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The Older the Doctor, the Higher the Patient Mortality Rate, Study Finds (arstechnica.com)

Posted by BeauHD on from the losing-their-touch dept.

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.

13 of 136 comments (clear)

  1. Flawed study by Anonymous Coward · · Score: 5, Insightful

    How do we know that older patients don't just like going to older doctors?

    1. Re:Flawed study by arth1 · · Score: 4, Insightful

      How do we know that older patients don't just like going to older doctors?

      RTFS?
      "700,000 hospital admissions of elderly patients"

      My personal guess is that older doctors might be a little better at weighing quality of life against longevity, while younger doctors might be following the book more, prolonging life no matter what the physical/mental/monetary cost to the patient is. That would explain why older doctors with a high workload didn't show the same drop in longevity - they won't have time to get to know each patients as well.
      I know that when my time draws near, I hope I find a doctor that can help me have a good quality of life for my last few days or weeks, even if it's shorter. And preferably without bankrupting those I leave behind on expensive treatments that can only prolong agony.
      So I'll likely try to find an older doctor with empathy.

    2. Re:Flawed study by Zaelath · · Score: 4, Interesting

      Summary says they were all "elderly patients", so the factor changing is the age of the doctor.

      I think the busy doctor == good doctor correlation holds true as well, was certainly the case for mine. Might be that the good ones are kept busy, but I suspect as much that the work keeps their minds sharp.

    3. Re:Flawed study by clovis · · Score: 4, Informative

      How do we know that older patients don't just like going to older doctors?

      The patients were unlikely to be choosing their doctor in this study.

      The doctors used for this study were hospitalists. Hospitalists care for patients admitted to the hospital.
      Your regular primary care doctor is unlikely to be a hospitalist (although some hospitalists do have regular clinic days) because you are not getting admitted to the hospital for a sore throat or broken arm.
      Hospitalists treat very sick people, and in the hospital where I worked, they were considered to be higher-skill doctors then your regular doctor.

      The study used the records of hospitalists because generally speaking, the patient does not get a chance to choose their hospitalist, and the study wanted to avoid that factor. Also because hospitalists treat admitted patients, they are dealing with people who are far more likely die without treatment, so that makes the numbers interesting.

    4. Re:Flawed study by taustin · · Score: 3, Interesting

      "Elderly patients" covers a lot of territory. A 60 year old and a 90 year old are both elderly, but do not have the same life expectancy. And the 90 year old has likely been seeing the same doctor for years longer, so that doctor is likely older.

      If they didn't ask the question, it's not a very useful study.

    5. Re:Flawed study by Zaelath · · Score: 3, Interesting

      Yeah, I agree, except that the life expectancy for people over 65 going to the doctor is probably more consistent.

      Plus, it's about the weight of numbers; if the mortality rate for all patients that attend hospital A was 10% and hospital B was 15%, does it matter how old you are when you're picking between those two hospitals? Assuming the same catchment area, hence the choice.

      Attending hospital tends to already select for people with a higher than average mortality rate.

      Besides, the authors understand there's not enough information to act on, but it's enough to suggest that the area be studied at greater depth to see if there's a case for adjusting how continuing education is managed.

    6. Re:Flawed study by ShanghaiBill · · Score: 4, Informative

      If they didn't ask the question, it's not a very useful study.

      They adjusted for patient age. This is explained in the actual paper. They also adjusted for gender, ethnicity, household income, day of week of admission, etc.

      They also considered many characteristics of the doctor besides age, including gender, medical school attended, etc.

    7. Re:Flawed study by ShanghaiBill · · Score: 4, Insightful

      A young Dr can also be very selective in the areas they want to practice ... An older doctor might serve a poor area

      The study compared doctors working at the same hospital, and adjusted for patient household income.

    8. Re:Flawed study by ShanghaiBill · · Score: 5, Informative

      The study adjusted for severity of the illness or injury. It also adjusted for the age of the patient.

      Disclaimer: I RTFA and then clicked on the link and read the actual paper where all of this is explained.

  2. So many possible confounds by The+Raven · · Score: 3, Insightful

    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.
    1. Re:So many possible confounds by ShanghaiBill · · Score: 5, Informative

      Do doctors who take many patients mostly do the easy stuff?

      The study adjusted for severity of injury or illness. So, no, that is not the explanation for the age disparity.

  3. Which Doctor? by Fire_Wraith · · Score: 4, Funny

    Which Doctor though? Did they say it mattered in terms of total age, or solely the age of that particular incarnation of the Doctor?

  4. Re:tl;dr by arth1 · · Score: 3, Interesting

    You seem to presuppose that a longer time between admission and death is necessarily a good thing, and that doctors who don't score high on that has "lost ther edge".

    I'm not sure your premise is correct. A doctor who resorts to induced coma will score very well for that premise, but that does not mean he's a good doctor. A doctor that can't explain that a person is brain dead and that life support should end is not doing a good job either. And a doctor who prescribes expensive treatments that patients and families can ill afford, while it only prolongs life in agony is IMHO a worse doctor than one who sees where palliative care is a better solution.