Sunday, April 15, 2018

An occupational living will

My wife says that I love my work too much to ever retire. Perhaps she is right. However, my experiences as a neurologist and clinical director of an Alzheimer center have led me to think a lot about the circumstances under which it would be wise to move on. ...

More specifically, I have begun to develop an “occupational living will,” something akin to a medical advanced directive but expressly intended for one’s professional life. ...

When I was starting out as a young physician, I noticed there were always a few older, formerly very accomplished doctors who would consistently stand up during important meetings and make irrelevant comments that caused me and others to cringe. If I helped to take care of their patients, I was often struck by the mediocre treatment they were providing. At the time, my youthful colleagues and I remained oblivious to the possibility that their fate could ever become ours.

Since then, I have had the opportunity to help care for many previously high-functioning professionals with progressive dementing illnesses. Depending on the stage of the disease and the degree of disruption of brain systems important for self-awareness, patients have widely varied insight into their predicament and appreciation of the impact of their neurological disease on their work. ...

It is estimated that 15 to 20 percent of adults who are 65 years and older suffer from mild cognitive impairment and 10 percent from dementia. ...

I suggest that for adults approaching their 60s or beyond, especially those with no intention of retiring, preparing an occupational living will is a particularly important endeavor. ...

No blueprint exists to guide me in this process, so I have broken down this seemingly overwhelming task into manageable steps:

1. Crafting a written document articulating advanced directives for work that represent a personal commitment to how, depending on my cognitive status, I would want to comport myself in the future.

2. Sharing the document with others I trust, who can support me through this process.

3. Recording a video that communicates my wishes and can be used to speak to my future self.

4. Identifying a few peers or colleagues I can confide in, who can access my work and make a fair and reasonable assessment of my functioning.

5. Explicitly empowering these individuals to share their observations with me.

6. Finally, if concerns are raised, having a plan in place for evaluating — via formal assessment by a cognitive neurologist or geriatric psychiatrist — whether my decline exceeds the bounds of normal aging and is truly worrisome.
--Harvard Professor of Neurology Kirk Daffner, Washington Post, on a professional commitment device