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February 15, 2005

BehindTheMedspeak: Are older doctors dangerous?


Today's USA Today greeted me with a story by Liz Szabo headlined, "Older Doctors Try To Keep Up."

The gist of the article is that older is not better when it comes to your doctor.

For example, in a 2000 study of heart attack victims, mortality rates rose 1% for every two years since a patient's doctor graduated from medical school.

The newspaper's story is based on the results of a new study reported in today's Annals of Internal Medicine.


Should I hang up my stethoscope, I wonder?

As regards the practice of anesthesiology, the issue of knowledge v experience is a most interesting one.

Not only because an anesthesiologist's error can kill you, rather than simply keep you from getting better quite as quickly.

The way I look at it, I never knew more anesthesia-related information than on the day I took my oral anesthesiology board examination, way back in the early years of the last century.

But my experience now, after more than 25,000 anesthetics given (and still without ever having been sued, knock on wood), is immensely greater than when I was a board-certified smartypants–neophyte.

I can solve problems now without even having to think about them, because I've seen them before: recognition is 9/10 of remedy, is how I put it.

So, all things considered, I think a person is safer going under now with me at the anesthesia machine controls than back in the day.

But then, I'm sure I'll say the same thing when I'm walking into walls instead of through doorways.

Here's the thought–provoking USA Today story.

    Older Doctors Try To Keep Up

    Older doctors are less likely to practice according to the latest medical standards than physicians fresh out of school, according to an analysis in today's Annals of Internal Medicine.

    Researchers who reviewed 59 previously published studies were surprised to see that more than 70% showed declines in performance over time, says the lead author, Niteesh Choudhry, a Harvard Medical School instructor.

    In a 2000 study of heart attack patients, for example, mortality rates rose by 1% for every two years since a patient's doctor graduated from medical school.

    The problem is not aging but the challenge of keeping up to date with rapidly evolving medical science, Choudhry says.

    Traditionally, older doctors based decisions largely on training and experience.

    Younger physicians are being trained to practice "evidence-based medicine," in which they prescribe drugs and treatments that reflect the results of large clinical trials.

    Younger doctors also are often more comfortable searching the Internet and using handheld computers and electronic medical records, which can remind doctors about routine screening tests or flag drug interactions.

    In some cases, younger doctors also must meet more rigorous standards.

    In the field of internal medicine, which is the specialty that deals with adults, only doctors initially certified since 1990 are required to take additional board exams every few years.

    Doctors certified before then are exempt.

    Older physicians have a wealth of experience that younger ones lack, Choudhry acknowledges.

    Older doctors also might have strong relationships with longtime patients.

    None of the studies in his analysis asked patients whether they were happy with their care, he noted.

    Yet Mary Frank, president of the American Academy of Family Physicians, says the article shows that the medical profession needs to find better ways to help doctors stay current.

    The study also shows that doctors should evaluate their own work, says Maureen Padden, an AAFP board member who practices at Naval Hospital Camp Lejeune in North Carolina.

    "This is the future of medicine," Padden says.

    "Medicine has got to move into the next generation, with lifelong learning, lifelong self-assessment and lifelong improvement."

February 15, 2005 at 12:01 PM | Permalink


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Gotta tellya, Joe, the thought of going under for surgery scares the hell out of me -- but if I had my choice of anesthesiologist, you'd be #1 with a bullet: it's pretty obvious that in addition to lots of experience, you keep up with developments in the field. And I'll bet that a lot of other doctors are like that too, just by their nature.

But I've often wondered how many doctors, having graduated from med school in, say, 1980, and settled into private practice in Smallville, Kansas, are still practicing medicine as it was practiced 25 years ago?

Posted by: Craig | Feb 17, 2005 3:18:18 PM

It's not your age alone that counts.
Saturday last, the NYT had an article about a 73 year old man running marathons in less than 3 hours. I recently watched 74 year old Lorin Maazel conduct the NY Philharmonic with over 100 musicians on the stage. I'm years younger and wonder where his stamina comes from.
Yes, there are competency issues that our current licensing systems do not adequately address, but they exist in physicians of all ages.
See recent posts on my weblog under "Physician Competency" (Feb 11th), and "Working to Seventy" (Feb 15th).

Posted by: Ivo Drury | Feb 15, 2005 10:10:04 PM

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