Jim and group
This triggered my own memory too Jim. I think this is the paper you may have in mind, with this uncomfortable finding from 2005.
http://scholar.harvard.edu/nkc/files/2005_length_of_time_in_practice_and_quality_of_care_annals.pdf
Systematic review: the relationship between clinical experience and quality of health care. Choudhry NK, et al. Annals of Internal Medicine 2005; 142: 260-273
- 32 of the 62 evaluations (52%) reported decreased performance with increasing years in practice for all outcomes assessed.
- 13 (21%) reported decreasing performance with increasing experience for some outcomes but no association with other assessed.
- 2 (3%) reported that performance initially increased with increasing experience but then decreased.
- 13 (21%) reported no association.
- 1 (2%) reported increasing performance with increasing experience for some outcomes but no association with other assessed.
- 1 (2%) reported increasing performance with increasing experience for all outcomes assessed.
Best wishes
Neal
Neal Maskrey
Programme Director
National Prescribing Centre
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-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Jim Walker
Sent: 28 July 2011 21:42
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.
Thanks, Paul.
Having identified (or at least highlighted) the need (which a previous study several years also "identified"), what is the evidence-based approach to meeting it?
My guess is that we don't begin to have the evidence we would need to construct a feasible and effective approach, which would need to factor in the differential effects of fatigue with aging (combined with the effects of fatigue on learning); the cognitive effects of current practice styles; the effects of mandatory re-certification in some younger cohorts (for example, those in practice less than about 20 years in the United States); the effects of well-designed EHRs and networked PHRs; the effects of team-based care (in which the physician may not be expected to be the sole repository of knowledge); any role of increased satisficing with time in practice; etc.
A grand challenge, unlikely to solved with more and even better courses or more and better tests.
Best regards.
Jim
James M. Walker, MD, FACP
Chief Medical Information Officer
Geisinger Health System
The best way to predict the future is to invent it.
- Alan Kay
>>> Paul Elias 07/28/11 4:14 PM >>>
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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