The Aging Physician and Surgeon.

Abstract

As the population of aging physicians increases, methods of assessing physicians' cognitive function and predicting clinically significant changes in clinical performance become increasingly important. Although several approaches have been suggested, no evaluation system is accepted or utilized widely. Literature was reviewed using Medline, PubMed and other sources. Articles discussing the problems of geriatric physicians were summarized, stressing publications that proposed methods of evaluation. Selected literature on evaluating aging pilots also was reviewed, and potential applications for physician evaluation were proposed. Neuropsychological cognitive test protocols were reviewed, and a reduced evaluation protocol was proposed for interdisciplinary longitudinal research. Although there are several articles evaluating cognitive function in aging physicians and aging pilots, and although a few institutions have instituted cognitive evaluation, there are no longitudinal data assessing cognitive function in physicians over time, and correlating them with performance. Valid, reliable testing of cognitive function of physicians is needed. In order to understand its predictive value, physicians should be tested over time starting when they are young, and results should be correlated with physician performance. Early testing is needed to determine whether cognitive deficits are age-related or longstanding. A multi-institutional study over many years is proposed. Additional assessments of other factors, such as manual dexterity (perhaps using simulators) and physician frailty are recommended, but detailed discussion of these issues is beyond the scope of this article.