The Myth of the Battle-Tested Veteran Doctor?
This is a concept that may less evident to us "older" physicians than to the interns and residents that some of us teach. It may be even less evident to patients. So much for the benefit of experience.
We expect this in Olympic gymnasts but in physicians? Before patients fire their gray-haired doctors, perhaps a little perspective is in order.
The authors reviewed 59 articles in the academic literature that evaluated the benefit of clinical experience (generally estimated by length of practice) on 62 "outcome" measures. These measures were grouped as knowledge base (the ability to answer specific questions in their field), adherence to modern standards of practice for the diagnosis, screening and prevention of disease, adherence to standards of treatment of disease and most controversially, "outcomes".
A formal meta-analysis (a statistical conglomeration of different studies) was not done due to the heterogeneity of the study methods. The overall conclusion was that the further a physician gets from his or her training, the lower the overall quality of care.
The first three groups of measures are relatively easy to measure in the setting of a study. Measuring clinical outcome is notoriously difficult however and some of the studies cited gave conflicting results. In addition, some had methodological problems that perhaps attenuated their usefulness. I would therefore suspect that this final and most important group may or may not actually be inversely correlated to duration of practice.
I am however willing to accept that the first three more easily quantified groups have been satisfactorily demonstrated to be inversely correlated to time out of training. Clearly these measures must logically affect outcomes as there is a large amount of data that correlates the adoption of formal standards of care (sometimes referred to as clinical pathways) to outcomes.
The question is are there other qualities about a physician that may improve with time? In other words can there be some benefit of experience? I suspect that there must be. As physicians, don't we all give credence to the notion that an engaged, thoughtful, caring physician may just make that diagnosis or pick up a subtle finding just on the basis of his or her experience? And don't those occurances occasionally impact the patient's outcome? Aren't some of us occasionally amazed by the veteran doctor's intuition in knowing who's sick and who isn't?
I don't believe that to give credit for just being on the planet longer is misplaced. I also believe that these results need to be taken extremely serious by both the physicians and the patients among us. I'll have more to say this on another post.