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From the transcript:
> But before you go looking for the oldest doctor you can find, you know, hold on for a second. Turns out that what David and his colleagues found in obstetrics may not apply to all fields of medicine. Let me give you an example. A few years ago, we looked at a similar question among internists who provide care to hospitalized patients. These doctors are called hospitalists and nowadays if you’re hospitalized with a general medical condition like pneumonia or heart failure, chances are you’ll be treated by one of these types of doctors. So, my colleagues and I looked at whether the age of a hospitalist physician was tied to outcomes among elderly patients. We looked at about 730,000 hospital admissions by nearly 19,000 physicians and we found that patients treated by older physicians had a higher rate of mortality within a month of their admission date — it’s called “30-day mortality” — compared to patients treated by younger physicians. More patients died under the watch of doctors who were age 60 or older. And interestingly, doctors who were just five years out from their training lost the fewest patients. That finding appears to contradict David’s data showing that obstetricians continued to improve even 30 years into their career.
Let's say someone is not treated that well by his doctor for a chronic condition. He gets to the emergency in a different hospital and probably dies. Does his GP get to know about it?
For example, many doctors in my country believe that Left Ventricular Hypertrophy (LVH) on an ECG is nothing much to worry about, as long as there is no anatomical LVH showing up on an Echocardiogram. Yet, study after study online concludes that ECG LVH is a serious marker of cardiac pathology distinct from (but related to) from anatomical LVH.
How do doctors who operate on this assumption going to learn from experience, if they mostly don't know that their patients have cardiac events as a result?
I disagree with this. If a patient dies from a surgical complication, it is often weeks or months later, on a nonsurgical service because there are no surgical options left for the patient.
> Let's say someone is not treated that well by his doctor for a chronic condition. He gets to the emergency in a different hospital and probably dies. Does his GP get to know about it?
Yes, they get to know about it. But ascribing cause and effect in a chronic disease is difficult.
Eventually everyone will die, even if they get perfect treatment. I'm not saying there's no such thing as medical error - in some cases there is clear and obvious error - but what's much more common is a situation of "Did I do the wrong thing, or did I do the right thing but they were so sick that they died anyway?" And there are often many years separating cause and effect, which muddies the picture even further. That's why learning from specific patient outcomes is tricky and why doctors lean so heavily on evidence based medicine, which means learning from large medical trials with rigorous statistical controls.
> For example, many doctors in my country believe that Left Ventricular Hypertrophy (LVH) on an ECG is nothing much to worry about, as long as there is no anatomical LVH showing up on an Echocardiogram. Yet, study after study online concludes that ECG LVH is a serious marker of cardiac pathology distinct from (but related to) from anatomical LVH.
There's a difference between serious pathology and serious pathology you can do something about. I agree that LVH on EKG is a bad sign, even if the ultrasound is normal. But what is your GP going to do about it? There are many test results that are abnormal and/or correlated with bad outcomes, but only a subset of those can be labeled with a concrete diagnosis that is well understood medically, and only a subset of those can be treated.
All your GP can do for an ECG finding of LVH is advise blood pressure control, cholesterol control, exercising frequently, and other things that are generally good for heart health.
On the other hand, if there is anatomical LVH, then the next question is whether there's hypertrophic obstructive cardiomyopathy. That's a concrete diagnosis where we know a lot about the underlying mechanism, which leads to specific advice like avoiding strenuous activity. And some patients with HOCM can benefit from a septal ablation. That's why anatomic LVH gets more attention from doctors.
I’m curious. How do they get to know about it? Maybe the process differs between countries. I’m from Ghana, by the way.
> All your GP can do for an ECG finding of LVH is advise blood pressure control, cholesterol control, exercising frequently, and other things that are generally good for heart health
Mostly true, but taking ECG LVH more seriously helps the patient understand how important it is for them to improve their general heart health. It also makes LVH regression (which is possible in more cases than doctors believe) a therapeutic target.
Genuine question, and I can see totally valid reasons for each course of action.
The feedback loop tends to be stronger on the inpatient side. In academic settings, it's common for each department to have a "morbidity and mortality" conference once or twice a month. This is a meeting where one or two physicians will present a case that they think went poorly and the rest of the physicians in attendance will give feedback on what could have been done differently.
> ...but is there any feedback to GPs about the effectiveness of their work?
Specialties too. esp for any misdiagnosis or hard to diagnosis conditions.
90% of what doctors do is completely routine and they all know and keep up with what the "standard of care" is for common conditions and in many cases it's the same today as was the standard of care in 1984.
Sure, if you have something unusual you might want to go to a younger specialist or a specialty clinic where they focus on leading-edge care for that condition.
A 60-year old GP will do fine for your annual physical.
An annual physical is such a small and simple subset of the total medical field so not sure why you bring it up.
(This is my understanding as a layman, so I’m happy to be corrected if wrong.)
I had a 55+ year old dentist who wanted to pull out my tooth and replace it with a bridge. The tooth was cracked and 1/3 of the tooth had fallen off. Luckily he worked only half time and was on vacation a lot so difficult to get an appointment so I got to see a young dentist who could fix the tooth by repairing it (building up the missing part). She said it could last a month or forever, but if not lasting then the next option would be a titanium implanted tooth. Making a bridge would have been considered malpractice nowadays she said. The old dentist was probably a master at putting in bridges, but if that method is bad and he never practiced the other technique, which you probably cannot learn in a 1 week yearly course, then tough luck.
Not the perfect example maybe, but imagine you have learnt assembler and C in school and programmed in that for 30 years doing say embedded applications. You maybe update yourself regularly in that very field of assembler and C. Then one day you are asked to program a web app using HTML, javascript and CSS and complete it in the same time and with the same quality result as someone who has learnt it in university and with a few years work experience. Quite hard.