Old Doctors Aren’t Coming To Kill You

Science reporting done (almost) right

Whenever I see something interesting in the news, I go and have a look at the study. Almost universally, I’ll sigh, roll my eyes, and think “dammit, all those articles were wrong”.

Occasionally I’ll see something amazing; most of the reporting was actually decent.

This is almost one of those times.

Doctoring Well

When it comes to doctors, we want quality. They are going to be messing around with your health, making decisions that will affect your life, and potentially be the difference between a sore toe and not having a leg.

“Where’s your stethoscope???” “I’m a radiologist” “I don’t care if you’re on the radio YOU NEED A STETHOSCOPE”

We know that clinical competence (how good your doctor is) can have a huge impact on your health, which makes perfect sense because these are the people who we trust with decisions like whether that’s a cancerous mole or just spilled barbecue sauce.

This is why there are things like medical registration, so that we can be sure that new doctors coming in have had a good quality education. It’s why we mandate continuing professional education, so that doctors have to keep up their skills and knowledge throughout their career.

Being a doctor is hard. Being a really good doctor is harder. And we try to make sure that all of our doctors are really good.

But what happens to doctors as they age?

Aging Faculties

A bunch of Harvard researchers recently published an awesome study that demonstrated a link between the age of a specialist physician and the wellbeing of their patient. Basically, people who were treated by younger doctors were less likely to die than people who were treated by the older members of the department.

I literally can’t stress how good this study was. They controlled for a massive range of factors, so it’s possible to make some pretty firm conclusions. They reported the absolute risk (which was small but significant), instead of hyping up the results using the relative risk. Not only that, but the study was huge.

Pictured; what makes a Health Nerd excited

Which is great and all, but if you’ve been reading my blog you’ll know that even the best science is* regularly misrepresented terribly when translated into the media. In the wonderful amalgam of stress, exhaustion, and ignorance that is modern journalism, most studies are misconstrued as That Big Terrible Thing That Will Change Your Life Forever instead of just That Piece Of Boring Research That Doesn’t Mean All That Much.

So what happened when this study was reported in the media?

They Got It (Mostly) Right

Amazingly, there was virtually no reporting on this study that got the science entirely wrong. There were some articles that looked as if they were written in a caffeine-induced semi-comatose state, but honestly there always will be.

Almost every news piece got the stats right, quoted the study authors, and generally did a decent job of telling you what the study found.

They were almost all wrong, but at least you can tell they tried.

Good job guys! Next time you might actually get it all right!

Almost every article quoted the Harvard press-release (many of them verbatim), which means it’s really easy to tell why the reporting is so good on this one. It also shows you just how incredibly important media releases are in the world of science communication, and how little time journalists have to write a story.

They were almost all wrong, but at least you can tell they tried.

I guess what I’m saying is that I wish they’d read the whole damn thing.

Correlation vs Causation

It turns out that virtually every article, despite being good in many respects, got one really important thing wrong. Yes, they all reported the stats right, and yes, they all got the design pretty bang on.

But every article said that old doctors were causing the increased risk of death. Which is something that the authors specifically denied in the press-release:

It was in. The. Press. Release.

This is because the old doctor study was observational; the researchers basically looked back in time and tried to see if having an old doctor was correlated with an increased risk of death. But there are hundreds of other factors that could be influencing this risk — for example that older doctors see patients who are less likely to follow their advice — so it’s hard to draw a direct line between age of a doctor and how good their care is.

This is especially true because the study found that, for older doctors who saw a ‘high’ number of patients (>200 per week), the increased death rate disappeared.

Which means that it likely had nothing to do with age at all.

Muddling Media

So what can we say about the results from this study? I think that the authors summed it up pretty well:

“Older physicians bring invaluable richness of knowledge and depth of experience, yet their clinical skills may begin to lag behind over time,” Jena said. “The results of our study suggest the critical importance of continuing medical education throughout a doctor’s entire career, regardless of age and experience.”

Which, again, is something any journalist would’ve known if the had read either a) the press release or b) the actual study.

Seriously, it’s not that hard. Most of them quoted the bloody press release anyway.

If you want a good doctor, don’t go for one who is young or old. Go for one who sees a lot of patients and keeps their clinical skills sharp.

Age probably doesn’t make any difference at all.

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*Yes, these are all separate blogs. Yes, you should definitely read them. They are brilliant.