Neuropsychological profile of impaired physicians involved in litigation

808 Abstracts / Archives of Clinical Neuropsychology 16 (2001) 697–862 examining the relationship between verbal fluency and confrontation naming, as measured by the Boston Naming Test (BNT). Therefore, the purpose of this investigation was to examine whether BNT performance is differentially associated with performance on phonemic and category fluency tasks. Subjects included inpatients and outpatients (N = 534) referred for neuropsychological evaluation. Patients were grouped according to the difference between age- and education-corrected T scores for category and phonemic fluency (below one S.D., within one S.D., and greater than one S.D.). ANOVA revealed that patients with better-category-than-phonemic-fluency outperformed patients with betterphonemic-than-category-fluency ( P = .009) on the BNT. Patients with better-category-than-phonemicfluency also showed a trend to outperform patients with relatively equal performances on phonemic and category fluency ( P = .055). The results of this investigation are consistent with previous studies and clinical observation that compared with phonemic fluency, category fluency may be more related to language/semantic functions. In addition, the current investigation demonstrated that in this sample, BNT performance was significantly associated with patterns of performance between phonemic and category fluency, regardless of overall level of performance. Referring physicians’ perceptions of the neuropsychological evaluation: how are we doing? Tremont G, Westervelt HJ, Podolanczuk A, Javorsky D, Stern RA Clinical neuropsychologists often serve as consultants to physicians. However, very little is known about physicians’ perceptions of the neuropsychological evaluation. Therefore, the present study examined the opinions of physicians who referred patients for neuropsychological evaluation. Surveys were mailed with the neuropsychological report to all physicians who referred patients to an outpatient hospital-based neuropsychology practice over 1 year. Physicians were instructed to respond to questions specifically for the patient they had referred. Of the 270 surveys mailed, 130 were returned, reflecting a 48% return rate. The frequency of referring physicians’ specialties were as follows: neurologists (37%), psychiatrists (27.8%), internists (23%), neurosurgeons (3.7%), and others (8.5%). The return rates did not significantly differ by specialty, ranging from 44% for neurology to 55% for internal medicine ( P = .73). Physicians reported that the most common reasons for referral were to establish a diagnosis (53.8%), to confirm a diagnosis (23%), and to establish baseline functioning (14.6%). The majority of physicians rated the evaluation and report as very useful (84%) or mostly useful (15.3%). Similarly, 94.7% of physicians stated that they were very likely to refer again. The majority of physicians strongly agreed or mostly agreed with the neuropsychologists’ diagnosis (99%) and recommendations (98%). Again, there were very similar satisfaction and agreement ratings among the different medical specialties. Overall, the present study demonstrates that physicians referring patients for neuropsychological evaluations commonly seek assistance with diagnosis, and they report a high level of satisfaction with the evaluation, including strong agreement with diagnosis and recommendations. FORENSIC Neuropsychological profile of impaired physicians involved in litigation Crean RD, Williams BW, Ozer S, Hickman S, Perry W Medical malpractice claims and disciplinary actions are on the rise, leading to a recent interest in physicians’ neuropsychological functioning as an attempt to elucidate causes of medical error. In the Abstracts / Archives of Clinical Neuropsychology 16 (2001) 697–862 809 present study, we assessed physicians who were referred by the Medical Board and the Attorney General’s Office as a result of an allegation of impaired performance. This cohort of demographic and neuropsychological data on impaired physicians can be a useful comparative sample for other forensic populations. Two hundred physicians were assessed and divided into two groups based on whether English was their primary language. All participants were assessed with a comprehensive neuropsychological battery, which included select subtests from the WAIS-R, the Reading subtest from the WRAT-III, the Neuropsychological Screening Battery (NSB), the California Verbal Learning Test (CVLT), and the Category Test. All WAIS-R scores were converted to age-corrected T scores. In general, both groups of physicians scored in the average range of intellectual functioning. Both groups demonstrated low average performance on the WAIS-R Picture Arrangement and Trails A, relative deficits on verbal and nonverbal learning, and poor performance on the Category Test. As expected, the results showed significant differences between physicians based on their primary language. These results suggest that, in general, ‘‘impaired’’ physicians are average in cognitive functioning. Understanding the nature of their relative impairments may be useful in developing continuing education programs, as well as providing a comparative sample for other forensic populations. Age effects on WMT performance in disability-related assessments Gervais R, Green P, Ford W The Word Memory Test (WMT) is increasingly being used in disability or compensation assessments of persons with musculoskeletal injuries or chronic pain. This study examined the effect of age on WMT performance in a sample of 561 persons referred for pain or disability-related psychological assessment or management. The sample was 55% male, age was 38.5 years (S.D. = 10.2), and education was 11.8 years (S.D. = 2.4). Age was negatively correlated with the WMT effort and memory measures: IR (r = .186), DR (r = .175), Cons (r = .201), MC (r = .285), PA (r = .330), DFR (r = .224), and LDFR (r = .268). The sample was broken down into 10-year age brackets between ages 20 and 70. ANOVAs revealed significant between-groups differences on all WMT subtests ( P < .0005). However, the magnitude of the effect was small and clinically insignificant. The mean effort measure scores for each age bracket were between 8.6 and 16.7 points above the cutoff for biased responding based upon STBI norms. The effort measure scores minus 2 S.D. were still above the cutoff for all age ranges except the Consistency subtest for the 60 and older age group. The results of this study suggest that the conventional WMT cutoff scores for biased responding are appropriate for use with persons presenting for disability or compensation-related assessments due to chronic pain or musculoskeletal injuries. Caution should be used when interpreting the WMT Consistency subtest score in people over 60 years of age. Effect of pain location and litigation status on neuropsychological test performance Gontkovsky ST, McSwan KL, Holmquist L, Mattingly ML, Perachio N, Beatt (...truncated)