Haider Javed Warraich: When I went on Terry Gross’s radio show last year, the very first question she asked me was one I get asked during my work as a doctor all the time:
“Can I ask how old you are?”
“So when family members or loved ones see you,” she went on, “do they ever look at you and go, ‘You’re so young, how can I trust you?’”
In many professions, a premium is placed on experience, with age often a surrogate for expertise — but probably no profession places more primacy on age than medicine. Nothing is more reassuring to patients than seeing a silver-haired doctor walk up to their bedside. To this day, medicine is largely an apprenticeship, with young physicians huddling around older physicians, straining to catch every word, so as to not lose a nugget of wisdom. Experience is even written into our dress codes: Students in many medical schools cannot wear long white coats, unlike their seniors; in some, even medical residents can’t have coats that extend much below the waist.
Yet, as the field evolves into one where data and evidence are beginning to outweigh anecdotes and opinions, one thing is becoming increasingly clear: In medicine, a lack of experience may not actually be a bad thing.
A paper published last year by researchers at Harvard showed something very striking — patients being taken care of by younger doctors were less likely to die. Younger, less experienced physicians are also less likely to order unnecessary tests in both men and women, to face disciplinary actionfrom state medical boards or be cited for improper prescription of opioid painkillers and other controlled substances. These findings are far from isolated: The majority of research shows a consistent, positive relationship between lack of experience and better quality of clinical care.
How can this be? For one, younger doctors are more likely to adopt innovative practices, such as prescribing newer medications with fewer side effects, or learning new ways of doing procedures such as performing cardiac catheterization from the wrist rather than the groin, which is safer for patients.
Their inexperience also allows them to be free of malignant relics from the past. Having not trained in an era steeped in medical paternalism, younger physicians are more likely to place the patient on the pedestal rather than themselves. Nowhere is this truer than at the end of life. Research showsthat younger doctors are more likely to discuss important but difficult issues with critically ill patients such as prognosis, preferences for life-sustaining treatments, hospice and the place where patients may want to die.
For all their qualities, though, young physicians are finding that opportunities to succeed are actually dwindling in medicine, which is getting more crowded at the top as doctors delay retirement. A fifth of American doctors are older than 65, a proportion expected to rise to a thirdby 2021. That leaves little room for young physicians to step into leadership positions.
To move forward, recognition is needed not just for the traditional model of learning in medicine — the young learning from the old — but also for the fact that there is much that more experienced physicians can learn from young doctors. Mentorship is a two-way street, with the most successful academics also being the greatest champions of their trainees. To encourage it, mentorship needs to be formally considered a factor in academic promotions. Positions for younger physicians ought to be allocated on committees that write medical guidelines, state medical boards and editorial boards for medical journals. Models also need to be developed to shorten training time, which is far too long given that the average age of physicians completing training is the early to mid-30s.
As a young doctor, I constantly look to my mentors for guidance. Yet, at the same time, I also believe that experienced physicians need to look to younger doctors to bring a fresh perspective to health care’s most vexing questions, like developing new patient-focused models of care, disentangling the role corporate interests play in the development of medical norms and guidelines, and incorporating patients’ values in medical treatment.
Over time, I have begun to see my lack of experience as a strength. Feeling like I have more to learn forces me to keep my eyes and ears open as I hope to learn from all those around me — from the seasoned clinicians who have seen medicine evolve from a cottage industry to an industrialized behemoth, from the patients who share their lives with us and, finally, from the medical students, interns and residents who are even younger than I am.
A few days ago, I was having coffee with a friend who had just finished medical school and was helping me develop a machine-learning model that could predict which patients in the hospital were at the highest risk of dying. There was so much I had to learn from him, and yet he told me that those who inspired him were even younger than he was.
“There are 19- and 20-year-olds I work with who will blow your mind,” he told me.
Young doctors are ready to make health care both more innovative and patient-centric. But are the senior doctors they work with, and the patients they take care of, ready for them?
Haider Javed Warraich, a fellow in cardiovascular medicine at Duke University Medical Center, is the author of “Modern Death: How Medicine Changed the End of Life.”
Source: NY Times