I'm not an expert, but I believe the literature in cognitive psychology demonstrates beyond serious question that humans don't learn when they are tired, and especially when they don't get sleep. For that reason, one of the critical factors to try to correct for in studies like the one we're discussing and in any plan for addressing the problem (that goes beyond exhorting people to be life-long students) would be to understand how work hours and sleep affect physician performance long-term.
Jim
James M. Walker, MD, FACP
Chief Health Information Officer
Geisinger Health System
>>> "Kalliainen, Loree K" <[log in to unmask]> 7/29/2011 4:15 PM >>>
Stephen;
Sad and possibly true. I remember being told ad nauseum during training that physicians are life-long students and that what we learned in med school would inevitably change. Looks like not all of us learned this, remembered it or took it to heart. Being a student is challenging, and changing established practice patterns even moreso. it will be interesting to watch how (if) the necessity to maintain board certification to retain hospital privileges affects the ability of physicians to be life-long learners, and, by extension, allows patient outcomes to be consistent no matter the age of the physician. One could hope that, with the addition of wisdom, outcomes could improve with the duration in practice!
Loree K. Kalliainen, MD, FACS
St. Paul, MN
(9 yrs in training, 11 in practice)
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Stephen Senn
Sent: Friday, July 29, 2011 3:00 PM
To: [log in to unmask]
Subject: Re: Patients worse off with more-experienced docs? In a study that flies in the face of common sense, sicker patients turned out to fare worse under the care of seasoned doctors than when newcomers to medicine looked after them.
It may not be true but if true I think that there is a simple explanation. Medics don't learn by interacting with patients because the feedback is not quick enough. To learn would require them to make extensive notes and regularly analyse and compare. The last time they had a chance to learn was in med school, hence the younger the more up to date.
Stephen
Stephen Senn
Professor of Statistics
School of Mathematics and Statistics
Direct line: +44 (0)141 330 5141
Fax: +44 (0)141 330 4814
Private Webpage: http://www.senns.demon.co.uk/home.html
University of Glasgow
15 University Gardens
Glasgow G12 8QW
The University of Glasgow, charity number SC004401
________________________________________
From: Evidence based health (EBH) [[log in to unmask]] On Behalf Of Paul Elias [[log in to unmask]]
Sent: 28 July 2011 21:13
To: [log in to unmask]
Subject: Patients worse off with more-experienced docs? In a study that flies in the face of common sense, sicker patients turned out to fare worse under the care of seasoned doctors than when newcomers to medicine looked after them.
http://www.reuters.com/article/2011/07/15/us-patients-worse-off-idUSTRE76E62T20110715
According to findings in the American Journal of Medicine, patients whose
doctors had practiced for at least 20 years stayed longer in the hospital and
were more likely to die compared to those whose doctors got their medical
license in the past five years.
no doubt this raises serious questions and supports the evidence based approach
and the need for doctors to remain seasoned and in touch with not just the needs
of the patient but the updated science.
Best,
Paul E. Alexander
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