Dear All,
What if it is more than expertise and experience? I noticed while working
with patient groups that patients felt that a terminal or treatment
resistant condition led to a distancing from their doctors. I asked about
40 doctors informally and individually if they had been trained to handle
their grief in medical school. All said no. I then asked if they considered
themselves to be more or less sensitive to their patients as they spent
years in practice. Most said less, 2 said there was no difference really and
some elaborated on how this was a real problem and that after a while they
and their colleagues just were numbed and failed to care. I asked if they
felt being numbed influenced their ability to make compassionate
decisions...most said yes, some did not know and one said why was I asking
such a stupid question.
I fully understand this is not a valid study, these were individuals I knew
and not a random sample but it is probably worth exploring that other
factors other than what we know or level of experiences may contribute
particularly given research on anger which claims repression or ruminating
is linked to unresolved chronic distress which in turn influences future
choices as contrasted with a healthier recovery when individual were taught
to reframe anger responses...
Best Regards,
Amy
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Jim Walker
Sent: 28 July 2011 04:42 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.
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-idUSTRE76E62
T20110715
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
IMPORTANT WARNING: The information in this message (and the documents
attached to it, if any) is confidential and may be legally privileged. It is
intended solely for the addressee. Access to this message by anyone else is
unauthorized. If you are not the intended recipient, any disclosure,
copying, distribution or any action taken, or omitted to be taken, in
reliance on it is prohibited and may be unlawful. If you have received this
message in error, please delete all electronic copies of this message (and
the documents attached to it, if any), destroy any hard copies you may have
created and notify me immediately by replying to this email. Thank you.
|