Saturday, May 07, 2005

More thoughts on Older doctor bashing,

Dr. Philip R. Alper has a regular column in Internal Medicine World Report. In the April 2005 issue, he discussed the Annals of Internal Medicine article Entitled " The Relationship between Clinical Experience and Quality of Health Care" (Ann Intern Med 2005:142;260-273.) He was critical of the article and the trailing editorial as was Medical Metamusings in an earlier blog and was Dr.Roy Poses (hcrenewal.blogspot.com) in his excellent analysis of the Annals article in his blog. Basically, the article, a systematic review, concluded that older doctors provided lower quality of care.
The editorial in the Annals accepted the article at face value-even though as Poses, Medical Metamusings and Alper point out the study had serious methodological problems-and used the article to claim that "quality improvement interventions" were needed.The editorialists, at least some of whom are members of the American Board of Internal Medicine, used the article to bolster their campaign for recertification giving the perception that their friendly acceptance of the flawed article might be self-serving.,
I bring this issue up again though it has been well blogged already to be able to quote a great insight Dr. Alper wrote in his column.
"...most of guideline surveillance should be automated.It is the subtleties of diagnosis and treatment and the establishment of a therapeutic relationship with the patient that cannot so readily automated.Everything is important but the notion of placing global responsibility on the primary physician's shoulders make sense only to those who seek to be their superiors.

Dr. Alpers also says in regard to recertification and other control measures "The absence of proof that uniform central planning in medicine will achieve the goals desired by its proponents (and may even be counterproductive) adds to my discomfort"
Not only is there absence of proof there is much proof demonstrating how badly central planning in general works.But,at least for some of the people who advocate it it is not about proof it is about power and control.

2 comments:

Anonymous said...

Would just like to note the correct link to Poses' critique.

KidneyNotes said...

I wouldn't characterize is as "older doctor bashing." As a younger physician who works closely with many older physicians, I think it would be more accurate to say that each generation has their own particular strengths, and the article (as I read it) seeked to highlight one of the weaknesses of the older generation -- they do not always follow the "standard of care." There are many reasons for this, including perhaps lack of time, energy, familiarity with the internet and other electronic forms of CME, and being under the significant disadvantage of not being recently trained. However, the older physicians have an enormous advantage compared to the younger physicians in maturity, perspective, and experience, which the article did not account for. Each generation has a lot to teach the other. I would agree that stronger guidelines for CME and recertification would be a possible solution to ensure that older physicians practice the current standard of care.