Armed Forces Medical Services Saw it Coming Two Decades Back

Dear Sir, In a paper published recently [1] Choudhry et al from Harvard Medical School, systematically reviewed nearly 40 years of research on how medical knowledge and healthcare quality relate to years of clinical experience. The results should be considered an eye-opener. The performance of long-practicing physicians was worse than that of less-experienced physicians on all measures in 52% studies (32 studies). In additional 21% studies (13studies), long-practicing physicians performed worse on some measures, with no experience-related difference on other measures. Physicians younger than 40 years of age were more likely to correctly believe in the value of therapies that improve survival (for example, thrombolytic agents, aspirin and beta-blockers). They were also significantly less likely to believe in the value of therapies that have been disapproved (for example, prophylactic lidocaine for preventing ventricular tachycardia after myocardial infarction). It is mainly because medical advances occur frequently and the explicit knowledge that physicians possess may easily become out of date. Implications for Army Medical Corps can not be ignored as majority of our specialists are above 40 years of age. So next time you fall ill, do not search for the adviser, look for a graded specialist! In early 1980s Armed Forces Medical Services decided to promote senior specialists to executive cadre and remove them from active patient care. It was a policy change praised by many though criticized by some. “You are removing specialists from active practice when they are most experienced!” “That is when a specialist really matters. You see, the best practicing doctors in civil are older ones!” This controversy was the subject of debate in many a coffee-room and bar-room discussion. Well! academic medicine has given its verdict in favour of the AFMS decision. However, Choudhry's paper had failed to assess important measures like communication skills and intuitive analysis which are generally the strong point with older doctors. Interestingly this report showed that, on average, older doctors took better care of older and sicker patients. The accompanying editorial [2] comments that, practice alone does not make perfect but must be accompanied by continuing active effort to maintain competence. Even the organizations that provide continuing medical education must develop a bold vision of how to facitlitate professional development over a lifetime of practice. In the Armed Forces, study leave in the late 30s or early 40s does ensure professional enhancement for some specialists with several years of practice behind them. Some argue that a professional capability report may be a good motivator for senior advisers to keep abreast of their profession. They forget that professional excellence remains a personal obsession with good specialists who see satisfying service to patients as an end in itself. Such specialists would keep in touch with recent advances despite service limitations. For others, there is always ‘the executive cadre.’