title: Physician don't heal thyself: a descriptive study of impaired older doctors.
abstract: BACKGROUND
  The growing and welcome interest in the issues leading to distress and impairment in younger doctors has not been mirrored by a focus on the similar issues in older doctors which is surprising given the aging medical workforce.
  
  
  OBJECTIVE
  To improve understanding of impairment in older doctors and to facilitate the planning of primary prevention strategies.
  
  
  METHODS
  Consecutive case records of notifications to the Impaired Registrants Program of the New South Wales Medical Board, Australia, of doctors over 60 years from January 2000 to January 2006 (N = 41) were examined. Details of demographics, type of practice, nature of referral, medical morbidity, cognitive examination, psychiatric diagnosis and outcome of assessment were recorded.
  
  
  RESULTS
  Impaired older doctors suffered cognitive impairment (54%), substance abuse (29%) and depression (22%) and 17% had two comorbid psychiatric conditions. Twelve percent had frank dementia. Two work patterns--the "workhorse" and the "dabbler"--were observed, as was a culture of postponed retirement due to a sense of obligation and working "until you drop." Impaired older doctors were found to have higher chronic illness burden compared with community norms. Almost half were the subject of patient complaints or of poor performance within ten years of presentation.
  
  
  CONCLUSIONS
  To our knowledge there has been no other comprehensive examination of patterns of impairment in older doctors. Older doctors are prone to suffer "the four Ds": dementia, drugs, drink and depression. We need to encourage mature doctors to adapt to age-related changes and illness and validate their right to timely and appropriate retirement.
authors.affiliation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia. cpeisah62@optusnet.com.au
authors.forename: C
authors.initials: C
authors.lastname: Peisah
authors.forename: K
authors.initials: K
authors.lastname: Wilhelm
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008007:Licensure, Medical / Q000331:legislation & jurisprudence / Q000592:standards; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010815:Physician Impairment / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D011322:Primary Prevention; D012042:Registries / Q000706:statistics & numerical data; D012179:Retirement; D013038:Specialization; D019966:Substance-Related Disorders / Q000453:epidemiology