Assessing when physicians' skills wane as the result of age

April 1, 2011

The number of older physicians who are practicing is giving rise to questions from groups such as the National Patient Safety Foundation. On Call asked dermatologists whether there was any process in their area for handling doctors whose mental and physical abilities might be diminishing, but who were unaware their ability to practice effectively was being hampered by slowing cognitive abilities.

Key Points

And the number of older physicians who are practicing is giving rise to questions from groups such as the National Patient Safety Foundation.

A 2005 study by the University of Oklahoma found that 6.6 percent of doctors out of medical school for 40 years had faced disciplinary action, versus only 1.3 percent of doctors who had practiced just 10 years.

Committee matters

"That committee deals with physicians impaired by alcohol, drugs or mental health issues, which I think are more common problems for doctors than aging-caused loss of cognitive abilities. But I would think if someone were concerned about a doctor's ability to practice, that would be the logical place to start," he says.

Kathryn Holloway, M.D., in Ocala, Fla., also cites the state medical board as a place doctors can be reported, but she says that would mean complaints would have to be filed before an investigation is started.

"We did have that happen to one surgeon who returned to practice after a stroke, and the state board did end up restricting the procedures he could do, but it did take complaints to get the state involved," she says.

Group effort

Perhaps the easier place to identify a doctor who is less cognitively aware would be in a group practice, as Tom J. Meek Jr., M.D., of Baton Rouge, La., explains.

"I'm in a group of eight. I certainly think that in this group, if that started to happen, it would be recognized and that individual would be asked to leave, just because of the liability issues," he says.

"If one of the physicians in this group was becoming impaired and we kept him or her on, there would be liability, not only for that individual, but perhaps as much, if not more, liability for us. Oftentimes, people who are developing true Alzheimer's do not realize it themselves, even as the individuals around them begin to realize it."

Dr. Meek, a clinical professor at Louisiana State University, says it wouldn't take one physician standing over another to be aware of even subtle changes. "Certainly, the first person to recognize a change would be the doctor's assistant. I can tell you that would get around quickly. I'm proud to say there aren't any secrets in this office."