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The good thing about older MDs

Younger MDs may be more up to date in medicine. But older ones get fewer complaints from patients. @NightshiftMD has the details of a new survey.

Some of Canada's doctors are getting a bit long in the tooth. The people who track these things say just under 15 per cent of Canada's doctors are age 65 and older.  A study published recently says that MDs with a bit of seasoning have something to crow about.  They get fewer complaints from patients than do younger colleagues.

That's the main conclusion of a study published in JAMA Ophthalmology. Researchers from Vanderbilt University Medical Center in the U.S. looked at complaints directed at ophthalmologists that were filed with the hospital's Patient Advocacy Reporting System between 2002 and 2015. Turns out that ophthalmologists age 71 and older had the lowest rate of unsolicited patient complaints of any age group.  Eye doctors age 31 to 40 were 2.36 times more likely than those over 70 to receive a complaint from a patient.  It also took younger physicians less time than older ones for patients to complain about them.

To my knowledge, this is the first study I've seen that finds that older physicians get fewer complaints from patients than younger colleagues.

Medical competence has little to do with it.  Younger physicians should be more up to date than older ones on the latest advances and the best practices for treating diseases. Their operating room skills should be closer to their peak than MDs at or near retirement age.  Clinical competence definitely declines with age.  A review that looked at 62 studies found that physician performance generally decreases with years in practice. 

And, older doctors are less likely than younger doctors to follow treatment guidelines. To that, you can add an increasing incidence of dementia with age.  Five to 10 per cent of people age 65 or older have dementia, and there's no reason to think physicians will be exempt from that.

The study did not look at the reasons why younger doctors get more complaints.  The authors speculated that young physicians may be new to their hospital, and may be learning how to deliver good medical care in a relatively unfamiliar place.  Even though they may technically more competent than older physicians, younger doctors may project a lack of confidence that some patients find jarring. Paradoxically, younger patients may get more complaints because they end up taking care of patients with more complicated illnesses that older doctors no longer feel competent to handle.

Another factor is that younger doctors have a hard time having conversations with patients that are difficult emotionally.  For instance, younger eye doctors have a tougher time telling patients they have or are likely develop permanent blindness.  I have to wonder if older physicians have more empathy for patients because they have more life experience accompanying loved ones to the hospital as I did with my late parents and my late father-in-law. 

This is a study of eye doctors.  Would the results be the same for other kinds of physicians?  When it comes to competence, eye doctors fare as well as other doctors.  A recent study conducted in one hospital found that patients treated by older physicians had higher mortality than patients cared for by younger physicians. The only exception to that finding is that older physicians treating high volumes of patients had lower mortality rates. In another study of close to half a million patients who had one of eight different kinds of operations, older surgeons did just as well as younger ones. However, in coronary artery bypass, pancreatectomy, and carotid endarterectomy — surgeons ages 41 to 60 had lower mortality than surgeons older than 60. 

The bottom line is that while the results of this study are a good news story for older physicians, competence wins out.  At around age 70 and up, competence goes down. Experienced older doctors know this, and compensate by cutting back on riskier types of practice.  When it comes to competence, I'd pick younger doctors.  If I need an operation, surgeons in mid-career are at the peak of their surgical prowess. 

As far as complaints are concerned, the authors recommend that doctors who get more complaints early in their careers could benefit from learning how to communicate better with patients.  The good news is that young physicians who receive feedback on complaints along with professional development training get fewer complaints.  Perhaps older physicians can teach younger colleagues a thing or two about empathizing with patients.

One final thing to emphasize is that there is no hard age cutoff for attributes such as competence and bedside manner.  There are physicians who maintain both well into their eighties, perhaps even better than some in their forties.  


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