5 ms·

It should be quite naturally so as a lot has happened in the field of medicine in the last 30-40 years. A 60 year old doctor who was trained 35 years ago uses o

It should be quite naturally so as a lot has happened in the field of medicine in the last 30-40 years. A 60 year old doctor who was trained 35 years ago uses old knowledge and techniques. Even though doctors get some updates via conferences and articles in journals and maybe some hand on course, they cannot absorb all that new knowledge in practice.

throwaway8877 2y ago
Perhaps. But they have advantage of 30-40 years of experience.
- Kalium 2y ago
  It's my understanding that the significance of that age can and does vary wildly. In some specialties, age makes errors more likely: https://psnet.ahrq.gov/issue/radiologist-age-and-diagnostic-errors https://psnet.ahrq.gov/issue/radiologist-age-and-diagnostic-...
- prmph 2y ago
  But here's the things I'm not clear about: Surgeon get immediate feedback if they make mistakes because their patient might die or get severely disabled, but is there any feedback to GPs about the effectiveness of their work? 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?
  - xyzzy123 2y ago
    Surgeons don't get immediate feedback because the advisability of procedure X ends up being a statistical matter that might not be decided in the surgeon's lifetime. It depends what it is. They will have opinions of course, but will work with the system and follow process.
  - Calavar 2y ago
    > Surgeon get immediate feedback if they make mistakes because their patient might die or get severely disabled, but is there any feedback to GPs about the effectiveness of their work? 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.
    - prmph 2y ago
      > Yes, they get to know about it. 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.
  - specialist 2y ago
    The importance of "feedback loops" was my key takeaway from my time larping as a QA/Test manager. > ...but is there any feedback to GPs about the effectiveness of their work? Specialties too. esp for any misdiagnosis or hard to diagnosis conditions.
  - dimatura 2y ago
    I don't know about GPs, but for surgeons I believe it's not so clear cut (pun not intended). From what I understand bad outcomes in surgery often take a while to manifest - but more importantly, it seems that even when they do, and get tracked in the medical record, not much is done about it either way. I recall reading an article a while back about investigations showing there's a wide disparity in outcomes among surgeons, but not much is done about it, and there's no way for patients to get access to this data. This was several years ago, though, so maybe things have changed since then.
- flakeoil 2y ago
  30-40 years of experience using the old knowledge and techniques.
  - SoftTalker 2y ago
    Human biology doesn't change in 30-40 years. 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.
    - dandy23 2y ago
      The biology doesn't change of course, but the procedures, drugs, medical devices, treatments and overall knowledge and best practices does. An annual physical is such a small and simple subset of the total medical field so not sure why you bring it up.
nradov 2y ago
Physicians are required to complete a certain number of hours of continuing medical education every year. These are training courses (online or in person) which have to meet at least some minimal quality standards; it's not just showing up at a conference. But whether they actually keep their skills current or just check the boxes depends on the individual.
- Tijdreiziger 2y ago
  Not in all countries. Doctors in e.g. Japan aren’t required to take any continuing education (IIUC). (This is my understanding as a layman, so I’m happy to be corrected if wrong.)
- flakeoil 2y ago
  It's quite hard to learn something completely new by taking 1 or 2 week courses once a year. 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.
  - Aerbil313 2y ago
    Not the perfect example. OT, but dentistry is unlike other fields of medicine, a huge amount of the practice is outright scam. See past thread: https://news.ycombinator.com/item?id=37022911 https://news.ycombinator.com/item?id=37022911

throwaway8877 2y ago

Perhaps. But they have advantage of 30-40 years of experience.

Kalium 2y ago
It's my understanding that the significance of that age can and does vary wildly. In some specialties, age makes errors more likely: https://psnet.ahrq.gov/issue/radiologist-age-and-diagnostic-errors https://psnet.ahrq.gov/issue/radiologist-age-and-diagnostic-...
prmph 2y ago
But here's the things I'm not clear about: Surgeon get immediate feedback if they make mistakes because their patient might die or get severely disabled, but is there any feedback to GPs about the effectiveness of their work? 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?
- xyzzy123 2y ago
  Surgeons don't get immediate feedback because the advisability of procedure X ends up being a statistical matter that might not be decided in the surgeon's lifetime. It depends what it is. They will have opinions of course, but will work with the system and follow process.
- Calavar 2y ago
  > Surgeon get immediate feedback if they make mistakes because their patient might die or get severely disabled, but is there any feedback to GPs about the effectiveness of their work? 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.
  - prmph 2y ago
    > Yes, they get to know about it. 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.
- specialist 2y ago
  The importance of "feedback loops" was my key takeaway from my time larping as a QA/Test manager. > ...but is there any feedback to GPs about the effectiveness of their work? Specialties too. esp for any misdiagnosis or hard to diagnosis conditions.
- dimatura 2y ago
  I don't know about GPs, but for surgeons I believe it's not so clear cut (pun not intended). From what I understand bad outcomes in surgery often take a while to manifest - but more importantly, it seems that even when they do, and get tracked in the medical record, not much is done about it either way. I recall reading an article a while back about investigations showing there's a wide disparity in outcomes among surgeons, but not much is done about it, and there's no way for patients to get access to this data. This was several years ago, though, so maybe things have changed since then.
flakeoil 2y ago
30-40 years of experience using the old knowledge and techniques.
- SoftTalker 2y ago
  Human biology doesn't change in 30-40 years. 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.
  - dandy23 2y ago
    The biology doesn't change of course, but the procedures, drugs, medical devices, treatments and overall knowledge and best practices does. An annual physical is such a small and simple subset of the total medical field so not sure why you bring it up.

nradov 2y ago

Physicians are required to complete a certain number of hours of continuing medical education every year. These are training courses (online or in person) which have to meet at least some minimal quality standards; it's not just showing up at a conference. But whether they actually keep their skills current or just check the boxes depends on the individual.

Tijdreiziger 2y ago
Not in all countries. Doctors in e.g. Japan aren’t required to take any continuing education (IIUC). (This is my understanding as a layman, so I’m happy to be corrected if wrong.)
flakeoil 2y ago
It's quite hard to learn something completely new by taking 1 or 2 week courses once a year. 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.
- Aerbil313 2y ago
  Not the perfect example. OT, but dentistry is unlike other fields of medicine, a huge amount of the practice is outright scam. See past thread: https://news.ycombinator.com/item?id=37022911 https://news.ycombinator.com/item?id=37022911