Whilst this editorial was originally posted some time ago (07/06/23), its comment about healthcare workers and cognitive decline is all the more relevant with the evidence showing now the effects of covid on the brain. In the editorial the author recounts her experience as a young doctor working under a supervisor who exhibited signs of cognitive impairment, failing to provide adequate care and guidance. This reflected a growing issue – up to 13% of older doctors may have deficiencies affecting their ability to practice independently.
Mandatory retirement ages for doctors exist in some countries but not others like Australia. However, Australian doctors over 65 have higher complaint rates regarding incorrect treatment and documentation. So ways to identify impaired doctors are needed to protect patients.
Doctors are reluctant to report impaired colleagues. Voluntarily stepping back also requires courage and insight that may be lacking. Regulators must balance discrimination concerns with patient safety. Retirement ages could vary by role; alternatives may include restricting certain duties.
Competency assessments could help maintain standards but may lack independence or rigor. Experts suggest age-based screening of cognitive domains as a starting point, with careful design to avoid false positives/negatives. This could identify the most impaired doctors while being supportive.
While seniority must be respected, the highest duty is to patients. There may be no perfect approach, but an fair, considered and informed one is needed, with the right to a second opinion. Even impaired doctors once understood “first, do no harm.”
When doctors can no longer honour that ethic, it falls to colleagues to ensure patient safety through their actions. This will likely require difficult but thoughtful decisions as more doctors work later into old age.
You can read the full editorial here.