Measuring Medical Quality - What Really Counts

I have written how challenging it is for ordinary folks, let alone medical professionals, to assess the quality and competence of physicians. There are no easily measurable and reliable parameters. Industries have emerged that specialize in assessing the competencies of practitioners and organizations in fields beyond medicine. It is typical for those who are targeted for assessment to howl in protest claiming that the testing methods are irreparably flawed and should be abandoned. Sometimes, these folks have a point. But other times, they are simply trying to avoid accountability. And just because an evaluation process hasn’t been perfected, doesn’t mean it offers no value. For example, teachers have recoiled against using student test scores as an element in assessing their pedagogical skills. I think that both the teachers and the testers have legitimate arguments. Professionals and tradesmen and their leadership advocates will reject processes that will disparage their members and will do their best to contrive more palatable objections. They won’t say, for example, ‘we oppose this measure because it will make us look bad.’

So, any method to assess quality is best designed by independents who are neutral. We can imagine how suspect the results would be if the testing organization has a conflict of interest. For example, would we accept the results if an organization rates its own members who pay dues to the organization?

There are many aspects of our lives that we cannot measure objectively. There is no tape measure we can use to determine the quality of a meal, a painting or a performance. This is why so often we encounter diametrically opposed reviews on the same event. I’m not stating categorically that such measurements are impossible or shouldn’t be attempted, but we should be mindful of the limitations on the process. Have you ever enjoyed a movie to learn later that the critics panned it?

Can I use this to measure medical quality?

And all of these points apply to measuring medical quality. We all have a sense that we know what constitutes quality medical care. And we think we know when our doctor is a high performer. But try to define this and you will see how difficult a task this is. I am still struggling with this after decades of thought and medical practice. And would doctors and the public even agree on what quality medicine is and how it can be reliably and fairly assessed? When folks aim to assess something that can’t be measured, they end up measuring stuff that doesn’t really count at all. What really counts, can't be measured.

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