The focus for competition in healthcare is moving inexorably toward meeting patients' needs with greater efficiency. As logical as this goal might be, measurement of the outcomes that matter to patients is an imperfect science, and improving those outcomes is a difficult challenge.
In this context, some clinicians have expressed concerns that measurement of patient experience might have perverse unintended consequences—and actually worsen care.
They argue that sample sizes are too small and somehow biased, and that patients do not understand real quality, and might push for more tests and medications, thus raising costs. For many issues, these critics note, the individual physician is not the right unit of analysis. They assert that incentives to improve on these measures might encourage suboptimal care, and that the pressure created by these measures drives physicians into retirement.
I recently asked one angry but thoughtful emergency medicine physician if he knew of any doctors who had a personal financial incentive to change patients' pain scores. Or if he knew any doctors who actually gave narcotics or antibiotics to every patient who asked for them in an attempt to raise their patient-experience scores. Or if he knew of any physicians who had left the practice of medicine because they believed these measures were causing them to do the wrong thing. He agreed that he could not demonstrate that any of these assertions were true—but, he said, “It feels like they are true.”
I get that. It's not easy for good, hard-working clinicians to take criticism. It's also true that data obtained directly from patients are always incomplete, and that every quality-related measure—even mortality—could have perverse consequences if carried to an extreme.
So how do we resolve the tension between our need to improve and the imperfections in the data? The answer is improving the measures, getting more data and using the data appropriately.