Dr. Aruyaru is a Consultant General and Laparoscopic Surgeon and a Healthcare Manager. He has solid experience in managing busy
Does it matter how old or young a doctor is? As a scientist, I would answer in the negative. As a possible consumer, I would look at many things. The personality definitely being the first. But that is because I harbour the insider’s insight.That insight also says that the old as well as the young doctors can face a complication.Which way, then? I asked this question in my poll on Linkedin. The results were that 55% would not bother about a doctor’s age. Only 25% would prefer the old doctor, the remainder opting for the young one.
“These are not the days we adored the gray haired bespectacled doctor, now we want the young and energetic”, one gentleman observed to my colleague and me while we sat discussing a possible medical field business idea.
In the comments section on my Linkedin poll, a gentleman from China observed that they consider the old doctor as “more knowledgeable and experienced”. That goes with the cultural inclination. To respect the elders or seniors is a ubiquitous behavior to be found across civilizations.Has this changed with the gen z? What would that mean then? Would it be the possibility of ‘connecting’ as opposed to experience and expertise?
Worse outcome among old physicians
According to American based research published in the British medical journal in 2017, younger physicians had fewer mortalities than old physicians treating a similar profile of patients, unless the old physicians were ‘high volume’. This study samples over 736000 patirnts managed by nearly 19000 doctors between 2011-2014. They assessed readmissions, cost of care and 30 day mortality. The cost of care was slightly higher among the old physicians too. There were no differences in re-admissions. Of course, as the authors argue, one cannot confirm if the older physicians may have treated patients at higher risk of death (patient preference or lack of ensuring strict randomization).
As much as skills and experience increase with age, the risk of outdated knowledge that fails to catch up with new knowledge, technology and up to date clinical guidelines can tip the scales in favour of younger doctors. This can be confirmed by finding no difference between high volume old physicians and the young ones in terms of the measured outcomes.
What does this tell us? That accrual of knowledge, skills, expertise and experience are not the end. Remaining a life long learner ( a very familiar statement to us doctors) is the main thing to consistently offer top notch care. Which takes us back to the question we began with; is there a point at which an experienced doctor is better than a younger colleague? Of course. An emphatic ‘of course’! The subsequent obvious question (you guessed it!) is, ‘ at what point then does that cease to matter?
To answer that, is an article aptly titled ‘Surgeons get better-then worse- with age..” This study, published in the same British Medical Journal but five years earlier than the American study, looked at the outcome of over 3500 patients operated by 28 surgeons across five busy hopsitals in France. The risk of complication was lowest when the operating surgeon had more than 5 but less than 20 years of surgical experience. The researchers conclusiom sums it all: “optimum individual performance in thyroid surgery cannot be passively achiebed or maintained by accummulating experience. Factors controbuting to poor performance in very experienced surgeons should be explored further”.
Damned if you are old, damned if you are young. It is now time to go on a wild goose chase for the holy grail of the age bracket. Enter the levels of competence. Competence is graded into four levels:
Unconsciously incompetent. Too ignorant you do not know that you do not know. This is the realm of a generalist trying to be a specialist without training. This is taken care of by the regulatory and licensing bodies.
Consciously incompetent: The person knows their limits. They know what they do not know. Here, the doctor will be prompt to refer or consult. It may be the playing field entry level doctors. It is incumbent on the institution to blend their staff to have a senior colleague to lend a helping hand.
Consciously competent: The person is competent in the skill and they know it. Everyone wants to
play at this league. Then the measure of competence has to be sustained at high level through audits, refreshers and the continuing medical education that the medical
council demands before renewal of every doctor’s license.
Unconsciously competent. In this category, one is so good that they do not even put any effort or they do it subconsciously or one is unaware of their expertise and have to be told by the others that they are good in that area. When applied in surgery? Hello grand master, connoisseur par excellence. The maestro. Even he or she cannot tell what they know. They execute great moves half attentive, much to the awe of juniors in sight. To paraphrase a colleague, ‘should this be every surgeon’s aim or is it the gateway to the ‘oops’ moment?’.
It seems the drift would be towards the Conscious competent doctor. One who is not just ‘able to tie his shoe laces (surgical lingua)’ but a master of his craft. Yet not too good to bother with second thoughts about even complex cases, with the ‘after all what is the worst that can happen?’ attitude.
Who do you speak for?
But when you make all the above onservations, who do you speak for? Time without a number, data has showed that the fancy standards and KPI (key performance indicators) we healthcare providers set for ourselves as quality indicators always fall short on one front: the reported patient experience. “I do not care about your charts, I was not satisfied by the consultation.” ” Not withstanding your bleak dash board charts, I connected with that doctor!” This is the moving target that is service provision. With one patient you are an angel, with the very next one, you descended straight from lucifer. Just based on how your energies rhyme, among other things.This does not negate expertise in the brick and motor competencies for doctors. I think it calls for us to invest more in the soft skills. Corporate world had observed that communication, leadership and time management make nearly half the list of skills with the largest skills gap in the work force. When we look at replacement of human skills with artificial intelligence, we still remain with skills like empathy and human connection giving man the upper hand over the robot. May be this is the discussion to have. Can a young doctor who is more composed, more listening and more collaborative represent what the bespectacled gray haired senior colleague represents?It is for sure the hope and ethical expectation of almost every one of those gray haired ones. It is an interesting discussion. It continues.
For now, we agree that a qualified doctor with a couple years of experience under their belt is as good as any other doctor. How will you know how many years? You can ask them. You can check up their names on the online doctors portal on the medical council. The council itself has set the mandatory period to work before being granted a specialist licence upon completion of ones specialist training. The aim and spirit is to get to that holy grail time bracket.