi:10.1016/j.jagp.2018.01.203

Cited by 16 publications

(13 citation statements)

References 34 publications

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“…Our findings argue against mandatory retirement age policies for surgeons and support individualized assessment strat egies. 3,29 Mechanisms may be considered to encourage older surgeons, who remain capable of delivering high-quality care, to remain in practice longer to meet impending shortages in the surgical workforce. 30 Further research is needed to understand the higher rates of adverse postoperative outcomes in younger surgeons and whether interventions to lower these rates could be started during training, at the time of the credentialing process 31 or with monitoring and mentoring during early independent practice.…”

Section: Discussionmentioning

confidence: 99%

Relation between surgeon age and postoperative outcomes: a population-based cohort study

Satkunasivam

Klaassen

Ravi

et al. 2020

CMAJ

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H igh-quality surgical outcomes require sound knowledge, communication skills, clinical judgment and technical proficiency. 1 Aging of the surgical workforce has been well recognized; however, the effect on patient outcomes is unclear. 2,3 The effect of aging, namely cognitive impairment, decline in visual acuity and worsening motor function, may negatively affect surgical ability. 4 However, age-related decline may be offset by the older surgeon's years of clinical acumen, surgical experience and clinical judgement. In addition, because surgeon volume is associated with improved surgical outcomes, 5,6 it is unclear whether surgical volume may offset age-related effects. Thus, surgical volume and age-related effects need to be evaluated concurrently. 7,8 Published evidence about the effect of physician age and experience on surgical outcomes shows mixed results. 9-11 Among Medicare beneficiaries undergoing pancreatectomy, coronary artery bypass grafting and carotid endarterectomy, mortality was higher among those treated by surgeons older than 60 years, especially those with low volumes. 12 This was corroborated in subsequent studies of particular surgical procedures. 13-15 In 2018, an observational study involving patients in the United States who were Medicare beneficiaries reported that patients who were treated by older surgeons had lower rates of mortality than those treated by younger surgeons. 16 However, these data lacked generalizability because the study included only a limited number of nonelective surgical procedures in patients 65 years and older and failed to inform the safety of older physicians performing most surgeries, elective procedures. We aimed to fill these knowledge gaps by assessing the association between surgeon age and outcomes across a broad range of patient age, surgical specialties and common procedures, while adjusting for surgeon volume.

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Section: Discussionmentioning

confidence: 99%

Relation between surgeon age and postoperative outcomes: a population-based cohort study

Satkunasivam

Klaassen

Ravi

et al. 2020

CMAJ

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“…Moreover, Soonsawat, et al reported in American Journal of Geriatric Psychiatry that patients who received poor care from an impaired physician might be reluctant to report their concern out of loyalty or respect for authority. 23 Accordingly, it is imperative to identify a competency assessment process that incorporates performance data and considers patient satisfaction.…”

Section: The Human Factormentioning

confidence: 99%

The challenge of competency assessment of the late‐career practitioner

Steffany¹

2021

J of Healthc Risk Manag

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Just as the general population of the United States is aging, so, too, is the population of active physicians. Training to become a physician and practice medicine is an arduous process. The competition to gain admission to medical school is fierce, the price tag of medical education is high, and waiting to learn about matching to a residency program is stressful. No wonder that physicians equate their profession with their identity. This sentiment, along with other factors, has resulted in many physicians continuing to practice well beyond the average retirement age. While each individual ages differently, there is evidence that the aging of physicians and length of time since medical school and residency is associated with deficiencies in history-taking, physical examination, record-keeping, and the ability to problem-solve. For late-career surgeons performing complex surgical procedures, there is a higher mortality rate for patients. Unlike other professions that have a mandatory retirement age, medicine does not. Health systems are grappling with how to fairly assess the competence of late-career practitioners. This article will explore that challenge from different perspectives, identify best practices, and describe how a risk manager can facilitate stakeholder discussion focused on implementing a competency-assessment process that is fair and effective.

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“…42 Expert screening, assessment, planning, remediation and follow-up are necessary to determine if and how the physician with mild cognitive impairment can continue to practise in a time-limited way, potentially with some limits placed on scope of practice. 43…”

Section: ) Mild Cognitive Impairmentmentioning

confidence: 99%

“…À ce titre, la reconnaissance de ce problème par les collègues et les organismes de réglementation est essentielle pour faire en sorte que les évaluations appropriées s’effectuent, afin de protéger les patients et le médecin 42 . Un dépistage spécialisé, une évaluation, une planification, une réhabilitation et un suivi sont nécessaires pour déterminer si et comment le médecin souffrant d’un trouble cognitif léger peut continuer à exercer avec des restrictions de durée d'exercice et, potentiellement, avec des limites imposées à l’étendue de la pratique 43 .…”

Section: ) Trouble Cognitif Légerunclassified