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Physician age and outcomes in elderly patients in hospital in the US

bmj.com

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Re: Physician age and outcomes in elderly patients in hospital in the US

#11

Post by Antrikshy »

carbocation wrote: post #10

I always find it concerning when authors dichotomize a variable without an extremely solid basis for doing so. It reduces statistical power, and it hints of over-mining the data to dredge out an effect. This group of authors is well respected and known for doing studies like this. However, if their chief interest is observing the effect of physician age on patient outcome, physician age should clearly be treated as a…

But sensationalism and page views!

Re: Physician age and outcomes in elderly patients in hospital in the US

#13

Post by npv »

tedmiston wrote: post #3

Could it be that older (more experienced) physicians are more likely to get assigned to patients with more complex or serious conditions? (I don't mean to state the obvious but this wasn't made explicitly clear enough to me.) Edit: My initial comment here is probably wrong based on the detailed section "Adjustment variables": > Patient characteristics included age in five year increments, sex, race or ethnic group (n…

Patient assignment to physicians (at least in internal medicine) is based upon either a rotated call schedule or, in the case of hospitalists, who tend to admit every day that they are on service, is done randomly to keep the different providers' patient load balanced in size.

Re: Physician age and outcomes in elderly patients in hospital in the US

#14

Post by Axsuul »

A similar trend exists with practices which I read about in the book Peak by Anders Ericsson. Older doctors and specialists' performance grew worse over time. Older doctors knew less and did worse in terms of providing appropriate care than doctors with far fewer years of experience.

Re: Physician age and outcomes in elderly patients in hospital in the US

#15

Post by s_gupta »

Sounds like a study with a lot of confounding factors. Example- patients treated in the ICU are more likely to die than those not in the ICU. The confounding factors being the critical condition of the patient. Patients in critical condition are brought to the ICU. The abstract of this paper says that it essentially compares doctors in the same hospital. Is it a stretch to think that senior doctors would see more complex cases.

Re: Physician age and outcomes in elderly patients in hospital in the US

#16

Post by akg_67 »

nihonde wrote: post #5

The news here (Japan) was talking the other day about cases of TB slipping through diagnosis because younger physicians had no experience with it. Older doctors knew what it was right away.

Funny, this reminded me of my own surgery that had complications. My surgeon said that he has done over 200 similar surgeries and I was his first complication. The first thing that came out of my mouth was no wonder you don't know how to handle complications because you have been running around like a headless chicken. In the end, postop complications were addressed by a surgeon half way around the world than the operating surgeon.

Re: Physician age and outcomes in elderly patients in hospital in the US

#17

Post by akg_67 »

gonzo wrote: post #12

It was an older vascular surgeon who found the ascending aortic dissection that the much younger ER attending and hospitalist had both missed. For hours.

It may have do with experience. When you have limited experience, you tend to use all your faculties and guided by logical reasoning. When you have lot of experience, you are guided by past experiences and likely to miss something new, when symptoms are similar to something you have encountered before. Interestingly both my major medical issues were diagnosed by my primar care physician and not by the specialists that I was already working with.

Even in my professional work experience, the new problems that may fall across multiple domains tend to be identified/solved by generalists rather than specialist.

Re: Physician age and outcomes in elderly patients in hospital in the US

#18

Post by badreader »

The way I see it in the field, older doctors are less likely to try and keep terminal patients alive as long as possible and more likely provide just palliative care. You know, instead of intubating 90+ y/o elders that won't get extubated until death.

Re: Physician age and outcomes in elderly patients in hospital in the US

#19

Post by chrisbennet »

I listened to a podcast on this, Freakenomics Radio Bad Medicine Part 3. The takeaway was that newer doctors had better outcomes than older doctors with the exceptions of surgeons.

"JENA: Exactly. So patients more or less end up getting quasi-randomized to physicians with different characteristics. So for example if you happen to get hospitalized in the first week of May, you may be treated by a group of doctors who on average have five years’ less experience than if you happen to get hospitalized in the second week of May. And we can basically see what happens if a patient happens to be treated by a doctor who is 20 years out of residency versus 5 years out of residency. And what we find is that if you happen to be treated by a doctor who is 10 years or 15 years out of residency, your mortality within thirty days of being hospitalized is higher."

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