The Huffington Post published an interesting and thought-provoking article two weeks ago, entitled “What If We Treated Doctors The Way We Treat Teachers?” The author, an assistant professor of education at Towson University, suggests that, since doctors and teachers both provide a vital service to society (and, importantly, to all members of society, not just those who care about whether they might develop diabetes in 30 years, or whether they can get into a good college), doctors and teachers should be evaluated by similar measures.
In particular, he writes, doctors and others involved in patient care should be evaluated by their patient outcomes, for example, whether a doctor’s patients meet certain standards of general health, whether a community’s specific health care needs are being met, and whether medical schools produce competent physicians. This emphasis on “outcomes” is in parallel with the education system’s emphasis on measuring student performance as a way to assess the effectiveness of teachers.
Even though his article was not meant to be taken literally, I believe that most of his proposals are quite sound. No one would argue that it is NOT the responsibility of the medical profession to make sure that people are healthy, that underserved communities get the care they need, that hospitals are available to take care of the sick, and so forth. And since we know the underlying causes of many diseases, and public health has identified numerous strategies that can prevent or delay the development of common conditions, one would think that we would welcome “outcome measures” as a way to demonstrate and prove how effective our interventions are.
[One underlying message of the article, however, which I won’t detail here, is that the same cannot be said for education; there are widely divergent opinions on the “right” way to educate a child, and even if there was one “right” way, the educational system (much less an individual teacher) absolutely cannot control what happens in the child’s home that may have a profound impact on how he or she learns.]
So why don’t we evaluate doctors on these measures? Well, for one thing, how do we measure “success” or “health”? When people are sick, they have abnormalities or lesions that we can see, measure, and fix. We can remove the tumor or help the blood pressure get back to normal, but is that the right measure of “health”? Another reason doctors aren’t subject to outcome measures is because it’s far easier to assess doctors on other measures that have little to do with patient care but serve some other special interest. For instance, I’m evaluated by various parties on how many prescriptions I write, how many days my patients stay in the hospital, how completely I fill out the mental status exam form in my patient charts, how many buttons I click in my electronic medical record system, and so on. Everything EXCEPT how well my patients do.
And then, of course, there’s the fact that so many other factors which are beyond the control of the physician (and usually outside of the patient’s control, too) prevent positive outcomes: insurance companies refuse to cover the cost of effective drugs and other treatments; direct-to-consumer advertising leads patients to demand medications that may not be helpful (and which might actually cause harm); and the lack of accessible and affordable primary care treatment, or other services such as therapy or rehab prevents patients from accessing vital components of effective care.
I’ll go on record to say that doctors ought to be evaluated on how healthy their patients are. After all, that’s why we do what we do. But before we start measuring patient outcomes, let’s first decide what we want to measure, and whether it’s valid. Simple measurements like blood pressure or cholesterol level are a start, but don’t tell the whole story; neither do “patient satisfaction scores,” as sometimes the best medical advice is something patients don’t want to hear. Second, let’s make sure patients and doctors have access to the resources that would promote positive outcomes. We know the elements of wise, cost-effective, preventive care, so we should implement them. Finally, if we are to measure patient outcomes, then let’s stop assessing and rewarding physicians on other measures that have nothing to do with patient care.
All doctors want to treat patients, just as all teachers want to educate students. Measuring outcomes—i.e., how effectively do we do what we set out to do—is one way to ensure good doctors and good teachers, but let’s make sure we’re measuring the right things, we have access to the tools we need to do the job, and we remove all the other obligations that interfere with the job we have undertaken. Whether that can be done (in medicine or in education) is anybody’s guess.