Training Doctors
Why do different doctors practice medicine differently? It may be because medical schools that train doctors are different:
Take Johns Hopkins Hospital and Mount Sinai Medical Center, for example. They are both prestigious, but around 50 percent of patients at Johns Hopkins were enrolled in hospice in their last six months of life, compared to only 23 percent at Mount Sinai. Residents at Mount Sinai “may therefore learn a higher threshold for referral of a patient to hospice or may decide to explore more aggressive treatment approaches first,” according to the report…
Interesting analysis. It’s interesting to see the different results of different training programs.
Where, in this discussion, is the PATIENT? Why are we talking about end-of-life issues witout considering that PATIENTS might make different choices, depending on their personal, religious or family attitudes about end-of-life care?
A little variation might be good. If you consider that teaching hospitals train doctors but don’t necessarily keep them once they graduate, it’s probably a good thing. That way, there can be a healthy debate about best practices at institutions that employ doctors with a diversity of perspectives.
Variation will be good in the long run: good techniques thrive and bad ones die.
@Alex – unfortunately that often also means patients die with them
I certainly wouldn’t want a doctor who was so quick to resort to hospice over another available treatment.
both sets of doctors are obviously trained but they may just have different thoughts on how to best proceed in certain situations. Not necessarily a bad thing as many have said because this can lead to a healthy debate on best ways to treat patients
Rather than attempt to train 780,000 disparate doctors to follow best practice, wouldn’t it be easier to train a few hundred medical school about the best practices?
There are 3 different type of care. What is the proper balance of supply-sensitive care and preference sensitive care?
-Effective care refers to services that are of proven value and have no significant tradeoffs; the benefits of the services so far outweigh the risks that all suitable patients should receive them.
-Supply-sensitive care represents services for which the supply of physicians and other resources—such as hospital beds—strongly influences the amount of care delivered.
-Preference-sensitive care comprises care for conditions for which there is more than one treatment option, each with its own benefits and tradeoffs. For these conditions, patients’ preferences should—but often do not—guide decision-making
It’s interesting that John Hopkins sends more patients into hospice in the last 6 months of life, but those patients see significantly fewer doctors over that same period. I wonder if that’s also hospice related..
I just wanted to point this out…According to Gold “…the thinking is that physicians who train at hospitals with better and more efficient care will be better-prepared to become leaders in changing how health care is delivered in this country…” am I missing something here? Isn’t this common sense? If you train at better places (no matter your professional field) you will indeed be more prepared and have better skills in specific areas than those trainning in poor-quality institutions. This just sounds obvious to me.
As the saying goes “sometimes it doesn’t matter how you get there, as long as you get there”. If different types of training programs help doctors-in-training become more skilled to perform certain tasks, then that should be just fine. It doesn’t matter if the way they are trained is different, as long as they all provide a good and efficient service. The problem arises when they are all trained in different ways and their performance varies tremendously from hospital to hospital.