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The Older the Doctor, the Higher the Patient Mortality Rate, Study Finds (arstechnica.com)
An anonymous reader quotes a report from Ars Technica: The age of your doctor may impact the quality of the care you receive -- and even cut your chances of survival -- researchers report in the British Medical Journal. Harvard researchers looked over data on more than 700,000 hospital admissions of elderly patients cared for by nearly 19,000 physicians between 2011 and 2014. They found that mortality rates crept up in step with physician age. Patients with doctors under the age of 40 had a 30-day mortality rate of 10.8 percent. With doctors aged 40 to 49, mortality rates inched up to 11.1 percent, then to 11.3 percent with doctors 50 to 59, and 12.1 percent with doctors aged 60 or above. The stats are adjusted for a variety of variables, such as hospital mortality rates and severity of patients' illnesses. All the patients were aged 65 or older and on Medicare. Though the age-related mortality trend was significant overall, it broke down when researchers sorted doctors by caseloads. Older doctors who saw high volumes of patients didn't see their patients' mortality rates increase.
How do we know that older patients don't just like going to older doctors?
10.8 to 12.1 is only a 1.3 difference. That seems like a lot better odds than my odds with no doctor.
And the problem solves itself.
Have gnu, will travel.
As a practicing non-physician American healthcare provider, patients are typically our third biggest problem (after insurance companies and healthcare administrators). That is, patients often don't do what you tell them to.
Perhaps you should stop telling them what to do, but give options. It's their life, not yours. And they're not problems; they pay your salary. Show some respect.
doctors with lighter patient loads lose their 'edge' and have higher patient mortality rates compared to doctors who see more cases (i dont think doctor age *itself* factors in at all in this study, despite the clickurbating headline)
I run a Help Desk. The reps who do the most tickets are not the best. That's because the best reps can fix issues without escalating, but that takes time. Do doctors who take many patients mostly do the easy stuff? Are the doctors who take fewer patients specialists in their field, or handling more difficult cases that take more attention per patient?
Does seniority mean they take more difficult cases? Does seniority mean they care less about their malpractice insurance (because they are more secure financially)? Does seniority change which patients seek you out?
There are so many potential confounding reasons for this correlation that do not depend on the doctor being less capable or providing worse care in some manner. I'm not saying that there is no cause for concern... I'm saying that the study has potential confounds that its statistical groupings did not eliminate.
"I will trust Google to 'do no evil' until the founders no longer run it." Hello Alphabet.
Unless you're declared mentally unfit, you're only ever given options.
Option 1) Take their advice
Option 2) Don't take their advice
Which Doctor though? Did they say it mattered in terms of total age, or solely the age of that particular incarnation of the Doctor?
Anyone who opposes Soviet America is mentally unfit. Proceed with Option 1.
This is why I always ask my 3 year old which pill I should take.
That's merely a Hobson's choice.
Before that is presented, the doctor has likely made choices he doesn't present to the patient. That's disrespectful at best.
Doctors over 60 are disproportionately male. The gender ratio for young doctors is relatively balanced.
It has been shown that female doctors have slightly better statistics for outcomes than male doctors.
http://jamanetwork.com/journal...
The JAMA study uses the same patient group as the old-vs-young study, that is hospitalized Medicare patients.
And they both looked at performance of hospitalists.
As near as I can tell, the gender ratio for hospitalists is more balanced than the all-doctors gender ratio, but I can't easily find numbers of age vs sex for hospitalists.
Another factor might be that hospitalists can migrate to be a specialist (waaaay more money), but that's not an option if you're not a very good hospitalist, so perhaps the old ones are a combination of dedicated hospitalists (the ones with large patient loads and good outcomes), and the ones that didn't advance (who may be just marking time).
So, I got curious and looked at both studies (but only the abstract for the JAMA). The difference in outcome between male and female hospitalists is smaller than the difference between young and the over 60 year old doctors. If I read correctly, the female vs male patient death difference was 11.07% vs 11.49%, but the young vs old was 10.8% vs 12.1%.
So it appears that age is a much greater factor than sex.
Please realize that patients tend to stick with the doctor they know, so aging of the physician co-varies with the age of the patient group being served by him. This is even reinforced by patients unwilling to expose their problems to physicians even younger than the kids of those patients.
You cannot get health care in america with the start of the trumpcare age, so why bother with doctors at all.
NO SIG
... the study says in its very own conclusions:
Patients in hospital treated by older hospitalists have higher mortality than patients cared for by younger hospitalists, except for hospitalist physicians with high volumes of patients.
In other words: It's not the age, it's caseload. Old doctors who receive a lower number of cases have a higher mortality rate. Maybe they're lacking the experience that other doctors their age have. Or maybe they receive less cases because they are known to be not as good as other doctors (either because they don't get the same jobs, or because they receive less cases on purpose).
A chronic health problem which dozens of doctors could not figure out was diagnosed by the oldest doctor I ever went to. After a few tests, some lifestyle changes, and a couple of months later when I went back feeling better than I had in decades. He expressed concern that he might have confused me with another patient and might have given me the other patient's diagnosis. He retired a few months later. Thankful he stuck around long enough to save me.
As this study proves yet again. Even with a supposed 700K gross value to impress the journalists, the relevant cohort comparisons are only a few per cent of that. Then they average the averages, which we all know does not work in general. They say they "corrected" for various factors, but the uncertainty in those "corrections" dwarfs the differences in results. This is just another blatant number fudging exercise to show a preconceived result. It's no wonder that 70-80 per cent of studies like this cannot be replicated. Because they are garbage.
EMH is obviously the best doctor.
The most difficult cases will be assigned to the most experienced and senior practitioners where as simple cases will be given to junior and inexperienced physicians. Clearly complex cases are higher risk that routine procedures.
Young doctor: "It's lupus!"
Old doctor: "It's never lupus"
For a symptom that occur 90% in an innocuous disease and 10% in a deadly ones, older doctors that saw lot of patients with the common one will diagnose the former while younger doctors who still believe to be able to find the rare one in their life could diagnose the latter.
It's very easy to draw wrong conclusion.
Imagine, for instance, that MORE DIFFICULT cases are handled by older doctors.
And suddenly higher mortality rate doesn't tell you much about how well they perform.
They've become used to letting people die. They've seen it too many times and stopped trying to treat diseases beyond a certain stage, no matter if the patient wants to live. Note the scare quotes — it's something that really scares me.
My great aunt who lived toil 115 had many doctors in her life. One of the last ones told me:
She has become this old not thanks to us doctors, but despite us doctors.
Truer words have never been spoken. I even have the letter where her father asked to be allowed to hold a goat for the sick kid. The doctors then thought she would not be older than 6 weeks. Oldest person in the world who also Open Sourced her body. They found a lot of interesting things. The first was proof that Alzheimer was not a de-facto elderly illness as she had no traces of it.
Don't fight for your country, if your country does not fight for you.
The older the doctor the more specialized they are and the more complicated the patient they receive.... because the easy patients are treated by the junior doctors.
Seven puppies were harmed during the making of this post.
Though the age-related mortality trend was significant overall, it broke down when researchers sorted doctors by caseloads. Older doctors who saw high volumes of patients didn't see their patients' mortality rates increase.
My guess is that older doctors with a larger caseload is a sign that they enjoy their job and are staying current in medicine and engaged with their patients. Those with a lower caseload are burned out and getting ready to retire.
... and I thought this place had a sense of humour.
j'ai découvert une démonstration vraiment admirable (de ce théorème général) que cette si
You see the same kind of thing in any classification metric used by the government, too. Poor classification and coarse gradations of severity are endemic. Which, of course, skews the veracity of any analysis performed using those classifications.
This is a mistake. The coding is not accurate.
Doctors rarely finish medical school and their residency before they turn 30. Unlike the tech industry, you can't pick up a few medical books at age 15 and start practicing medicine in your spare time.
... their doctors even as they get older.
Film at eleven.
I wonder:
Did the PhD get 500 000 in funding for this?
We suffer more in our imagination than in reality. - Seneca
Do you give a 30 year old doctor the risky heart surgery or the experienced vet? Of course the mortality rate goes up!
Patients WITH MORE SERIOUS ISSUES tend to be allocated to MORE EXPERIENCED (ie: odler) DOCTORS.
You called it.
Control for that classic selection bias was conspicuously absent from the description of the methodology.
(I was about to point this out but you beat me to it, and did so very nicely.)
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
Have they controlled for the fact that the older doctors were likely trained/qualified years earlier than the younger doctors (assuming all doctors qualify at roughly the same age, in their 20s or early 30s)? I would hypothesise that the quality of doctor-training/teaching has increased over the years/decades, so younger doctors will have been trained better. Age may not actually be a factor at all.
plain and simple
I used to work in IT at a hospital. It's because the older doctors absolutely refuse to make use of computers at all in any way.
I think they're reversing cause and effect here. Doctors whose patients keep dying have fewer customers left.
I know lots of /. ers here are really prickly about ageism, but it's there for a reason. I'm 46 and definitely admit that age takes it's toll. Luckily, when I screw up it means something might not compile the first time but I imagine in the non-virtual world the effects might be a worse.
love is just extroverted narcissism
The body heals itself, doctoring makes it worse, old doctors do less doctoring.
You don't want your body doctored, you want it healed, and healing happens best when it is done by yourself.
And to stop yourself getting declared mentally unfit by them this could help:
Open message to all sentient beings:
"""
I do not, have never and never will give consent to you, in regards to any matter, this in perpetuity.
I understand the information relevant to my decision.
I am able to retain the information relevant to my decision.
I have used and weighed up the information as part of the process of making my decision.
I am communicating my decision by speaking to you.
I am communicating my decision by written word.
Under the Mental Capacity Act of 2005 I have demonstrated my mental capacity is not lacking.
Detaining me any further would be torture under International law. Torture is illegal under international law.
Please, cease and desist your actions towards me.
"""
Only really need lines, 2 to 5, and that is what is required to show mental capacity is not lacking in the UK.
Aren't they talking about a spread of only 1.3% here? What difference could that make.
Unfortunately I can't find the article (possibly something about Atul Gawande) but it said that a typical doctor does most of their learning at the start of their career and that consequently it can take a generation before new best practice is adopted. If this is true then it could be that the older the doctor the more likely you are to be treated using outdated techniques.