Old doctors never die, they just loose their patients !
How do old doctors stay competent?
How do you know they are competent ?
There are a few ethical contradictions that have been bothering me lately.
1) Why is it that the older and more experienced lawyers are, the more they charge per hour ??? ( I hate lawyers. Especially old and experienced, ones .... )
2) Why is it that the older and more experienced doctors are, the more the College of Physicians and Surgeons of B.C. and every one else suspects them of being obsolete, alcoholic, and demented ? And why do they get paid the same as a rookie !
1) Why is it that the older and more experienced lawyers are, the more they charge per hour ??? ( I hate lawyers. Especially old and experienced, ones .... )
2) Why is it that the older and more experienced doctors are, the more the College of Physicians and Surgeons of B.C. and every one else suspects them of being obsolete, alcoholic, and demented ? And why do they get paid the same as a rookie !
As an intern I had an enlightening and wondrous and scary experience.
The anesthetist who was teaching me how to put people to sleep ( and more importantly, how to make sure they woke up ) decided to give me an impromptu seminar on anesthetic drugs.
There were three factors that amazed and mortified me throughout one of the best drug teaching sessions I have ever received:
1) All the drugs we reviewed had been developed since the date of my birth
2) The old geezer who was enlightening me had graduated from medical school long before the date of my birth.
3) Therefore, there was not a single drug we were using which he had learned about in medical school. Which was terrifying, because we were using some of the strongest and most potent drugs in existence. Me and the old geezer !
4) If he didn't learn about them in medical school, did he really know what he was doing ? ( It was pretty easy to see that he did - the big mystery to me was, "how" ??? )
The anesthetist who was teaching me how to put people to sleep ( and more importantly, how to make sure they woke up ) decided to give me an impromptu seminar on anesthetic drugs.
There were three factors that amazed and mortified me throughout one of the best drug teaching sessions I have ever received:
1) All the drugs we reviewed had been developed since the date of my birth
2) The old geezer who was enlightening me had graduated from medical school long before the date of my birth.
3) Therefore, there was not a single drug we were using which he had learned about in medical school. Which was terrifying, because we were using some of the strongest and most potent drugs in existence. Me and the old geezer !
4) If he didn't learn about them in medical school, did he really know what he was doing ? ( It was pretty easy to see that he did - the big mystery to me was, "how" ??? )
It was a little bit like discovering that there was a WWI fighter pilot flying your space shuttle. Or that a pharmacist from the days of Leonardo Da Vince was preparing all your medications.
The endless circle of time has repeated itself, and I am now the old geezer, and most of the drugs I have prescribed today were not around when I was in medical school. Which begs the question, how do I know what I am doing ?
Where exactly do old doctors learn new things ?
The scary truth is that , although the question has been researched somewhat, no one really knows that answer. Among the possibilities are :
1) They don't ! While this is fortunately quite rare, when the pressure is always there to work long hours and make more money, it is easy for continuing education to take a back seat.
To combat this situation many professions have requirements for continuing education. A realtor friend of mine has to do a certain number of hours per year to keep her licence. Plumbers quite often have to keep up their certification. I have heard that even lawyers have to keep up to date now and again.
But the weird truth is that the number of hours of continuing education that I have been required to take since I graduated from medical school thirty years ago is exactly zero. Nil. Nada. Not one hour of continuing education has been required of me yet !!!
Which is not to say that I have never gone on a course . I have gone on them regularly, and for the same reason many doctors do. They are often in interesting and exotic locations ( one of my first courses was in mainland China, back when hardly anyone got to go there) , and are ways of converting a journey to more interesting climes into an income tax deductible getaway
The endless circle of time has repeated itself, and I am now the old geezer, and most of the drugs I have prescribed today were not around when I was in medical school. Which begs the question, how do I know what I am doing ?
Where exactly do old doctors learn new things ?
The scary truth is that , although the question has been researched somewhat, no one really knows that answer. Among the possibilities are :
1) They don't ! While this is fortunately quite rare, when the pressure is always there to work long hours and make more money, it is easy for continuing education to take a back seat.
To combat this situation many professions have requirements for continuing education. A realtor friend of mine has to do a certain number of hours per year to keep her licence. Plumbers quite often have to keep up their certification. I have heard that even lawyers have to keep up to date now and again.
But the weird truth is that the number of hours of continuing education that I have been required to take since I graduated from medical school thirty years ago is exactly zero. Nil. Nada. Not one hour of continuing education has been required of me yet !!!
Which is not to say that I have never gone on a course . I have gone on them regularly, and for the same reason many doctors do. They are often in interesting and exotic locations ( one of my first courses was in mainland China, back when hardly anyone got to go there) , and are ways of converting a journey to more interesting climes into an income tax deductible getaway
Coffee chats !
Doctors often hit something they aren't sure about, and ask the next person the bump into at the water cooler or the coffee machine about it. The only drawback with this method is that the information is only as good or as up to date as the person giving it.
This method has a long and honourable history. It is even sometimes called the Socratic Method. Which is defined by Wikipedia on way, and by some surgeons as " the big doctor taking the little doctor by the hand and showing him what to do." It is not that different from a continuing apprenticeship, and while it is a little unregulated it is doubtless where a lot of useful information is picked up. We steal each others secrets !
A subset of this is stealing information from specialists. If an aging healer can't remember how to treat syphilis of the left ear lobe, we can always then them off to a left earlobe specialist. And the secret to success will be including in the specialists report. And so the next time someone with a left earlobe problem comes in , the initial doctor will have been pre - educated.
This method has a long and honourable history. It is even sometimes called the Socratic Method. Which is defined by Wikipedia on way, and by some surgeons as " the big doctor taking the little doctor by the hand and showing him what to do." It is not that different from a continuing apprenticeship, and while it is a little unregulated it is doubtless where a lot of useful information is picked up. We steal each others secrets !
A subset of this is stealing information from specialists. If an aging healer can't remember how to treat syphilis of the left ear lobe, we can always then them off to a left earlobe specialist. And the secret to success will be including in the specialists report. And so the next time someone with a left earlobe problem comes in , the initial doctor will have been pre - educated.
"Medical" journals and websites.
I used to subscribe to a number of these. But nowadays most of mine are internet based. Which is great, because all the updates on my favorite topics get sent to my smart phone. So as long as I don't loose the phone, I will be currently with all the latest developments.
This can also include non - traditional sources of education, such as lay magazines, newspapers, and some blogs and forums. For years I was a avid reader of Cosmopolitan. I had no desire to ever be a Cosmo girl, but when they had a column on medical topics it was invariably first rate ! And while I am currently a big fan of Dr. Oz, I still think the old issues of Cosmo were better !
This can also include non - traditional sources of education, such as lay magazines, newspapers, and some blogs and forums. For years I was a avid reader of Cosmopolitan. I had no desire to ever be a Cosmo girl, but when they had a column on medical topics it was invariably first rate ! And while I am currently a big fan of Dr. Oz, I still think the old issues of Cosmo were better !
Google and Wikipedia
It used to be easy to keep ahead of the competition. I had all the big medical textbooks, and my patients didn't. But these days I am constantly barraged with people who have googled their symptoms, investigated the available treatments on line, and come in armed with more knowledge about their particular condition than I have had since my last medical school exam on the topic.
Some days I think this is unfair. I have 10,000 diseases to keep up with, and treatments that can change from day to day. And then I get bushwhacked by someone who has spent three weeks researching syphilis of the left ear lobe on line.
These days my usual strategy is to find some excuse to leave the exam room, and then run off and check with Google myself. A few minutes later I return to the exam room all knowledgeable and all knowing.
This works particularly well except for the smart a**ses who are in the room actively undating their own knowledge on their smart phone. ( That is the real reason doctors don't like patients to use their phones in the office !)
Some days I think this is unfair. I have 10,000 diseases to keep up with, and treatments that can change from day to day. And then I get bushwhacked by someone who has spent three weeks researching syphilis of the left ear lobe on line.
These days my usual strategy is to find some excuse to leave the exam room, and then run off and check with Google myself. A few minutes later I return to the exam room all knowledgeable and all knowing.
This works particularly well except for the smart a**ses who are in the room actively undating their own knowledge on their smart phone. ( That is the real reason doctors don't like patients to use their phones in the office !)
The Cochrane Collaboration
This is like the entire world of medicine in one huge online library. It summarizes the current state of knowledge on thousands of medical treatments.
A bunch of scientists and physicians in Quebec once decided to sort out once and for all time what the best treatment was for whiplash. Their method was simple. There were ample medical journal articles and research papers on the subject. They would just analyze all the papers, separate the wheat from the chaff, and out would pop the best possible treatment for whiplash.
This lead to what became known as the Quebec Task Force on Whiplash Associated Disorders. And it turned out to be a bit of a disaster. The first problem was that there were too many articles on whiplash treatment. About ten thousand !!! . Far too many for even the hundreds of researchers involved in the project to read and analyze.
So they weeded out all the articles that were obviously biased, did not have a good sample size, did not have a control group, or were just plain weird. This cut the number of articles down to about 300. And the researchers then spent two years analyzing these remaining studies in excruciating detail. And produced an epic report which summarized the state of the art as far as whiplash is concerned.
Which means that they developed a good and reproducible ( but useless ) classification system for describing the severity of whiplash. And summarized the fact that there is conflicting information about the various treatments. And while they could say that some treatments were useless , they could not actually decide on the best treatment for whiplash. So in the end they were just confused, but at a higher level !
What the Quebec Task Force did for whiplash, the Cochrane Collaboration does for everything else. Thousands of scientists review the entire sum of medical knowledge on various topics, and their conclusion is usually more about the things we don't know than the things we do. But as the Buddhists say, ignorance is the start of knowledge .....
A bunch of scientists and physicians in Quebec once decided to sort out once and for all time what the best treatment was for whiplash. Their method was simple. There were ample medical journal articles and research papers on the subject. They would just analyze all the papers, separate the wheat from the chaff, and out would pop the best possible treatment for whiplash.
This lead to what became known as the Quebec Task Force on Whiplash Associated Disorders. And it turned out to be a bit of a disaster. The first problem was that there were too many articles on whiplash treatment. About ten thousand !!! . Far too many for even the hundreds of researchers involved in the project to read and analyze.
So they weeded out all the articles that were obviously biased, did not have a good sample size, did not have a control group, or were just plain weird. This cut the number of articles down to about 300. And the researchers then spent two years analyzing these remaining studies in excruciating detail. And produced an epic report which summarized the state of the art as far as whiplash is concerned.
Which means that they developed a good and reproducible ( but useless ) classification system for describing the severity of whiplash. And summarized the fact that there is conflicting information about the various treatments. And while they could say that some treatments were useless , they could not actually decide on the best treatment for whiplash. So in the end they were just confused, but at a higher level !
What the Quebec Task Force did for whiplash, the Cochrane Collaboration does for everything else. Thousands of scientists review the entire sum of medical knowledge on various topics, and their conclusion is usually more about the things we don't know than the things we do. But as the Buddhists say, ignorance is the start of knowledge .....
"Up To Date"
Since I have stopped reading Cosmo, this has been my favorite source of medical information. It is an online ( and smartphone ) database that makes one simple promise --- that it will be medically "up to date". All the time. On every topic !
The best thing about Up To Date is that it is expensive. Which means that I have it and my patients don't ! So I can run down the hall, and come back to the exam room later with information that is guaranteed to be both expert opinion, and up to date expert opinion. It is pretty much the same as having an entire medical library on your smartphone - and one that gets updated every month, so that I know that I am never going to be out of date.
The best thing about Up To Date is that it is expensive. Which means that I have it and my patients don't ! So I can run down the hall, and come back to the exam room later with information that is guaranteed to be both expert opinion, and up to date expert opinion. It is pretty much the same as having an entire medical library on your smartphone - and one that gets updated every month, so that I know that I am never going to be out of date.
Up To Date Patient Information Sheets.
Up To Date also has patient information sheets. These are printable for patients, except I am usually too busy to print them. But I have gotten permission from up to date to put links to their information sheets from my web site here. So from now on for a lot of topics you will see a link for up to date "Up-To-Date Patient Information - Beyond the Basics". These are pages of information that you can read or print out for yourself, which have the latest and most accurate medical information possible on any given subject.
And if there is a medical topic that you would like to see an information sheet on and don't - just email me and let me know !
And if there is a medical topic that you would like to see an information sheet on and don't - just email me and let me know !