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  • q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    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.

     

     

     

    #215890 Reply
    hatton1 hatton1 
    Participant
    Status: Physician
    Posts: 3064
    Joined: 01/11/2016

    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.

    #215905 Reply
    ACN ACN 
    Moderator
    Status: Physician
    Posts: 636
    Joined: 01/08/2016

    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.

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #215915 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2859
    Joined: 01/03/2017
    Earnest refinancing bonus

    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.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #215921 Reply
    Avatar snowcanyon 
    Participant
    Status: Physician
    Posts: 531
    Joined: 10/22/2018

    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.

    #215930 Reply
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 346
    Joined: 03/09/2017

    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.

    #215948 Reply
    Liked by hatton1, Tim
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 3523
    Joined: 01/14/2017

    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.

    #215988 Reply
    Avatar G 
    Participant
    Status: Physician, Small Business Owner
    Posts: 1799
    Joined: 01/08/2016

    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.

    #216080 Reply
    Liked by Anne
    Avatar adventure 
    Participant
    Status: Spouse
    Posts: 1186
    Joined: 10/24/2016
    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?

    #216727 Reply

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