Dr Philip Morris AM
June 2023
The Inappropriateness of Mandatory Cognitive Testing of All Doctors Age 70
Introduction
The proposal to introduce mandatory cognitive testing for doctors at the age of seventy has raised concerns about its appropriateness, fairness, and effectiveness. This article argues that such a proposal is not supported by evidence and amounts to ageism, akin to racial profiling. While ensuring patient safety is crucial, there are already established mechanisms in place to assess doctors of all ages for medical conditions that may impact their cognitive abilities. This article examines the lack of evidence for significant cognitive impairment among healthy aging doctors and highlights the need for a more targeted and fair approach to ensure public safety without resorting to age profiling.
The Parallels with Racial Profiling
To understand the inappropriateness of mandatory cognitive testing for all doctors age 70, we can draw parallels with racial profiling. Racial profiling is a discriminatory practice that relies on stereotypes about race, colour, ethnicity, or religion to subject individuals to greater scrutiny or different treatment without reasonable suspicion. Similarly, age profiling, as proposed by medical registration authorities, is discriminatory and based on an unjustified stereotype about older doctors.
Lack of Evidence for Cognitive Impairment in Healthy Aging Doctors
There is no substantial evidence to suggest that healthy aging among doctors is associated with significant cognitive impairment that would affect patient care. Studies have shown that older physicians perform as well as younger physicians on various measures, including patient mortality rates, adherence to guidelines, diagnostic accuracy, and patient outcomes. Medical indemnity insurers also do not impose age-related increases in premiums, indicating that age alone is not considered a significant risk factor for medical practice. Furthermore, doctors known to Health Committees of Medical Boards, who have impairments based on underlying medical conditions, do not show a significant difference in the proportion of doctors over the age of sixty compared to other age groups.
Balancing Changes in Cognitive Capacities
Cognitive capacities change over time, with fluid intelligence gradually declining while crystallized intelligence, which encompasses experience, pattern recognition, and knowledge, tends to improve. The balance between these changes generally results in minimal overall cognitive decline in healthy aging doctors. Consequently, there is little evidence to suggest that these changes impair the capacity of older doctors to function effectively in clinical practice.
Alternative Approaches
Rather than resorting to age profiling, medical boards can employ more targeted approaches to address potential risks posed by cognitive impairment in doctors. These include evaluating doctors with multiple complaints made against them, regardless of age, as this group has shown a higher likelihood of health or cognitive problems. Additionally, evaluating doctors’ cognitive and health status after significant lapses in the standard of care can be a more objective and fair assessment method, applicable to doctors of all ages.
The Value of Retaining Older Doctors in the Workforce
There are several reasons why older doctors should continue practicing and can be of great assistance to the medical profession:
- Experience: Older doctors have a wealth of experience that they have gained over the years of their practice. This experience is invaluable in making clinical decisions, diagnosing complex cases, and providing expert advice to younger doctors.
- Mentoring: Older doctors can serve as mentors to younger doctors, passing on their knowledge and experience to the next generation of medical professionals. They can provide guidance, support, and advice to help younger doctors develop their skills and expertise.
- Continuity of care: Older doctors often have long-standing relationships with their patients. These relationships are built on trust, respect, and a deep understanding of their patients’ medical history and needs. This continuity of care is crucial in providing the best possible outcomes for patients.
- Patient advocacy: Older doctors can be strong advocates for their patients. They have the experience and knowledge to navigate the healthcare system and ensure that their patients receive the best possible care.
- Research: Older doctors can contribute to the medical profession by participating in research studies and clinical trials.
Older doctors have a lot to offer the medical profession. Their experience, mentoring skills, continuity of care, patient advocacy, and research contributions are invaluable. By continuing to practice, older doctors can help to improve patient care and contribute to the advancement of medical knowledge.
Conclusion
Mandatory cognitive testing of all doctors age 70 is an inappropriate and discriminatory practice. There is insufficient evidence to support the notion that healthy aging doctors pose a significant risk to patient care. Age profiling undermines the principles of fairness, equality, and individual assessment. Instead, medical registration authorities should focus on targeted assessments based on reasonable suspicion, such as evaluating doctors with multiple complaints or significant lapses in the standard of care. By adopting fair and evidence-based approaches, we can ensure patient safety without resorting to ageism or age discrimination in the medical profession.
Dr Philip Morris AM