Our leaders need more cognitive testing

Cognitive testing for many professions is being implemented or being considered.  Motor skills and reflexes decline with age, and that is why commercial airline pilots have a mandatory retirement age.  In my own profession, the practice of medicine, this is under serious review.

An article published in the Journal of the American Medical Association (JAMA), 1/14/2020, addressed this issue.  The authors, Leo Clooney, M.D. and Thomas Bakezac, M.D., studied physicians at Yale University and their cognitive abilities.  Their study was entitled "Cognitive Testing of Older Clinicians Prior to Recredentialling."  Their focus was on doctors aged 70 or older, and they found that 57% of these older physicians passed the testing just fine.  Many physicians had some minor cognitive defects with memory.  But 12.8% had enough cognitive defects to raise questions about their ability to safely practice medicine.

This is not the final word on this subject, and we, as a profession, are very defensive about our abilities.  Actually, I welcome this testing because I want to know if I am beginning to decline.

The average physician may be healthier than much of the public.  We, as a group, are probably less likely to be heavy smokers or have dangerous contact sports injuries.  We exercise our brains every day with a myriad of analysis, assessment, and decision-making.  These skills are honed over time, and one can argue that wisdom should be part of the assessment.  But without a good memory, wisdom is in short supply.  At stake is the welfare of our patients.

Although electronic medical records help to prevent medication errors, there can still be fatal errors.  And telemedicine has many pitfalls because of the inability to personally do a physical exam and observe the whole patient.  Telemedicine may seem like a nice transition for the older physician, but it is a malpractice suit just waiting to happen.  We owe it to our patients to be the best that we can be, in person.  For now, it remains difficult to determine just who is impaired enough to mandate retirement, but the difficult questions are being asked.

There have also been queries about testing lawyers, judges, and politicians.  Almost half of the members of the U.S. Senate and House are over 65.  If we use the Yale study of doctors, within five years, 12.8% of them will be cognitively impaired.  Many would cynically say they are often not playing with a full deck, but we have no data from testing.

The Supreme Court tends to be much older, and the discussion about their mental acuity has been off limits thus far.  But, I contend, we need to be very concerned about the cognitive ability of our presidents.  The mental and physical demands of the office can exhaust a young man.  Donald Trump works up to 20 hours per day and seems to have almost boundless energy.  He has passed his cognitive test with flying colors.  We get the impression that Joe Biden is in mental decline.  He is often forgetful and loses his train of thought.  We should demand he have a cognitive test.  Should we sit idly by while a possibly mentally impaired president is trying to negotiate with Xi Jinping, Vladimir Putin, or Kim Jong-un?  Will he be able to negotiate trade deals or be able to thwart military threats from our enemies?  Will he even know if his every decision is circumvented by the "power behind the throne"?

The welfare of 330 million Americans is at risk, and much of the free world.  America needs a leader and not a puppet.  What I would say to Joe is, "Come on, man, man up and get tested."

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