Many of the reasons for impaired physician performance (such as physical illness, substance abuse, or psychological difficulties) will not affect all physicians, but all who are fortunate enough to reach an advanced age will have to struggle, sooner or later, with its effects on their work, notes Richard B. Gunderman, MD, PhD, associate professor of philosophy, vice chair of radiology, and director of pediatric radiology at Indiana University– Purdue Univers ity, Indianapolis.
As part of a group presentation called The Problem Physician, he spoke at the RSNA meeting on November 26, 2007, in Chicago, Ill. His topic was the older physician.
The two primary areas of agerelated decline affecting radiologists’ work are cognitive and visual, Gunderman says. Recent research, he explains, has not only clarified the physical processes of aging, but pointed toward steps that can be taken to lessen its effects. He adds that not all of the consequences of aging are misfortunes; for example, the command of vocabulary increases throughout life and does not appear to be reduced with age, at least until the age of 70 and probably beyond it.
General knowledge also improves with experience. For example, as Gunderman puts it, one may not come up with the answers to Jeopardy questions quickly, but the number of correct answers will continue to increase over time. Occupational expertise is maintained with age, and can even be improved.
Despite these benefits, aging also brings with it some less pleasant effects. In the cognitive arena, declines in ability begin around age 25. Of course, this also implies that most practicing radiologists have been coping with such declines successfully ever since residency. Short-term (or working) memory begins to decline at the same time, but the decrease in ability accelerates with advancing age. Multitasking becomes more difficult with age, and reasoning speed decreases.
Fortunately, much of the cognitive slack is taken up by what Gunderman calls crystallized intelligence: the learning and use, over time, of a great deal of information concerning one’s profession and other pursuits continue to increase until one reaches the age of 60, 70, or even more. Gunderman states that much of what is perceived as agerelated decline is actually avoidable and is due to disuse, especially following what he describes as the curse of retirement.
For radiologists, the loss of visual power over time can be particularly troubling; after all, Gunderman says, there are no practicing blind radiologists. With aging, some of the refractive ability of the cornea is lost. Of people older than 60 years, 96% exhibit reduced transparency of the eye’s lens, and the retina receives only a third as much light as it does in a 20-year-old person.
The ability to adapt visually, both to glare and to darkness, is reduced with age. Not all effects are limited to the eyes themselves: in the brain, aging is associated with changes in the processing of images by the cortex. Knowing that these are common circumstances suggests adaptations that can be helpful in addressing declining visual performance among physicians.
For those who hope to retain (and build on) the cognitive abilities of their youth, Gunderman recommends taking a lesson from research done with mice, in which an enriched environment (with toys, littermates, and daily challenges) has been shown to improve problem solving and memory. Enrichment even causes cellular changes in the brain, promoting the development of brain cells and enhancing the connections among them. Gunderman says that health systems, hospitals, and radiology departments should try to be enriched environments for humans in order to produce the same benefits.
Another strategy is avoiding the tendency, promoted by aging, to solve problems using the first solution considered (premature closure). Awareness itself can reduce this problem by reminding one to consider alternative solutions as well. Practices can be structured to reduce multitasking and promote focus. Cognitive decline can also be reduced or prevented— to such a degree that the subject performs as well as someone 14 years younger—through daily learning and problem solving (cognitive activity), through working and playing with others (social activity), and through combining exertion and skill (physical activity).
Because physicians are in short supply, Gunderman says, each one should be regarded as a health care resource, and each should