Does Experience Make Physicians Better?

This seems like a dumb question. We assume experience makes doctors better. Our most revered teachers have been practicing since before we were born. We defer judgment on difficult cases to the physicians who have "seen it all." But is this right?

I'm sure this question is not cut-and-dry. Some things - instinct, gut reaction - develop with age; others - reading the latest journal articles - are found more frequently in the young graduate. Still others may have no difference. But I want to plant a seed of doubt out there: experience is not always the best thing.

The problem with experience is that the more patients or cases one sees, the more likely one is going to see that dreaded rare event. A surgeon may go ten years replacing knees without a problem, but by pure chance, replaces a knee that gets infected a decade later. After that, he may want extra unnecessary antibiotics. Why? Because of that one infection. This is irrational.

The anesthesia for a standard laparoscopic case rarely requires more than one IV. But if you practice enough, you're bound to run into that case where the laparoscopic case converts to open, involves a lot of bleeding, and requires better access. The anesthesiologist, trained to address "the worst possible scenario," may start placing two IVs in standard laparscopic cases. But perhaps this is overtreatment.

It's easy to be swayed by that one bad case. Experience means we will run into that one bad case - which could have been pure chance. How do we make sure we account for the outliers in our experience without treating every experience like it could be an outlier?