To the Editor: Re “For Doctors, Age May Be More Than a Number,” by Haider Javed Warraich (Sunday Review, Jan. 7): The article troubles me for many reasons, mostly for its hubris but also for its conceit. Dr. Warraich, who is 29, writes, “In medicine, a lack of experience may not actually be a bad thing.” As a recently retired general and vascular surgeon who was privileged to be part of the training of some 240 surgical residents, I feel qualified to comment. I happily admit that the “training” went both ways all those years. I’d like to think the benefits were mostly in favor of the residents. After all, they learned when, why and especially how to operate. And most important, when not to operate. Would you want an inexperienced pilot or a pilot in training to fly your next flight? There is no doubt that medical students and residents are the lifeblood of the future of medicine. But there is no substitute for experience. STEVEN KAHN, PRINCETON, N.J. To the Editor: I agree with Dr. Haider Javed Warraich. Young doctors have many good qualities that have nothing to do with age, for better or worse, But when he writes that “nothing is more reassuring to patients than seeing a silver-haired doctor walk up to their bedside,” I have to disagree. To the contrary, seeing a silver-haired doctor walk up to my bedside could give me plenty of concern about his experience with modern techniques and recent medical research. FIONA BAYLY, NEW YORK To the Editor: When I started medical school, I was 30. When I start my neurology residency in July, I will be 34. Will my age, in and of itself, make me any more likely to order unnecessary imaging studies or prescribe opioid painkillers than my 25-year-old peers? Of course not. Dr. Haider Javed Warraich means to suggest, rather, that those who have been in practice for fewer years are more open-minded, with more innovative inclinations, and that these traits may lead to better outcomes for patients. But what will keep the vibrantly unprejudiced young doctors of today from becoming obstinate and old-fashioned senior attendings tomorrow? Or should we simply insist that physicians stop practicing once they reach a crucial tipping point on the longitudinal scale of clinical experience? Perhaps instead of correlating improved health outcomes with the life-years that the youngest doctors lack, we should focus on determining which educational/professional experiences closely correspond with novice doctors’ patient-care successes and focus on making those accessible to and even required of doctors of every age, at every stage of their careers. ADINA WISE, PHILADELPHIA To the Editor: Dr. Haider Javed Warraich correctly identifies the worst of old-school medical practice: arrogant doctors who rely on anecdotal experience. As a psychiatrist and a medical school clinical faculty member for 30 years, I have learned a lot from my students. They are dedicated to social justice, attentive to language and more aware of policy, ethics and social determinants of health. What they struggle with, however, and what remains an area poorly addressed in their training is the more nuanced interpersonal domain. If tradition blinds older doctors, ideology can blind younger ones. Holding impeccable values does not help them engage authentically, with honest, insightful emotional awareness. Needing to understand an individual patient requires more than machine-learning, big data, political correctness or treatment algorithms. Psychological depth may be the real new frontier of sound medical care. It can also reduce error, burnout and patient dissatisfaction. SARA HARTLEY, OAKLAND, CALIF. To the Editor: After 24 years in orthopedic practice, my small community hospital in upstate New York affiliated with a medical school, and suddenly we were inundated with medical students, residents and fellows. From my standpoint, this was the best thing that had happened to my practice since I left my fellowship. I could no longer just do what I had been doing, I needed to explain it, not only to the students but also to myself. The presence of younger colleagues, whether trained surgeons or students or doctors in training, gave new life and meaning to my practice. Passing on my knowledge is a gift that will keep on giving, but learning from them in turn has been enlightening. I cannot imagine a better way to approach my final years. I get to bask in the excitement of new learners and to leave a mark on the next generation. In the last four years I have learned not to take anything I have done for granted. This serves me and, more important, my patients well. BETH DOLLINGER, ELMIRA, N.Y. To the Editor: I am an 80-year-old neurologist, and I, too, have been asked my age all the time since I started in practice. When patients ask how old their doctor is, I find that it is always a question of relevant knowledge, skills and attitudes. In medical school and residency, doctors learn what can be done and how to do it, but not whether, when or why to do it. Nothing is more difficult for me than treating a patient who has had a stroke or some other adverse event during a procedure or an operation that I believe should have never been undertaken in the first place. It is the delicate balance between technical skills and judgment that is at issue in choosing a doctor, and there is no easy answer. My own experience suggests that people should rely on a well-trained primary care physician to guide their care, and not self-refer to specialists for the great majority of medical problems. MATTHEW MENKEN, ST. JOHN’S, ANTIGUA Source
