For years, a debate has raged: at what point does a doctor’s age begin to affect his or her ability to practice medicine?
Particularly among surgeons, cognitive decline and degradation of skill cause concern about patient safety.
Evidence of a link between age and competence
A case study published in Clinical Ethics summarizes the problem with an outdated population of physicians. An 80-year-old practicing pulmonologist began to show symptoms of short-term memory impairment. After scoring low on mental status tests, he started taking donepezil to improve mental function.
But 6 months later, after his schools dropped for mental status, he still refused to retire, despite a suspected diagnosis of senile dementia.
The authors cited various reviews and analyzes that indicate that the above case is no exception. One study found that although non-analytical knowledge appears to remain constant as parents of clients, the analytical processing tends to decrease. Also, a review concluded that the performance of physicians decreases with age.
Some of the doctors retain all their cognitive capacities regardless of their age
However, other studies have found that this is not a black and white situation. One study evaluated the cognitive functioning of a cohort of 1002 physicians and 581 non-physicians. The researchers found that each group tended to show decreased cognition as they got older, but there was much more variation among physicians compared to the other group. In fact, some physicians retain all of their cognitive abilities regardless of their age.
The authors of the Clinical Ethics case study note that reductions in ability occur in different ways for different people. For some, it may be a reduction in strength; for others, sight; still others, cognition. As such, physicians in certain specialties may be fine to continue their practice.
The question then is: How and when do we assess the capabilities of physicians as they age?
Research suggests that physicians “have limited ability to assess their own competence.”
Physicians also tend to have a reluctance to report their disabled colleagues, in part as a result of a culture that presents the elderly as mentors. The authors of the Clinical Ethics case study conclude that cognitive screening should be applied, but the framework remains a matter of debate.
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