There are lies, damned lies, and statistics. Your idea of proof is weird.
The emotions stuff is more character assassination.
The dumb discussion of anecdotal evidence is just you not listening to reality. Had nothing to do with mushrooms.
Then grow a pair and admit you have no experience in medicine. You have no clue what does or does not work after the report that xyz has ABC results. Truth is later on most ABC results are wrong.
Again
That is actual experience. You have none.
You think you can reason it away. That is nonsense.
You are condescending because you can not do or teach. This is not your area of expertise. Stop acting as if you know medicine.
I do not go to a cardiologist for advice on a dermatology problem. Never mind looking for RNA advice. If you actually had to carry malpractice insurance youâd sing a very different song.
Iâd say that youâre getting pretty close to needing a reminder that, when youâre in a hole, itâs a good idea to stop digging. You are, however, providing a good few âteachable momentsâ, as my husband calls themâŚhowever unwittingly. âŚso carry on.
And these are words that you should take to heart yourselfâŚand not just where âmedicineâ is concerned.
Iâve noticed in the past that these extended threads with a pattern of you making a dogmatic statement, as if you know, receiving a challenge (because you manifestly dont) and then getting bent out of shape and firing off insults, all seem to coincide with times when youâve mentioned youâre back on zoom or noom or whatever your diet programme is. Do you think you might be firing on too aggressive an energy deficitâŚor am I erroneously seeing patterns that donât actually exist?
Keep in mind those words above. Making believe other wise is nonsense.
I really could careless what your claims are about who published what in your family. Research is very often wrong or nonsense.
You are still typing. Yes you will want to know about BIL research. He has done a lot of work. Most of it is simply figuring out what molecule is in a cell. He does not come up with conclusions. He ends with more questions than anything else.
The equally simple truth is that, where novel research is concerned with publication of hypothesis generating/hypothesis testing studies in academic journals, this might well be an accurate statementâŚand those with the appropriate background in science understand that. As explained upstream, there is no way to test a new hypothesis for accuracy without performing a controlled experiment and the potential to be wrong is always there, regardless of prior plausibility.
That hypothesis testing might well show an initial positive result (like the nitric oxide/periodontal disease study Iâve mentioned) but then on further testingâŚwith greater numbers, say, or a different subject base or any number of variables independent researchers might use to attempt to reproduce/refute said hypothesisâŚdemonstrate less correlation. Hereâs the thing, even if that initial research report doesnât appear to hold up to further testing, it doesnât mean that the initial pilot study shouldnât have been performed or submitted for publication and public scrutiny by peer review. That is how the scientific method works. If you have a better method of hypothesis testing, we need to hear about itâŚnot the beef you have with folk whoâre pointing out your gaffes.
We looked at nationally representative data on Medicare patients hospitalized between 2011 and 2014 with a general medical condition and treated by a hospitalist physician, a general internist who specializes in the care of hospitalized patients. Our final sample consisted of approximately 700,000 hospitalizations treated by 19,000 hospitalists in 3,000 hospitals across the United States.
There are swathes in the West and in the South of states where people might not see a doctor before dying. How old the doctors are on average in those regions could play a role.
How many people die without going to hospital in a state was never conceived as a necessary calculation.
It is certainly an important topic but doing research that indicates older doctors are on average not as good as younger ones is bound to make one pretty unpopular.
That is the central issue, how do we make sure doctors keep up with advances in medical technology as they age? It is very controversial, as one can see from this editorial on medical recertification requirements. NEJM Group Pain Management and Opioids and AMBOSS - Pain Management CME
The argument for recertification of MDs is essentially the issue being discussed here:
âA certification/recertification program to measure competence encourages us to keep pace with change. Research shows that without continuous updating, a physicianâs skills and knowledge tend to decline with time â and that clinicians who choose to recertify tend to perform better on standardized measures of quality and patient outcomes than clinicians who do not recertify.â
Fortunately, most medical treatments do not require state of the art expertise. Broken bones and sore throats tend to be uncomplicated. It is typically when you get into the medicare age and the risks of diabetes, arthritis, heart disease, cancer, and dementia become really significant that having a doctor with up-to-date skills/knowledge becomes important.
The studies are suggestive but not conclusive. I remain impressed however that the impact of physician age on patient outcomes is in the same range as taking statins. Thatâs pretty significant to me.
Ironically when research papers do have a problem it is usually because of inadequate statistical analysis. You see, the practice of medicine is mostly about statistics. The effectiveness of a drug is determine by whether its impact is statistically significantly better than a placebo effect. Ask an oncologist about whether to do surgery, radiation, or chemo and one will get a statistical description of the likelihood of success and the probabilities of side effects for each treatment. The choice of antibiotic to use for a bacterial infection is determine by which is statistically more likely to be effective for that bacterial strain.
It is all about statistics.
That may be true, but you should consider the alternative explanation that it just sounds condescending to you because you are being extraordinarily dogmatic on a topic you seem to know very little about.
We donât know what such research would show, nor do we really know the reaction. Perhaps requiring a more proactive approach to annual/periodic continuing education to reduce this effect would be the result, thereby improving medical outcomes for all patients.
My thought is that your statement above is an oversimplification. New doctors should get better with more experience. That would imply that there is a curve in patient outcomes vs. time since finishing residency. My guess is that doctors are adequately competent after residency and continue to hone their skills for some time after they enter practice. But after further passage of time, they tend to fall behind the current state of medical practices for various reasons (comfort in their practice, âpencil-whippingâ continuing education requirements [which is a problem in my particular professional field], readjustment of work/life balance - a common problem in the medical field, and probably several other potential reasons).
I was hoping for a more full discussion of the issue rather than just repetition of the same mantra.
You are never wrong. VeeEnn was quite open about the edge of research. It is problematic. The doctors have to sit with patients that have serious problems and help the patients understand the fallibility of the research.
If you had to face an actual patient youâd see this differently.
Iâve provided links showing such research has been done and they have been controversial. I also provided a link about doctor recertification requirements, which is both proactive and controversial. Every professional, MDs included, understand the need to keep up with technology. It is hard to do, particularly in fields that move quickly like medicine with new drugs coming out all the time.
My statement is simply a summation of the data showing younger doctors have more current knowledge, are more likely to follow the most recent protocols, and have better patient outcomes than older doctors. It is probably the case that younger doctors are less confident so they prescribe more tests and are more likely to ask for second opinions. Less efficient but also less likely to make mistakes of omission.
Mantra! Sheesh.
If you want a full discussion you need to pull your weight and read the links and do some research. Otherwise I am just teaching, which Leap keeps pointing out is condescending and something to be avoided. Iâve provide four papers from four different groups. One is a meta review of the literature that found a majority of studies on the issue concluded that younger physicians had more current knowledge and tested higher on recertification exams that older physicians. A second surveyed health professionals (mostly nurses over 40 years) and found that younger health professionals were perceived as having more current knowledge and provided more patient-centric care. A third examined patients with a specific type of heart disease and found that mortality rates increased with the age of the cardiologist. Finally the big BMJ study of Medicare patients found higher rates of mortality with older doctors despite the patients having similar levels of coMorbidities.
So you have four different studies from different researchers using different methods and examining different populations coming up with the same observation that younger medical professionals seem to be outperforming their older colleagues when it comes to stuff like current knowledge and patient outcomes. What do you conclude from all of this?
I donât mean to sound defensive but why not actually read and discuss the information rather than criticise the provider of the information?
No one is talking about statistical models. Using statistical tests to assess whether the difference between two treatments is significant is not âstatistical modelingâ.
Again, you really shouldnât use terms you donât understand.
You ignore anyone else anyway. That is why you state things like the above. Or other garbage about your being condescending. Those are not rebuttals.
I just put up two posts you can not counter.
Sheesh??? That is the research you keep siding with as correct. The research is statistical.
That is so wrong and lame.
We are discussing a statistical model about older doctors. We were not discussing different drugs. Which is still statistical modeling.
Actual patients are not statistics. Individuals have diagnosis and prognosis that do not fall into statistical âMODELSâ for those who know nothing but say a lot.
