Physician Health Matters

Neuropsychological Testing of Physicians

This article is adapted from an April 24 presentation at the annual meeting of the Federation of State Physician Health Programs.

Throughout a physician’s life, cognitive issues can arise through illness, injury, aging, acute trauma, or other reasons. It is important that physicians experiencing such problems be referred for evaluation to determine treatment options and if there is any impact on their ability to practice. Early symptoms could include, among others, a combination of problem-solving difficulties, memory loss, disorganization, and mood changes.

A neuropsychological evaluation is an assessment of cognitive and behavioral functions using a set of standardized tests and procedures. Functions systematically tested include intelligence, attention, problem-solving skills, organization, judgment, insight, reasoning, memory, language, and visuospatial perception. Emotional functioning, behavior, and personality may also be tested, depending on the purpose of the evaluation and the reason for referral.

The neuropsychologist will also review the physician’s background information (such as personnel and medical records, incident reports, or memos) and conduct a comprehensive face-to-face clinical interview. If deemed necessary by the examiner, collateral interviews with relevant third parties and/or consultations with a specialist such as a behavioral neurologist will take place.

Preparatory Tips
Physicians receiving such evaluations must be given certain considerations.Given the importance and sensitivity of such evaluations, the person ordering the evaluation should:

• Know the neuropsychologist. Lists of providers with special expertise in performing these evaluations for physicians are available.
• Put the referral in writing so the physician being evaluated and the neuropsychologist know the reason for referral.
• Discuss the limits of confidentiality. This type of evaluation may be discussed with third parties, such as hospital personnel or the state medical board, as appropriate.
• Obtain a release from the physician under evaluation prior to consulting third parties. The release should detail the conditions and type of information to be disclosed.

What Testing Entails
A comprehensive neuropsychological examination will provide a precise quantification of various cognitive functions, a profile of deficits and extent of involvement, a profile of strengths useful for rehabilitation, a baseline for future assessments, and a determination of functional status for return to work. In rare situations, the neuropsychological examination can also assist in assessing competency.

In the case of high-functioning individuals such as physicians, the neuropsychologist also needs to consider the individual’s “cognitive reserve.” By virtue of their intellectual abilities and education, physicians typically perform well on cognitive tests. Research has shown that those with higher levels of cognitive reserve tend to find alternate strategies in response to task demands. Consequently, an impaired physician might perform within the normal range on cognitive tests because of the ability to compensate for brain damage or the aging processes. Therefore, the neuropsychologist needs to consider whether the test scores are consistent with the physician’s ability level, rather than merely evaluating the physician against a normative standard.

Back to Work?
There are no specific, empirically derived guidelines for determining if an impaired physician is fit to return to work. However, a few basic principles hold. The first consideration is the protection of the public. Can the physician return safely to his or her job? In some cases, supervision or a transfer to a field that does not involve patient care may be required. If possible, a specific treatment or intervention or monitoring plan will be outlined to remediate the problem, and a re-evaluation will be required to ensure the physician has recovered.

Finally, as physicians age, they will experience more cases of neurodegenerative illness. Therefore, even in the absence of a biological marker, a neuropsychological evaluation is an important tool in determining the cognitive health of a physician.

For more information about neuropsychological testing for physicians, contact Physician Health Services at (781) 434-7404 or www.physicianhealth.org.

– Dorene M. Rentz, Psy.D.,
Division of Cognitive and Behavioral
Neurology, Harvard Medical School