Re: Physician age and outcomes in elderly patients in hospital in the US: observational study
Dr Sharma's response introduces even more questions
Apart from the point I made in my earlier response that 200+ care episodes a year would seem ridiculously low volume not "high volume" in a UK setting for an acute geriatrician or general or acute physician managing the whole care episode often with very little recourse to speciality referral...
1. It may be that more senior, experienced physicians are more likely to recognise and accept that a patient is dying and to move towards a palliative or minimally interventionist approach. They may also be more likely to accept that discharge from hospital is not free of risk and that a higher readmission rate is perfectly acceptable in the context of trying to get people back home. A far more balanced range of outcomes is required than crude mortality or readmission rates - outcomes based on the person's own goals for their care or for a good death.
2. The USA has a far higher proportion of intensive care beds than systems such as the NHS. Although UK hospitals have excellent 24/7 access to critical care outreach teams, most patients dying in british hospitals do not die in ICU or HMU but in general ward settings and many won't receive input from ICU outreach teams or cardiac arrest teams because there has already been a decision not to escalate treatment further or to initiate supportive or palliative care
Not only is the study subject to multiple confounders but its external validity in other very different health systems is doubtful.
Rapid Response:
Re: Physician age and outcomes in elderly patients in hospital in the US: observational study
Dr Sharma's response introduces even more questions
Apart from the point I made in my earlier response that 200+ care episodes a year would seem ridiculously low volume not "high volume" in a UK setting for an acute geriatrician or general or acute physician managing the whole care episode often with very little recourse to speciality referral...
1. It may be that more senior, experienced physicians are more likely to recognise and accept that a patient is dying and to move towards a palliative or minimally interventionist approach. They may also be more likely to accept that discharge from hospital is not free of risk and that a higher readmission rate is perfectly acceptable in the context of trying to get people back home. A far more balanced range of outcomes is required than crude mortality or readmission rates - outcomes based on the person's own goals for their care or for a good death.
2. The USA has a far higher proportion of intensive care beds than systems such as the NHS. Although UK hospitals have excellent 24/7 access to critical care outreach teams, most patients dying in british hospitals do not die in ICU or HMU but in general ward settings and many won't receive input from ICU outreach teams or cardiac arrest teams because there has already been a decision not to escalate treatment further or to initiate supportive or palliative care
Not only is the study subject to multiple confounders but its external validity in other very different health systems is doubtful.
David Oliver
Competing interests: No competing interests