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Do physicians with less experience provide better care than do those with more?

The New York Times recently published an Op-Ed from a 29 year old physician writer who argued that younger doctors provide better medical care than older, more experienced physicians.

Dr. Warraich’s confidence in the wisdom of young doctors might be warranted were today’s medical “facts” always true, were acute-care medical procedures more important than doctors’ and patients’ long-term preferences, and were an administrator’s definition of “better quality of clinical care” more worthy than the patient’s desires.

Few young physicians understand how often their medical school lessons will later be found to have been wrong, because medical knowledge changes. My medical school class learned, with certainty, that anxiety causes peptic ulcers (the idea that ulcers can have a bacterial cause was thought insane), that autism is due to poor parenting, and that estrogen supplement corrects Nature’s error of menopause. Far from certain, cardiovascular medicine still debates whether interventional or pharmacological care best treats some types of heart disease. Has Dr. Warraich yet seen, or had to treat for decades, a patient permanently injured by a new procedure or drug based on an innovative thought that was later found to be wrong? It takes experience for doctors to learn when staying one’s hand may be a better choice.

Cardiologists like Dr. Warraich make decisions urgently. The goal is to prolong, not necessarily save, a life. The ICU vision of the cardiologist is narrow. Outside the ICU, in long-term illness—timing intervention to an optimal moment, deciding when not to intervene, negotiating choices, doing no harm—are the broader goals.

Innovation and new ideas are, of course, always welcome. So is asking the question, How do we know this is right? Although experience requires time to acquire, it leads to wiser judgement. Dr. Warraich has confidence in the new. Perhaps, as he grows older, he will value humility and caution as well.

 
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