Who do you trust, a young or an old doctor?

I ask the following question in all seriousness. Is anyone surprised by the findings from this Medscape article summarizing an article in Annals of Internal Medicine?

Conventional wisdom about physician expertise generally holds that the longer a physician has been in practice, the better honed his or her clinical skills become. But a new study turns that adage on its head with its conclusion that physicians who have been in practice longer may, in fact, provide lower quality of care.

I find the article refreshingly honest, and I hope the findings are taken seriously. I truly believe that one of the biggest problems in the medical community where I work is the quality of care/lack of knowledge of a handful of the older doctors in the community. I'll give two examples.

The most recent example came yesterday when a doctor told his nurse to tell us (the hospice) that he is "not Dr. Kevorkian" when we asked to up a patient's Duragesic Patch. We were told that we need to "educate the family that people in [the patient's] condition are going to be uncomfortable and there is nothing we can do about it." This is a lady who is moaning and thrashing in the bed because she is in pain. I listened while the patient's niece cried yesterday afternoon because she couldn't stand to see her aunt hurt like this. That's the most recent example.

The one that is most personal is, of course, my favorite. When I was much younger, I had a sports related injury that required surgery. I had the surgery done by a local orthopedic surgeon and the injury recurred about a year later. This time I went somewhere else to have the repair work done. I was assigned to a young surgeon who opened my chart, scanned it, excused himself from the exam room, called his father (who was in the same practice), asked his father what this procedure was, listened, said "you learned it in Med. School?", listened, said "how long has it been since you have done one?", listened, and then laughed out loud. He came back in the room, told me that the procedure I had the first time has about an 80% success rate and that he's going to use a different procedure that has about a 98% success rate. He also informs me that he will only have to use about 1 inch of the 5 inch scar from the last procedure. I had the surgery and have gone years without any trouble. The out of date surgeon that I went to probably still practices, and if I were a betting man, I'd bet that he still uses the same procedure that was out-of-date when he used it on me years ago.

Unfortunately, most old people have old doctors, so my nurses spend many a day cursing at the phone after they hang up with doctors who are unwilling to allow us to do something that we know will work because it wasn't taught back in the '70s.