COMMENTARY

I Reported My Older Physician Friend for Competency Issues

Arthur L. Caplan, PhD

Disclosures

June 26, 2019

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU School of Medicine. Should doctors have to undergo cognitive testing when they reach a certain age, say 65, 70, or even 75 years, in order to continue to retain privileges to practice?

I know this is a hot issue. I know many people think it is discriminatory to test. I'm on the side that says testing ought to be done, if not as the final say about whether you can practice, then at least as a trigger to go further and examine whether a particular doctor or nurse might not have the cognitive wherewithal to continue to do the work that they're being asked to do in a hospital clinic or private-practice setting.

A couple of years ago, I had a good friend who worked with me on my medical ethics course. He was an intensivist. When I was working with him on designing our course, I began to notice that he seemed to have a hard time remembering certain things that we had discussed, and I noticed that his vocabulary began to shrink. He seemed to have an issue.

He's a good friend of mine. I worked with him for decades. I had to ask myself whether I should do something. Should I report my concerns to anybody? I thought about it and I felt that I had to. I did not want to end his work on the clinical side as a physician, but I wanted someone to observe him and give their opinion of what was going on. He was getting older. He was at least 70 years old.

I did mention this to people on his service and some of his supervisors, and they monitored him. Ultimately, they stepped in and decided to pull away his clinical privileges. He did not lose his professorship. He was given other duties but could no longer be out on the front lines in intensivist care.

I felt good about that. I felt like it was appropriate to put patient safety first. When I was concerned about my good friend and his ability to carry out his clinical duties, I decided I had to make a report and let others know.

I did not tell him that I had done that because I didn't want to ruin our friendship. I didn't want him to become angry with me. I felt almost embarrassed that I was going to do this, but at the same time, I wasn't controlling whether he could practice or not. I asked others to see if they saw what I thought I saw.

After he had been removed, I did tell him that I was probably the trigger to having him watched, talked to, and ultimately moved out of the clinical situation. I did tell him I was concerned, and as a friend, I thought I'd better speak up because I didn't want him to end up hurting anybody or practicing in a way in which he would be ashamed. He thanked me.

I don't think he would have said that initially. However, once he was observed and he realized that others were seeing problems—he also began to pick up cues at home from his wife and kids—I think he understood that it was better that we moved him and got him to a place of work where he could carry out the duties and not jeopardize anybody's health.

That's how I feel about testing. We can argue about what age it might be needed, but we should use screening, surveillance, and some of the tests that are out there—there's one called MicroCog—to assess brain function.

Just as pilots are tested after a certain age to see whether they can function adequately, it seems to me that for physicians and nurses—people who hold lives in their hands—there ought to be some sort of mandated testing. Again, not that you can't practice if you flunk it, but that it is a sign or a signal that someone may need to supervise you, check on you, or otherwise intervene to make sure that you're mentally able to keep going.

I have met many doctors in their eighties who are doing great. Their memories are better than mine, they're cognitively sharp, and they can do what they need to do. I've also seen, as in the case of my friend, those who are starting to decline and show some symptoms. I think it would be good if we could screen healthcare professionals and make sure that errors, problems, and bad outcomes are not caused by failing to monitor adequately this critical workforce.

I say yes to certain types of screening. We can argue about who should do it, how often it should be done, and at what age, but let's get past objections that say this is age discrimination. I'm not trying to get rid of older doctors, nurses, or even bioethicists. I'm trying to make sure that they can still do their jobs when we know that there are a lot of cognitive decline issues associated with age.

I'm Art Caplan at the Division of Medical Ethics at NYU. Thanks for watching.

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