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Does Practice Really Make Perfect for Doctors?

An old man's experience Vs a young surgeon's precise hands.

by
Theodore Dalrymple

Bio

May 4, 2013 - 7:00 am
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Does practice really make perfect? Does it even lead to improvement? One feels instinctively that it should, that the more experience a physician has, the better for the patient. Much of the skill of diagnosis is pattern-recognition rather than complex intellectual detection, and it follows that the longer a physician has been at it, the quicker he will recognize what is wrong with his patients. He has experience of more cases than younger doctors to guide him.

But the practice of medicine is more than mere diagnosis. It often requires manual dexterity as well, and the ability to assimilate new information as advances are made. These may decline rather than improve with age. Too young a doctor is inexperienced; too old a doctor is past it.

A recent paper, whose first author comes from the Orwellianly named Department of Veterans’ Affairs Center for Health Equity Research and Promotion, examined the relationship between the years of an obstetrician’s experience and the rate of complications the women under his care experienced during childbirth. The authors examined the records of 6,705,311 deliveries by 5,175 obstetricians in Florida and New York. No one, I think, would criticize the authors for the smallness of their sample.

They examined the rate of serious complications such as infection, haemorrhage, thrombosis, and tear during or after delivery, divided by obstetrician according to his number of years of post-training experience. Reassuringly, and perhaps not surprisingly, experience reduced the number of such complications decade after decade. The rate of complications was 15 percent in the first ten years after residency; it declined by about 2 percent to 13 percent in the first decade thereafter, by about 1 percent in the subsequent decade to 12 percent, and by  half a percent in the next. In other words, improvement continued, but less quickly as the obstetricians became more experienced; the authors appear not to have continued their study to the age at which the rate of complications started to rise again (if indeed there is such an age).

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Top Rated Comments   
Perhaps, as doctors become more experienced, they become more picky; the new guy on the block with a zillion dollars of unpaid loans is hungry, and takes on all comers. The older, more experienced doc learns to avoid high risk patients.
That's one of the benefits of our wonderful malpractice industry.
1 year ago
1 year ago Link To Comment
There's a lot to be said for old doctors as well as young ones, as in every profession. Experience and judgement versus stamina and acuity.

I had three (!) young doctors misdiagnose my daughters continuous high fever. My father suggested taking her to his, much older, doctor. He looked at for one minute and said, 'She's got meningitis' then promptly put her in the ICU. She's almost certainly alive today because of his experienced eye. So here's to older doctors!
1 year ago
1 year ago Link To Comment
All Comments   (21)
All Comments   (21)
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A fantastic neurosurgeon once told me how to shop for a surgeon to do a complex procedure. Don't just look at numbers or years. Look as well at the philosophy regarding the entire surgical team at different facilities. The best ones, even though their record may not be the best, (those that tackle the worst and toughest may have deceiving success rates) are at those research and teaching hospitals where the entire team for a given procedure has performed the procedure together as a team many times.

I believed him then, and I still do.
1 year ago
1 year ago Link To Comment
I can assure you from personal experience the the most important thing in medicine...especially surgery...is not knowing what to do...but...KNOWING WHAT NOT TO DO.......and that ONLY comes with experience...10 or 15 years.. ;-)
1 year ago
1 year ago Link To Comment
been working 20 years fixing bones and feel i am better now than ever in my life. partly by not doing the things i am not as good at and honing the skills where i am really good.
1 year ago
1 year ago Link To Comment
Half of the docs graduated in the lower half of their class.
1 year ago
1 year ago Link To Comment
Perhaps, as doctors become more experienced, they become more picky; the new guy on the block with a zillion dollars of unpaid loans is hungry, and takes on all comers. The older, more experienced doc learns to avoid high risk patients.
That's one of the benefits of our wonderful malpractice industry.
1 year ago
1 year ago Link To Comment
very good point. low man on the totem pole gets more call and so more women with no prenatal care who show up to deliver a baby.
1 year ago
1 year ago Link To Comment
Dr. Sean "the Butcher" Scott (the youngest doctor in a local practice) worked on me, when I was down and out. I was referred to a second specialist to fix the damage he had done and do the job correctly.

You get what you pay for.
1 year ago
1 year ago Link To Comment
Such findings corroborate the idea that the practice of medicine is an Art, rather than a Science.

As Obamacare hammers its way into our lives and onto our nation, expect a lot of our older Artists to get out of Dodge.
1 year ago
1 year ago Link To Comment
There's a lot to be said for old doctors as well as young ones, as in every profession. Experience and judgement versus stamina and acuity.

I had three (!) young doctors misdiagnose my daughters continuous high fever. My father suggested taking her to his, much older, doctor. He looked at for one minute and said, 'She's got meningitis' then promptly put her in the ICU. She's almost certainly alive today because of his experienced eye. So here's to older doctors!
1 year ago
1 year ago Link To Comment
looking at things statistically is not always best. for diagnosis, more patient contacts, more pathology seen, more likely to be right.
the new doctors would have been more up to date when your daughter got to the ICU, i suspect
1 year ago
1 year ago Link To Comment
Always liked the "gray hairs" in medicine.
1 year ago
1 year ago Link To Comment
Let the market decide. If it's true that doctors in their sixth decade are objectively the best let them charge accordingly. If all you can afford is the young guy, well, he beats a government-paid nurse practitioner (although maybe not if she's been practicing for 40 years).

1 year ago
1 year ago Link To Comment
Da Gubbmint won't allow a higher professional fee for experience... :(
1 year ago
1 year ago Link To Comment
Plenty of experienced RNs that I would trust over wet behind the ears greenhorns.
1 year ago
1 year ago Link To Comment
Dead bodies per year per indivisual doctor would be a useful metric.
1 year ago
1 year ago Link To Comment
right....never take a complicated case...
1 year ago
1 year ago Link To Comment
no it wouldn't. an opthamologist should never lose a patient. a trauma surgeon or oncologist might lose half and still be the best in the business.

funny though.

1 year ago
1 year ago Link To Comment
Even in high risk fields, some doctors will have a better batting average than others-or a lower body count. Caveat emptor.
1 year ago
1 year ago Link To Comment
i'm well aware of that, having been one. but body count alone is too simplistic. your original comment was amusing. try too hard to make too much of it and you lose the humor and the point.
1 year ago
1 year ago Link To Comment
The point is obvious. Iatrogenic deaths( doctor caused deaths ,for those without training in Greek) are not funny,as you are well aware. If you stopped laughing,perhaps you got the point. You can't tell the good players without a scorecard.
1 year ago
1 year ago Link To Comment
Body count is an unreliable metric. My father-in-law was a well-respected neurosurgeon but, especially before today's advanced imaging and microsurgery, lost many patients. If he had referred all his difficult cases to a distant medical center, he would have had a higher survival rate. With Obama care, the quality of medicine will decline as the costs increase. Socialized medicine was sold on the lie of greater access and quality at lower cost, but it has already driven premiums skyward. When fully implemented, it will encourage experienced doctors to quit, discourage young people from choosing medicine as a career, and bring all the usual frustrations attendant to dealing with a huge bureaucracy.
1 year ago
1 year ago Link To Comment
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