Patients sometimes ask me an interesting question when I’m referring them to another physician.

“Is he an older doctor?”

I know what they mean. They aren’t really asking me how old he is. They want to know whether he has some age and experience on him, whether he has been doing this for a while, or whether he just got out of training.

It’s a perfectly reasonable question. The part I hadn’t really thought about until recently was this: When did I become the older doctor?

I graduated from medical school in 1995. I’ve been practicing medicine for more than thirty years. There really isn’t any creative way to do the math that still puts me in the young-doctor category.

I saw a T-shirt not long ago that made some joke about an older doctor, complete with the obligatory gray-haired old physician. I don’t remember exactly what it said, but I remember being mildly offended by it. Then it occurred to me that apparently I am now part of the demographic they were making fun of.

So how do I feel about being the older doctor?

I think I actually like it.

There is something reassuring about having thirty years behind you. I don’t feel like I have to prove that I know what I’m doing anymore. I’ve seen thousands of patients. I’ve made a lot of decisions, some of them easy and some of them very difficult. I’ve been right a lot of times. I’ve also been wrong, and sometimes you learn more from being wrong than you ever do from being right.

Experience matters in medicine.

That doesn’t mean the older doctor is necessarily the better doctor. There are some definite advantages to being young and recently out of training. A physician finishing residency today has learned things that didn’t exist when I was in medical school. Some of the medications, tests and treatments I routinely use today weren’t around in 1995.

A younger doctor may know something I don’t know. On the other hand, I may have seen something he hasn’t seen yet. There is value in both.

One thing that does happen after you’ve practiced medicine for a long time is that you become a little more skeptical about whatever the newest thing happens to be.

I’ve watched medications come onto the market with great fanfare and later disappear. I’ve seen treatments enthusiastically recommended and eventually abandoned. I’ve watched things that were considered standard medical practice become things we would never consider doing today.

After you’ve seen that happen enough times, the word “new” doesn’t impress you quite as much as it used to.

That doesn’t mean I’m against new medications or new treatments. Obviously medicine has advanced tremendously during my career, and I use plenty of things today that I couldn’t have used thirty years ago. A doctor who stops learning is going to become a bad doctor sooner or later.

But new doesn’t automatically mean better.

I’m perfectly happy using an older generic medication if it does the job. We know how it works. We know its side effects. We know most of the ways it can get us into trouble because millions of people have taken it over many years. It usually costs a fraction of what the newest medication costs, and most importantly, it still works.

I don’t feel any particular obligation to abandon something that works just because a pharmaceutical company has something newer to sell me.

Maybe that is part of being the older doctor too.

The other part is realizing that medicine doesn’t work exactly the way the textbooks say it does.

Patients certainly don’t.

People have financial problems, family problems, transportation problems and bad habits. They don’t always take their medicine. They don’t always follow your advice. Sometimes they can’t afford to follow your advice. Diseases don’t always present the way they are supposed to, either.

After thirty years, you learn to practice medicine in the world that actually exists instead of the one described in a textbook.

I think that may be the biggest difference between the doctor I was in 1995 and the doctor I am today.

When I was younger, I had a tremendous amount of freshly learned medical knowledge and not much experience actually being a doctor. Thirty years later, I’m sure I’ve forgotten things I once knew, and there are certainly things younger physicians know better than I do. That’s why I keep learning.

There is another part of experience that is harder to put into words.

Years ago, either in medical school or residency—I honestly don’t remember which—I did a rotation with a very good, well-known pediatrician in Evansville, Indiana. He would send me into the room first to see the patient, then I would come back out and present the case to him.

At some point during that rotation he told me something I’ve remembered ever since. He said I had a relatively rare ability to look at a patient and tell whether that patient was sick or wasn’t sick.

I took that as a tremendous compliment, especially coming from him.

I understood what he meant then, but I understand it much better now.

Sometimes a patient walks into the room and something just doesn’t look right. The vital signs may not be particularly alarming. I may not have finished the history yet. Sometimes I can’t immediately tell you exactly what is bothering me. I just know this person is sick.

That’s not magic, and it certainly isn’t infallible. Some of it may be instinct, but after thirty years there is also an enormous catalog of patients stored somewhere in the back of my head. The person sitting in front of me is being compared, consciously or not, with thousands of other people I’ve examined over the years.

That pediatrician thought I had some of that ability when I was still learning how to be a doctor. Thirty years of seeing patients has given it a lot more material to work with.

You don’t learn that from a PowerPoint presentation. You learn it by seeing patients over and over again for years.

So I guess I have my answer. I am the older doctor now, and I’m actually pretty comfortable with that.

It doesn’t mean I know everything, because I certainly don’t. It doesn’t mean I’m always right. And it absolutely doesn’t mean I should still be practicing medicine exactly the way I did when I graduated in 1995.

It just means I’ve been doing this long enough to have seen medicine change, sometimes for the better and occasionally back again. I’ve watched wonder drugs become ordinary drugs and a few become drugs we no longer use at all. I’ve learned that patients will surprise you, diseases will fool you, and being absolutely certain about anything in medicine can be dangerous.

The younger doctor has the advantage of the newest education medicine can provide.

The older doctor has something that takes a little longer to acquire.

He’s been around long enough to see what happens next.