Wednesday, September 26, 2018

Key Words in Patient Complaints May Point to Physicians With Neurocognitive Disorders

As the number of practicing physicians in the United States over the age of 60 continues to grow, so, too, do the number of questions on how best to identify physicians who may experience neurocognitive disorders. A study in the September issue of the American Journal of Geriatric Psychiatry suggests that the language used in complaints by patients may offer clues about those physicians with probable or possible neurocognitive disorders.

William O. Cooper, M.D., M.P.H., of Vanderbilt University and colleagues analyzed data on 33,814 physicians who practiced in 144 U.S. hospitals, health care systems, and medical groups that participated in the Vanderbilt Patient Advocacy Reporting System (PARS) program from 2014 through 2016. The PARS data includes unsolicited patient complaints attributed to physicians as recorded by each health care organization's patient relations staff.

As part of participation in the PARS program, leaders report on physicians in their organization who have been referred for evaluation based on concerns related to possible neurocognitive disorders (defined as having a deficit in recent memory, executive functioning, social cognition, global functioning, or visuospatial functioning). For the study, Cooper and colleagues compared the words contained in the patient complaints regarding physicians with and without neurocognitive disorders.

Of the 15 physicians identified in the system with evidence of neurocognitive disorders, 11 (73%) had at least one word in a complaint that described potential cognitive impairment (for example, “forget/forgot,” “confuse(d),” “inappropriate”). In contrast, only 8% of age- and sex-matched comparisons and 18% of site- and complaint-matched comparisons were associated with at least one complaint describing potential neurocognitive disorders. Individual words were also all statistically more likely to appear in unsolicited patient complaints for physicians with probable or possible neurocognitive disorders compared with physicians in the comparison groups.

While the authors noted several limitations of the study, including the small number of neurocognitive disorder cases identified, they wrote, “[t]he findings suggest a methodology for determining which older physicians might warrant additional assessments without imposing testing burdens on those who do not … [T]he high risk group would include those older physicians who experience an unusually high number of complaints, a substantial increase in numbers of complaints relative to their baseline, and/or whose complaints include words consistent with potential impairment in domains related to NCD [neurocognitive disorders].”

They concluded, “Like information from any surveillance tool, UPCs [unsolicited patient complaints] suggesting potential impairment should be considered in the context of all available information about the physician to guide whether further evaluation and support may be needed.”

For related information, see the Psychiatric News article “Gabbard Describes Possibilities, Perils for Aging Physicians.”

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