From the Wall Street Journa; Victoria McEvoy writes Why ‘Metrics’ Overload is Bad Medicine.


‘Quality” has been the buzzword in health care for a decade, but the worthy goal is driving health-care providers to distraction. All stakeholders—insurers, patients, hospital administrators and government watchdogs—are demanding metrics to ensure that money is spent wisely.

Metrics do matter: Pre-operation checklists, hand-washing mandates, length-of-stay goals for inpatient stays, and infection rates for patients with catheters have improved health care in a perceptible way. But holding physicians accountable for specific outcomes or measures of patient compliance ignores the complexity of managing a patient’s care. Metrics are chosen because they are measurable, not because they are proxies for excellence.

Primary-care providers like me are bearing the brunt of these often misguided efforts. As front-line providers responsible for a patient’s health, we have had every aspect of our professional lives invaded by the quality police. Each day we are provided with lists of patients whose metrics fall short of targeted goals.

Primary-care providers are forced to monitor innumerable other metrics, including hemoglobin A1Cs for diabetes, LDLs for high cholesterol, colonoscopy rates for patients over 50, emergency-room visits for all patients, eye exams for diabetics, flu shots and many others. Primary-care providers are swamped with lists, report cards and warnings about their performance.

Countless other personnel have been recruited in primary-care practices and hospitals to manage the metrics. While controlling health-care dollars is paramount, the financial toll for pursuing these measures is significant. Medicine is becoming a nanny state in which doctors must chase down patients because one metric is off.


Everything worth measuring cannot be measured and everything that is measured is not worth measuring.

Complicated factors, often involving the art of medicine and intuition, is sacrificed to measurements  just because they can be measured.  This may be largely due to the fact that medical practice is now directed by institutions rather than consumers.  Better quality medicine is more complicated than engineering a better quality car,  and is more a result of patience and thought rather than mere collections and applications of data.