Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

bmj.com

Post reply on HN
Print view View original

21–30 of 43 posts

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

#21

Post by Lordarminius »

In my experience, older doctors simply... get old.

They lose enthusiasm and energy. They are inclined to study less. They perform fewer procedures due to diminishing motor, visual-spatial and cognitive skills. They suffer the same ailments as their patients - hypertension, diabetes, arthritis, dementia; divorce, overwork, errant children (that's a whole category of grievance and burden !) as well as sundry personal issues.

There is the drudgery. Paperwork. After a few decades you have seen it all: the rare cases don't excite as much. They are just another presentation of the human condition.

Finally,medicine is a hierarchical discipline, younger practitioners are discouraged from questioning (dubious) decisions made by their seniors.

Older practitioners compensate for these deficits with an accumulated body of experience that a younger doctor simply does have.

The best age(s) to be a doctor is mid-thirties to early fifties. Just like most other professions.

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

#22

Post by manmal »

akg_67 wrote: post #16
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 ope…

I don't get the phrase you used, "running around like a headless chicken" - do you mean the doc did not pay attention to postop complications?

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

#25

Post by DanBC »

chrisbennet wrote: post #19

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…

Another exception might be obstetricians.

http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14649/f...

"The effect of senior obstetric presence on maternal and neonatal outcomes in UK NHS maternity units: a systematic review and meta-analysis"

> Fifteen studies fulfilled the inclusion criteria, presenting data from 125 856 births. Overall, there was no significant difference between lesser and increased consultant presence for any outcome. When data were stratified by comparison type, the likelihood of emergency caesarean section was significantly lower (odds ratio, OR 0.91; 95% confidence interval, 95% CI 0.86–0.96) and the likelihood of non-instrumental vaginal delivery was significantly higher (OR 1.07; 95% CI 1.02–1.12) when the rostered hours of consultant presence per week were increased.

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

#26

Post by Lordarminius »

akg_67 wrote: post #16
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 ope…

> 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.

I daresay you drew the wrong conclusions from this incident. All things being equal, a doctor with more experience and a lower rate of complications should be your preferred choice for any medical procedure.

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

#27

Post by Lordarminius »

chrisbennet wrote: post #19

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…

In my experience older physicians (internists in American lingo) and pediatricians trump younger ones any day.

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

#29

Post by walshemj »

s_gupta wrote: post #15

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 com…

Why? if its a realy serious case maybe a junior doctor might pass it on to a more senior one

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

#30

Post by appleflaxen »

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…

great point. they mention the same thing here:

Physician age was modeled both as a continuous linear variable and as a categorical variable (in categories of can you explain what it means? Specificially, how does making it categorical allow for it, and keeping it continuous prevent it?

Any ideas?

Post reply on HN