Nederlands tijdschrift voor geneeskunde vol:158 issue:42 pages:1792-1793
The rising costs and potential harms of medical care are matters of growing concern. In a recent article from the USA, Sirovich et al. examined the association between the intensity of the training environment and clinical-management decisions made by recent graduates. They found that, regardless of overall medical knowledge, internists trained at programmes in hospital referral regions with lower-intensity medical practice are more likely to recognise situations in which conservative management is appropriate. These internists remain capable of choosing a more active approach when indicated. This study suggests that residents adopt the practice style experienced in their training environment. Sometimes less healthcare can actually result in better health. In contrast, an aggressive practice style may waste resources and harm patients through inappropriate intervention. The training environment appears to have a considerable impact on the wisdom of medical decision making.