One third of all physicians in the United States are older than 65. A 2006 study found that mortality rates among patients in complicated operations were higher when the physician was 60 or older. The New York Times recently ran an article about the need for safeguards to protect patients from physicians who suffer from cognitive decline as they age and it is sparking debate about older physicians and patient safety. Pilots are required to undergo biannual physical and mental exams beginning at age 40 and they must retire at age 65. There are no such guidelines for physicians, some of whom proudly practice into their 90s.
Interestingly, the physicians who make up the credentials committee at hospitals where I work, recently discussed the issue of aging physicians and the wisdom of mandating an annual physical exam and letter from the treating physician attesting to the health of a doctor after age 70. One large medical center had already instituted such a practice and the others are considering it. But when you start digging a bit deeper, the simple solution of an annual exam becomes more complex.
The debate between the physician leaders was that a routine physical would not pick up subtle cognitive decline that might affect decision making. Annual physical exams generally do not test dexterity or judgment and would find only the most blatant physical deficits. Should we expect all older physicians to undergo expensive and time-consuming psychological and cognitive tests? Is there a way to test function under stress? These questions remain unanswered.
We are truly entering a time of more public scrutiny and better self-policing by physicians. The fact that we are having these discussions within the organized medical staff is great. We already have policies in place that address medical error and the disruptive physician and our increasingly aging medical staff is next for review.
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