Cognitive Impairment in Aging Physicians: Current Challenges and Possible Solutions

Aging physicians are at a higher risk of cognitive impairment, undermining patient safety and unraveling physicians' careers. Neurologists, occupational health physicians, and psychiatrists will participate in both health system policy decisions and individual patient evaluations. We address cognitive impairment in aging physicians and attendant risks and benefits. If significant cognitive impairment is found after an appropriate evaluation, precautions to confidentially support physicians' practicing safely for as long as possible should be instituted. Understanding that there is heterogeneity and variability in the course of cognitive disorders is crucial to supporting cognitively impaired, practicing physicians. Physicians who are no longer able to practice clinically have other meaningful options.

Job characteristics, well-being and risky behaviour amongst pharmacists

Healthcare practitioners' fitness to practise has often been linked to their personal and demographic characteristics. It is possible that situational factors, such as the work environment and physical or psychological well-being, also have an influence on an individual's fitness to practise. However, it is unclear how these factors might be linked to behaviours that risk compromising fitness to practise. The aim of this study was to examine the association between job characteristics, well-being and behaviour reflecting risky practice amongst a sample of registered pharmacists in a region of the United Kingdom. Data were obtained from a cross-sectional self-report survey of 517 pharmacists. These data were subjected to principal component analysis and path analysis, with job characteristics (demand, autonomy and feedback) and well-being (distress and perceived competence) as the predictors and behaviour as the outcome variable. Two aspects of behaviour were found: Overloading (taking on more work than one can comfortably manage) and risk taking (working at or beyond boundaries of safe practice). Separate path models including either job characteristics or well-being as independent variables provided a good fit to the data-set. Of the job characteristics, demand had the strongest association with behaviour, while the association between well-being and risky behaviour differed according to the aspect of behaviour being assessed. The findings suggest that, in general terms, situational factors should be considered alongside personal factors when assessing, judging or remediating fitness to practise. They also suggest the presence of different facets to the relationship between job characteristics, well-being and risky behaviour amongst pharmacists.

Mandatory notification of impaired doctors

Mandatory reporting of impaired doctors is compulsory in Australasia. Australian Health Practitioner Regulation Agency guidelines for notification claim high benchmark though the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians suggest they still obstruct doctors seeking help. Western Australia excludes mandatory reporting of practitioner-patients. This study examines reporting, consequences and international experiences with notification. Depressed doctors avoid diagnosis and treatment, fearing consequences, yet are more prone to marital problems, substance dependence and needing psychotherapy. South African research confirms isolation of impaired doctors and delayed seeking help with definable characteristics of those at risk. New Zealand data acknowledge: errors occur; questionable contribution from mandatory reporting; issues concerning competence assessment; favouring reporting to senior colleagues or self-intervention to compliance with mandatory reporting. UK found an anaesthetist guilty of professional misconduct for not reporting and sanctioned doctors regarding Harold Shipman. Australians are reluctant to report, fearing legalistic intrusion into care. Australian research confirmed definable characteristics for doctors with psychiatric illness or alcohol abuse. Exposure to legal medicine evokes personal disenchantment for doctors involved. Medicine poses barriers for impaired doctors. Spanish and UK doctors do not use general practitioners and may have suboptimal care. US and European doctors self-medicate using samples. US drug-dependent doctors also prescribe for spouses. Junior doctors are losing empathy with the profession. UK doctors favour private care, avoiding public scrutiny. NZ and Brazil created specific services for doctors, which appear effective. Mandatory reporting may be counterproductive requiring reappraisal.

Identifying poor performance among doctors in NHS organizations

AIM

To account for the means by which poor performance among career doctors is identified by National Health Service organizations, whether the tools are considered effective and how these processes may be strengthened in the light of revalidation and the requirement for doctors to demonstrate their fitness to practice.

METHOD

This study sought to look beyond the 'doctor as individual'; as well as considering the typical approaches to managing the practice of an individual, the systems within which the doctor is working were reviewed, as these are also relevant to standards of performance. A qualitative review was undertaken consisting of a literature review of current practice, a policy review of current documentation from 15 trusts in one deanery locality, and 14 semi-structured interviews with respondents with an overview of processes in use. The framework for the analysis of the data considered tools at three levels: individual, team and organizational.

RESULTS

Tools are, in the main, reactive--with an individual focus. They rely on colleagues and others to speak out, so their effectiveness is hindered by a reluctance to do so. Tools can lack an evidence base for their use, and there is limited linking of data across contexts and tools.

CONCLUSIONS

There is more work to be done in evaluating current tools and developing stronger processes. Linkage between data sources needs to be improved and proactive tools at the organizational level need further development to help with the early identification of performance issues. This would also assist in balancing a wider systems approach with a current over emphasis on individual doctors.

Substance misuse among health care workers: national survey of occupational physicians

BACKGROUND

National Health Service (NHS) occupational health departments assist in the identification and assessment of substance-use disorders among health care workers (HCWs) and are involved in the management of an individual's return to work after treatment.

AIMS

To determine the experience and training of NHS occupational health physicians (OHPs) in identifying substance misuse among HCWs.

METHODS

A national, cross-sectional, postal-based questionnaire was administered to the Association of National Health Occupational Physicians membership.

RESULTS

A total of 145/224 (65%) OHPs (55% male), with a mean age of 49 years (SD ± 9.1; range 28-76), who had worked in the NHS on average for 9.6 years took part. The majority of respondents were consultant grade (59%). Since taking up their NHS post, 26% had received no training in substance misuse. Of those who had undergone formal training, the mean duration received was 2.8 days for drugs and 3.5 days for alcohol. OHPs reported that they did not feel sufficiently trained in this area. Most (65%) did not routinely include standardized screening tools or deliver 'brief interventions' (78%), although many reported that they would routinely ask about substance use when there was no clear indication of use (42%). The majority did not feel they were adequately supported (54%) in this work, nor did they have adequate resources for these patients within their organization (68%).

CONCLUSIONS

OHPs see HCWs with substance-use problems as part of their work, but the support provided is likely limited by insufficient training and inadequate support.

Mental health and stigma in the medical profession

Until recently, much of the recent upsurge in interest in physician health has been motivated by concerns about improving patient care and patient safety and reducing medical errors. Increasingly, more attention has turned to examining how the management of mental illness among physicians might be improved within the medical profession and one key direction for change is the reduction of stigma associated with mental illness. I begin this article by presenting a brief overview of the stigma process from the general sociological literature. Next, I provide evidence that illustrates how the stigma of mental illness thrives in the medical profession as a result of the culture of medicine and medical training, perceptions of physicians and their colleagues, and expectations and responses of health care systems and organizations. Lastly, I discuss what needs to change by proposing ways of educating and raising awareness regarding mental illness among physicians, discussing approaches to assessing and identifying mental health concerns for physicians and by examining how safe and confidential support and treatment can be offered to physicians in need. I rely on strategically selected studies to effectively draw attention to and support the central themes of this article.