BMJ study: Patients treated by older physicians (60 and older) had higher mortality vs. younger physicians (39 and younger)

From BMJ:

The researchers evaluated a 20% random sample of Medicare fee-for-service beneficiaries aged 65 and older admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians.

Main outcome measures 30 day mortality and readmissions and costs of care.

The study included 700,000 admissions managed by 18,800 hospitalist physicians (median age 41).

Patients’ adjusted 30 day mortality rates were:

- 10.8% for physicians younger than 40
- 11.1% for physicians aged 40-49
- 11.3% for physicians aged 50-59
- 12.1% for physicians aged 60 and older

See the figure here: http://www.bmj.com/content/bmj/357/bmj.j1797/F1.large.jpg

Note: Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality.

Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients. The calculated "number need to harm (NNH)" was 77.

Patients treated by physicians aged younger than 40 had 0.85 times the odds of dying or an 11% lower probability of dying compared with patients cared for by physicians aged 60 and older. This difference in mortality is comparable with the impact of statins for the primary prevention of cardiovascular mortality on all cause mortality (odds ratio of 0.86) or the impact of β blockers on mortality among patients with myocardial infarction (incidence rate ratio of 0.86), thus indicating that the observed difference in mortality is not only statistically significant but arguably clinically significant.

The adjusted risk difference of 1.3 percentage points suggests that for every 77 patients treated by doctors aged 60 and older, one fewer patient would die within 30 days of admission if those patients were cared for by physicians aged 39 and younger.

Though clinical skills and knowledge accumulated by more experienced physicians could lead to improved quality of care, physicians’ skills might become outdated as scientific knowledge, technology, and clinical guidelines change.

Older physicians might have decreased clinical knowledge, adhere less often to standards of appropriate treatment, and perform worse on process measures of quality with respect to diagnosis, screening, and preventive care.

References:

Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1797 (Published 16 May 2017)
Cite this as: BMJ 2017;357:j1797

Image source: OpenClipArt, https://openclipart.org/detail/284296/instructor

Surgeon grows vegetables across from his hospital to cope with stress and burnout

From this Reuters/Yahoo article:

"Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan. His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients. "You really have to find the balance to put it a little more in perspective," he said.

Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected."

Burnout as a syndrome is marked by emotional exhaustion, cynicism and decreased effectiveness. A 2015 Mayo Clinic study found that more than 7% of 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers.

Some blame the way medicine is practiced in the United States since the introduction of EMRs, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.

It can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.

Atrius Health, Massachusetts' largest independent physicians group, is aiming to cut 1.5 million mouse "clicks" per year.

Tips for managing stress (watch the 2-minute BBC video embedded below)

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park



Read more: http://www.bbc.co.uk/scotland/brainsmart 

References:

Counting the costs: U.S. hospitals feeling the pain of physician burnout

Mosquito controls with AGO bucket traps, Autocidal Gravid Ovitrap (AGO), tested by CDC

Autocidal Gravid Ovitrap (AGO) bucket trap is a standard 5-gallon bucket adapted in a specific way to capture mosquitoes.

AGO traps are available for purchase online from Springstar. Two traps cost $75, free shipping: https://www.springstar.net/collections/mosquitoes/products/ago

The Autocidal Gravid Ovitrap (AGO trap), was developed by the Center for Disease Control (CDC) and has been proven to reduce populations of Aedes mosquitoes by over 80%. It is effective for the mosquitoes that transmit Zika, dengue, chikungunya, and yellow fever. No pesticides or pheromones required. Just add water and a little hay.



From Springstar website: "The Trap-N-Kill® Autocidal Gravid Ovitrap is an 18 liter black bucket fitted with a “capture chamber” on the top. The capture chamber allows you to swap out the sticky board without having to pull off the whole lid. Twist the top half of the chamber and you'll have access to where the sticky board rests. The bucket itself is filled with water up to a specific depth that is controlled by a series of slots which are machined into the bucket sides. Gravid female Aedes mosquitoes are attracted to the hay-infused standing water and seek to lay their eggs on a hard surface right at the water line.

They try to do that by entering the capture chamber through the top screen. They can get through that screen with ease but other critters, like squirrels or birds can't. The capture chamber, a cylinder, contains a replaceable glue board that covers the entire inside portion of the cylinder. The mosquitoes cannot get to the water surface because the bottom screen is made of a finer mesh than the top one -- too fine for a mosquito to get through. As they keep trying to get to the water, they tire and may need to rest. When they choose to rest on the glue surface, that will be their final resting place, so to speak.

No pesticides or pheromones required. Just add water and some grass clippings or hay."

The "stickies" are the sticky issue here, as the replacements are not readily available for purchase. Pest management company Catchmaster lists "AGO Trap Replacement Glue Boards" on its website but there is no link to purchase them online.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631065/
https://www.nbcnews.com/storyline/zika-virus-outbreak/low-tech-trap-might-help-fight-zika-virus-outbreaks-cdc-n571501
https://stacks.cdc.gov/view/cdc/21081
http://www.miamiherald.com/news/nation-world/world/americas/article130514329.html
http://mosquito.ifas.ufl.edu/Workshop/Documents/Dengue_Workshop_Introductory_Talks.pdf

Who are the doctors who don't get stressed at work? Check if you have the personality type


Who are the doctors who don't get stressed at work? According to this meta-analysis, the personality type to have is: extravert who is open to experience and has a deep learning style. If you are this type, congratulations! If not, read below, and be sure to check the references at the end.

The Big Five personality inventory measures personality based on 5 key traits:

1. neuroticism
2. extraversion
3. agreeableness
4. openness to experience
5. conscientiousness

There are several approaches to work (SSD):

- Surface-disorganised approach is apparently the worst, and is predicted by surface learning in medical school and by higher neuroticism scores and lower conscientiousness

- Surface-rational approach to work is predicted by strategic learning in medical school, and by less openness to experience and higher conscientiousness

- Deep approach to work is predicted by a deep approach to learning at medical school, by greater extraversion, by greater openness to experience, and by lower emotional exhaustion. This is supposed to be the best.

A deep approach to work occurs in extraverts who are open to experience and have a deep learning style. The surface-rational and surface-disorganised approaches to work are both greater in those with a surface learning style. However, a surface-disorganised approach occurs in individuals with higher neuroticism scores, in those with lower conscientiousness scores, and in those who have been stressed, whereas the surface-rational approach to work occurs in strategic learners and in those who are low in openness to experience.

A workplace climate dominated by a high workload is predicted by higher stress and emotional exhaustion measures five years earlier, and by lower openness to experience. A supportive-receptive workplace is predicted by lower stress and depersonalisation, and a higher sense of personal accomplishment when measured previously, and by a more agreeable personality.

"A critical element contributing to the stress that many conscientious doctors experience is internal". According to researchers, stress is not a characteristic of jobs but of doctors. Different doctors working in the same job being are no more similar in their stress and burnout than different doctors in different jobs.

References:

Stress, burnout and doctors' attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Medicine20042:29, DOI: 10.1186/1741-7015-2-29.

Physician Burnout Now A Top Concern Across the United States. Wael Barsoum.

Who blogs? Personality predictors of blogging
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