Home > Uncategorized > Efficiency Is The Enemy Redux: Numbers DON’T Tell The Whole Story in Medicine Either!

Efficiency Is The Enemy Redux: Numbers DON’T Tell The Whole Story in Medicine Either!

I am graded these days not by test performance or classroom participation, but by my success in getting patients to do well. Not necessarily to feel well or to be well, mind you, but to perform well on their own tests. They do well, I do well. They do badly, I flunk.

Gone are the days when anyone paid attention to my peer interactions, effort, improvement, or to the difficulty of the assigned material. Most of those variables are now impossible to assess — and as for the medical equivalent of the essay question, forget it. No one has the stamina to plow through my notes.

Rather, “continuous quality improvement,” as we call the process of getting doctors to be their very best selves, requires something snappy and easy to track.

So, every set of doctors marches to its own numbers. Surgeons are assessed by their complication rates, internists by what fraction of their diabetic patients are well controlled and have seen the proper specialists, and by how many other patients are persuaded to accept recommended medications and vaccines.

Ah yes… performance evaluations based on what is EASY to measure as opposed to what is IMPORTANT to measure… where oh where have we heard this lament before? After describing the nonsensical and reductionist methods used to measure her performance and several of the mitigating circumstances three of her patients faced, Zucker concludes her essay with this paragraph:

I have things to say about Patients D, E and all the others, too — long shaggy-dog stories, explanations, rationalizations, narratives about life and health, exactly the hangdog commentary you’d expect from a straight-A student gone bad. You could say it’s all so much embroidery. Or you could say that the numbers don’t tell the whole story.

There is one difference between Dr. Zucker and her child’s Kindergarten teacher, though… if her Kindergarten teacher gets a low grade she loses her job… if her colleagues collectively get a low grade their school closes… and if her boss doesn’t get enough teachers with high grades they are out of work. Here’s hoping medical reform doesn’t lead to the closure of hospitals!

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