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Study Characterizes
Older Doctors As Risky
A new study from the Harvard Medical
School suggests that older doctors generally know less, provide
lower quality care and expose patients to greater risks than physicians
recently out of medical school.
The Harvard team analyzed nearly
40 years of research into factors that shape health care quality
and found older doctors were less likely to know or follow current
treatment standards on everything from surgery to treating children's
fevers.
One study found that heart attack
patients were 10 percent more likely to die in the care of a doctor
20 years out of medical school, compared with a recent graduate.
Harvard researchers emphasized
that older doctors may improve over time in ways that are hard
to measure, such as gaining a patient's trust. But older doctors
generally agreed it's difficult to keep pace with rapidly changing
medical technology, The Boston Globe reported.
"You store a lot of factual knowledge
during school, and then ... you're expected to, on your own, keep
up with what is an enormous flood of facts," said Dr. Donald Berwick,
58.
The problem isn't just the volume
of new information or people's tendency to forget facts as they
age, but also a shift in the basic philosophy of medicine over
the last 30 years, said Niteesh Choudhry, 33, the lead author
of the study, which appeared in Tuesday's Annals of Internal Medicine.
Doctors used to rely heavily on
their own experience to make decisions, but now they depend more
on research published in journals, he said. Doctors untrained
in "evidence-based medicine" may be slower both to adopt new approaches
and to abandon outdated ones, Choudhry said.
Jonathan Winickoff, a 34-year-old
pediatrician at Massachusetts General Hospital, said he doesn't
think the issue is age, but the willingness to keep up with research.
"My gut feeling is that the very
best doctors are the ones who both have the experience and make
a commitment to keep up with guidelines," he said.
In an editorial that accompanies
the study, officials from the American College of Physicians and
American Board of Internal Medicine said doctors should be required
to undergo more rigorous training to maintain certification, the
seal of approval given by boards representing medical specialties.
Most boards that give specialty
certification either don't require a renewal of certification,
have very limited requirements for renewal or waive the requirements
entirely for older doctors, said Berwick, president of the Institute
for Healthcare Improvement in Boston.
The Harvard study combines the
findings of 59 papers since 1966 that looked at physicians' age
or years out of medical school when measuring knowledge or the
quality of patient care. Most of the studies didn't delve only
into age-related issues, but the Harvard team focused exclusively
on age as a factor in physician knowledge or quality of care.
Forty-five of the 59 studies found
that age or years since medical school graduation had a negative
effect on performance for everything from following proper cancer-screening
techniques to prescribing aspirin to angina patients.
Just two of the studies found the
doctors' performance improved over time — on advising patients
to exercise and on referring diabetic patients for eye tests.
A 2000 study by the American Board
of Internal Medicine, which looked at patients treated by more
than 4,500 family practitioners, internists, and cardiologists
in Pennsylvania, found that patient mortality increased by half
of 1 percent for every year since the doctor graduated from medical
school.
Reference
Source 102
February 16, 2005
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