To world-famous heart surgeon Michael DeBakey, who at 96 is still practicing full time at Baylor College of Medicine in Houston where he is chancellor emeritus, the study underscores the importance of competence, rather than age.
As with people in all professions, DeBakey said, doctors vary tremendously in their abilities, a reality that is often overlooked. "I suspect 20 years from now a study would find the same thing" as the Harvard researchers did. Most physicians who are very good early in their careers, he said, will probably retain these skills as they age.
DeBakey said he keeps up by "reading all the journals, writing articles, doing research" and teaching. He said he stopped operating on patients about nine years ago.
Alan Pocinki, 45, an internist who practices in the District, said the Harvard study has limitations. Adhering to practice guidelines and measuring performance on recertification exams as some studies did, he said, does not measure a doctor's diagnostic capabilities, clinical judgment or other skills, which often accompany experience.
Pocinki said he is reminded of a saying popular among his medical school classmates at Cornell that "the top third of the class were the smartest and made the best researchers, the middle third made the best doctors and the bottom third made the most money."
Sometimes, he added, young, inexperienced doctors become overly wedded to guidelines and ignore the patient. "They're going to follow those guidelines and if somebody doesn't fit, damn it, they're going to make them fit," he said. "I see that all the time."
The perspective that accompanies clinical experience is critical, said cardiologist Stuart F. Seides. "I've seen a lot of new, big, greatest things in my time," said Seides, 57, associate director of cardiology at Washington Hospital Center. The reality, he said, is that in medicine, knowledge "is seldom revolutionary and much more likely to be evolutionary."
Staying abreast of new findings and ways of doing things, Choudhry and his colleagues suggest, will take more than recertification exams. One solution may be "academic detailing," a concept borrowed from drug companies' sales pitches, in which specially trained educators visit doctors in their offices and make them aware of recent advances. The concept, pioneered in Australia, has had some success there, he said.
Choudhry, who finished his residency training in 2000, said he regards competence-enhancing efforts as a boon.
"I already feel that it's hard to keep up," he said.•
