Challenging cognitive cases among physician populations: case vignettes and recommendations

Area of Science:

• Medical Science
• Neurology
• Psychiatry

Background:

• Physicians can experience cognitive impairment, posing risks to practice.
• Objective evaluation and screening guidelines are needed but lack published data.
• Physician health programs (PHPs) encounter physicians with cognitive issues.

Purpose of the Study:

• To describe presentation characteristics of cognitive impairment in physicians.
• To provide tailored evaluation recommendations for impaired physicians.
• To inform diagnostic and management strategies within PHPs.

Main Methods:

• Retrospective review of 124 physician cases in a PHP.
• Analysis of cognitive impairment domains and contributing factors.
• Case highlighting through descriptives and clinical vignettes.

Main Results:

• Four primary impairment domains: brain diseases (48%), mood/anxiety/side effects (28%), substance use (9%), TBI (7%).
• Age was not a reliable predictor; Montreal Cognitive Assessment showed a ceiling effect.
• Impairment did not consistently predict poorer outcomes post-care.

Conclusions:

• Physician cognitive evaluations require diverse secondary sources, especially vocational reports.
• Diagnosis can be lengthy; initial assumptions may mislead referrals.
• PHPs must carefully manage cognitive cases, addressing clinical and psychosocial facets.