Cognitive difficulty in physicians

Purpose. Remediation of some incompetent physicians has proven difficult or impossible. The authors sought to determine whether physicians with impair ed competency had neuropsychological impairment sufficient to explain their incompetence and their failure to improve with remedial continuing medical education (CME). Method. During a one-year period, 1996-97, all 27 participants in the Physi cian Review Program (PREP) conducted at McMaster University, a physician co mpetency assessment program, undertook a detailed neuropsychological screen ing battery. Results. Nearly all physicians assessed as competent also performed well on the neuropsychological testing. However, a significant number (about one t hird) of the physicians who performed poorly on the competency assessment h ad neuropsychological impairments sufficient to explain their poor performa nces. The difficulties were more marked in elderly physicians. Conclusion. A significant minority of incompetent physicians have cognitive impairments sufficient to explain both their incompetence and, probably, t heir failure to improve with remedial CME. Testing physicians for these imp airments is important: to detect and treat reversible conditions, to manage irreversible conditions that preclude successful educational intervention, and to facilitate compensation in this instance. Serious consideration sho uld be given to the incorporation of neuropsychological screening in all in tensive physician review programs.