It is a rarely challenged dogma in clinical medicine that the more experienced you are, the better care you provide. The government is pushing for consultants to be in hospital on a more consistent basis over seven days and the RCPCH have a target that all children admitted acutely should be reviewed by a paediatric consultant within twelve hours.
But surprisingly there is no strong evidence in the literature that more experienced doctors provide better care, however that is defined. Indeed, it seems the converse may be true. A systematic review published in 2005 looked at 62 published studies that measured physician knowledge or quality of care since medical school graduation or age. More than half suggested that physician performance declined over time for all outcomes measured. Only one study suggested that increasing experience improved patient outcomes. And deteriorating performance had a real impact for patients. One study examined the management of hospitalised patients with a myocardial infarction. After controlling for all confounding factors researchers observed a 0.5% increase in mortality for every year since the treating physician graduated from medical school.
So being a good doctor seems to be about staying up to date. Reading journal articles may be one way to do this. And yet we all live busy lives whilst medical journals appear through the letter box with alarming regularity. I currently receive the BMJ and Archives of Diseases in Childhood. That is “only” six journals a month. Reading just these would take about a day a month. So the majority make their way to the recycling bin with only a brief stay, unopened on the living room table. All that money and time spent on research remains unappreciated and, more importantly, unable to impact on patient care.
The twitter journal club run by Archives of Diseases in Childhood is trying to change this. Run once a month, it allows doctors from around the world to read and discuss a recently published paper relevant to general paediatricians. The article is made open-access for a few weeks before so you don’t have a paywall to worry about. Think of it is an informal and more accessible way to help access some of the journal content you are currently throwing away.
Why not join us. We promise you’ll learn something. And that you’ll probably become a better doctor.
The next @ADC_JC is on Thursday 26th March at 9 pm BST discussing this paper http://adc.bmj.com/content/early/2016/03/16/archdischild-2015-309451.short. Follow @ADC_JC on twitter for further information.