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    couple questions, if i might be so bold.

    let's assume that we are all up to date on literature.

    do you find that your practice has evolved as the years have gone by?  if so, in what way?  more conservative with recommendations for surgery/procedures?  more aggressive?  is this due to better understanding of the human condition and recognition of aging processes/natural history of disease?  seeing people find their own solutions to some limitations?  worry about patient's financial status?  recognition that some things are out of your hands?

    if ordering less tests than younger colleagues, why is that?  technology theoretically offers opportunities (albeit with potentially higher costs).  maybe sometimes technology is ahead of its time and looking for indications (early days of robotic perhaps) but certainly diabetic monitoring and medications have improved.  are we just more familiar with things we encountered when we were younger?  is it hard to teach an old dog new tricks?  is it lack of confidence that ordering six studies instead of two studies will ultimately help the patient?  belief that healing hands are more important to the patient than diagnostic magic?

    or your practice has not evolved with your own experiences, simply reflects changes in overall medical practice.  almost indistinguishable from someone 5 years out of training.  it is my feeling that the first five years people tend to follow the guidelines rigorously, afraid to miss something.  over time, experience helps them to have a more nuanced practice approach to many problems and order tests more thoughtfully.   that's why i picked the arbitrary cutoff.  but as always, i easily could be very wrong.

    thanks!

    let's all be nice to each other.

     

     

     

  • #2
    I guess I qualify as senior.  Yes I definitely practice differently than some younger folks.  I have been practicing long enough to see lots of change both good and bad.  I think I am able to intuitively figure out some things by hearing the history that certainly the NPs are amazed by.  I am more efficient than my younger peers.  This will probably change when Cerner goes live in my office in a few months.  We will see.

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    • #3
      I'll give the other perspective.  I'm a new partner at my group with the range of Drs practicing from 0-35 years.  Some of those who are older, 25+ years definitely do the surgical procedures more "old school" compared to what I do.  Even their post-op management differs in some respects.  However, they are invaluable when it comes to looking at xrays or advice on difficult cases.

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      • #4
        Our group also spans from new grads to those in their third decade of practicing. Some of the older docs are what I would term "old school" and may not be completely up to date on the latest and greatest but their clinical gestalt is second to none. If I had to choose between being up to date and having fantastic clinical gestalt, I'd take the gestalt every time.

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        • #5




          I guess I qualify as senior.  Yes I definitely practice differently than some younger folks.  I have been practicing long enough to see lots of change both good and bad.  I think I am able to intuitively figure out some things by hearing the history that certainly the NPs are amazed by.  I am more efficient than my younger peers.  This will probably change when Cerner goes live in my office in a few months.  We will see.
          Click to expand...


          Cerner has driven more than one doc to retirement. Best of luck with the beast.

          Comment


          • #6







            I guess I qualify as senior.  Yes I definitely practice differently than some younger folks.  I have been practicing long enough to see lots of change both good and bad.  I think I am able to intuitively figure out some things by hearing the history that certainly the NPs are amazed by.  I am more efficient than my younger peers.  This will probably change when Cerner goes live in my office in a few months.  We will see.
            Click to expand…


            Cerner has driven more than one doc to retirement. Best of luck with the beast.
            Click to expand...


            Ugh, Cerner, sorry you're going there. Never have I felt more like a keyboard monkey than when we changed to Cerner. Too many clicks to get the job done.

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            • #7
              Page 47 of this report would support the conclusion that younger docs tend to adhere to guidelines more:

              https://www.nehi.net/writable/publication_files/file/cpg_report_final.pdf

              However, guidelines have also been more of a "thing" in the last 10-20 years rather than 30+ years that the older docs have been around.  So it could be a culture thing and less an age thing, but as the report above shows it's not a seismic shift.

              I don't know if I qualify as senior or not, but I'll say that I was much more willing to take on more fringe cases earlier on in my career - things that would make me more uncomfortable now.  You learn what you can help and what you can't, what you should be doing and what you should be passing to a colleague with more advanced training.  As far as decision making goes, I moved away from recommending things when there is no obvious choice - treating cancer with X vs not doing anything, for example, provides a clear choice.  However, quality of life decisions are different  IMO.  Once the car belongs on the race track I tell them about the turns and hazards, potential glories of hitting the finish line, but it's the patient's job to press the gas pedal, or brakes.

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              • #8
                in general as I've gotten less young, my risk tolerance has gone down, now that I have something in my bank account.  also I'm less willing to suffer fools and tolerate BS, for the same reason.

                I am no good at ultrasound and the other electronic gadgets and that makes me nervous.  however, on occasion, the fancy gadgets are broken/missing/off-the-floor and that makes me feel warm and fuzzy.

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                • #9


                  However, they are invaluable when it comes to looking at xrays or advice on difficult cases.
                  Click to expand...


                  For a general sounding board?

                  For actually knowing the newest/best procedures (based on evidence)?

                  For thinking through the larger medical/surgical care needs?

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