Thursday, June 8, 2023
This activity is intended for all physicians.
The goal of this activity is to analyze how to respond ethically and effectively to suspected cognitive impairment among physicians.
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CME Released: 11/14/2013; Reviewed and Renewed: 11/17/2017
Valid for credit through: 11/17/2018
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This case study is one in a series of case histories with commentaries by the American College of Physicians (ACP) Ethics, Professionalism and Human Rights Committee and the Center for Ethics and Professionalism. The series uses hypothetical examples to elaborate on controversial or subtle aspects of issues not addressed in detail in the College's Ethics Manual, the Physician Charter on Professionalism, or other College position statements. The sixth edition of the ACP's Ethics Manual, the Physician Charter, and additional College policies on ethics, professionalism, and human rights issues are available at http://www.acponline.org/running_practice/ethics/ or by contacting the Center for Ethics and Professionalism at 215/351-2839.
Dr. Jamison, a 73-year-old internist, has long been a respected physician in the community. Yesterday morning, his patient, Ms. Swenson, arrived at the hospital's emergency department complaining of shortness of breath. The emergency department admitted her for follow-up testing. Dr. Randall, a younger physician on staff, is covering for Dr. Jamison today. In reviewing Ms. Swenson's chart, he notes that although Dr. Jamison had seen his patient on the floor following her admission, he had not ordered an electrocardiogram or other appropriate follow-up tests. Dr. Randall comments about this to the nurse on the unit, who then confides that during the past several months, she and several other nurses on the floor have noticed moments when Dr. Jamison has seemed confused and did not know where he was supposed to go. That reminds Dr. Randall of a recent committee meeting at which Dr. Jamison had difficulty following the discussion. When a committee member half-jokingly said, "Hey, Bill, pay attention," Dr. Jamison laughed it off saying he had been up late reading about a difficult case.
Dr. Randall is concerned that Dr. Jamison may be experiencing an impairment affecting his clinical ability and that his patients may be at risk. He is understandably uncomfortable at the prospect of confronting a well-respected senior colleague about the quality of the medical care he is providing. However, if, as he suspects, Dr. Jamison's episodes of confusion and forgetfulness are due to age-related cognitive decline, impairment will likely continue. How should he proceed?
