Dr Robert Wachter - NY Times Op Ed yesterday

Bruno, Michael mbruno at HMC.PSU.EDU
Tue Jan 19 15:24:13 UTC 2016


Hi Bob,


This is a very nice article, thanks for sharing it.



To your question, are figures essential to know we are improving, I would say "yes," and very much so.  But there is need for caution - since having the wrong metrics is clearly worse than having none.



When I read Dr. Wachter's article, I can't help but think we're seeing a "clash of the cultures" here.  Medicine's historical character / core culture is a bit more fluid than the "performance improvement" culture that many of us espouse.  There are good and bad things about that, but I think that those of us in the "measurement" camp are of the mind that there was more bad than good in the old culture, such as its blamefulness and unrealistic ideas about error and how to eliminate error.  On the other hand, we can look to other industries, like aviation and manufacturing, to see how the performance improvement culture has actually delivered quite well on its promises.



I think all of us will agree that the caring, personal touch of a physician cannot be replaced, nor can it be measured very well.  Like the value of the H&P-which is argued in some circles because it doesn't produce measurable outcomes-we doctors understand it and know that it actually has great value to us and to our patients.



But there are a great many things that can be measured, and some of them, nearly all of them perhaps, badly need to be improved!  And one of the tenets of our "Quality & Safety Religion" is the adage that, 'if you can't measure something, you can't improve it,' which succinctly states my own personal bias.  I actually believe that Dr. Wachter is one of "us," an improver.  But I get what he is saying about how poorly chosen metrics will actually do more harm than good, since they inevitably create perverse incentives.  Probably everyone knows that Wachter wrote a great book about the perils of the Electronic Medical Record, for example, pointing out how that whole project seems to have gone horribly wrong.



My answer to this NYT article is just that there is a real imperative in asking WHICH metrics actually matter-using those and de-emphasizing or ignoring the rest, which I believe is his underlying point.  Not all metrics are created equal, because everything measurable is not truly important.  And indeed there are a few un-measurables which matter a great deal.  But the process of measurement, iterative change and re-measurement is a process we can rely on to improve our performance.



My faith in measurement is unshaken!  Measurement doesn't always fail, in fact, I think the evidence shows that it mostly succeeds.

[cid:image004.png at 01D112FF.F77F98B0]
Michael A. Bruno, M.S., M.D., F.A.C.R.
Professor of Radiology & Medicine
Vice Chair for Quality & Patient Safety
Chief, Division of Emergency Radiology
Penn State Milton S. Hershey Medical Center
* (717) 531-8703  |  * mbruno at hmc.psu.edu<mailto:mbruno at hmc.psu.edu>  |  6 (717) 531-5737
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From: robert bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Sent: Monday, January 18, 2016 5:21 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Dr Robert Wachter - NY Times Op Ed yesterday

Do we need figures regarding Errors in Medicine (including Diagnostic Errors) to be able to know if we are improving?

Is that essential?

Rob Bell, MD
On Jan 18, 2016, at 1:52 PM, David L Meyers <dm0015 at COMCAST.NET<mailto:dm0015 at COMCAST.NET>> wrote:

http://www.nytimes.com/2016/01/17/opinion/sunday/how-measurement-fails-doctors-and-teachers.html?action=click&contentCollection=undefined&region=Footer&module=WhatsNext&version=WhatsNext&contentID=WhatsNext&moduleDetail=most-emailed-0&pgtype=undefined

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