Comments on: In which curious challenges me http://www.medrants.com/archives/4787 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: DB’s Medical Rants » Blog Archive » Measurement – the good and bad http://www.medrants.com/archives/4787/comment-page-1#comment-529138 DB’s Medical Rants » Blog Archive » Measurement – the good and bad Wed, 26 Aug 2009 00:49:50 +0000 http://www.medrants.com/?p=4787#comment-529138 [...] is the context – In which curious challenges me. I said “I favor limited guidelines, but not measurement. Measurement has too many unintended [...] [...] is the context – In which curious challenges me. I said “I favor limited guidelines, but not measurement. Measurement has too many unintended [...]

]]> By: curious http://www.medrants.com/archives/4787/comment-page-1#comment-529123 curious Fri, 21 Aug 2009 00:14:25 +0000 http://www.medrants.com/?p=4787#comment-529123 If you cannot measure a thing (even in theory), then the thing in question lacks practical meaning. The definition of any concept implies its measures. The problem is never measurement. It is only the use of measurement that can be problematic...especially in unintelligent, conflicted, or malicious hands. Or the use of measurement that does not acknowledge the limitations of existing measures. There's nothing wrong with measuring the average HbA1c in any given population of diabetics. What's wrong is attaching powerful incentives to an A1c threshold that is so low that patients are, on average, harmed. And who says we can't measure bedside manner? There is a growing number of patient experience survey instruments designed to do just that. I'm sure you already know that multiple teams are currently working on measures of diagnostic error. If you cannot measure a thing (even in theory), then the thing in question lacks practical meaning. The definition of any concept implies its measures.

The problem is never measurement. It is only the use of measurement that can be problematic…especially in unintelligent, conflicted, or malicious hands. Or the use of measurement that does not acknowledge the limitations of existing measures.

There’s nothing wrong with measuring the average HbA1c in any given population of diabetics. What’s wrong is attaching powerful incentives to an A1c threshold that is so low that patients are, on average, harmed.

And who says we can’t measure bedside manner? There is a growing number of patient experience survey instruments designed to do just that. I’m sure you already know that multiple teams are currently working on measures of diagnostic error.

]]> By: pcb http://www.medrants.com/archives/4787/comment-page-1#comment-529122 pcb Thu, 20 Aug 2009 21:06:12 +0000 http://www.medrants.com/?p=4787#comment-529122 "We should not do something for the sake of doing something." But what about not letting the perfect be the enemy of the good? But what about moving forward because the status quo is untenable? oops, I forgot about the R. W. Emerson quote over to the right. something about foolish consistency? :) (sorry, DB. couldn't resist.) “We should not do something for the sake of doing something.”

But what about not letting the perfect be the enemy of the good?

But what about moving forward because the status quo is untenable?

oops, I forgot about the R. W. Emerson quote over to the right. something about foolish consistency? :)

(sorry, DB. couldn’t resist.)

]]> By: Ed Whitney http://www.medrants.com/archives/4787/comment-page-1#comment-529121 Ed Whitney Thu, 20 Aug 2009 21:01:39 +0000 http://www.medrants.com/?p=4787#comment-529121 At the Paris peace conference in 1919, David Lloyd George made an observation about the idealistic Woodrow Wilson. The exact words escape me, but it was very close to this: “He found that his rigid yardstick could not take an accurate measure of timber that had been gnarled and twisted by the storms of centuries.” The context is different, but perhaps the metaphor applies. Measuring sticks are rarely flexible enough to measure accurately the contours of a multidimensional surface whose boundaries may change from one day to another. Does that sound apt? At the Paris peace conference in 1919, David Lloyd George made an observation about the idealistic Woodrow Wilson. The exact words escape me, but it was very close to this: “He found that his rigid yardstick could not take an accurate measure of timber that had been gnarled and twisted by the storms of centuries.”

The context is different, but perhaps the metaphor applies. Measuring sticks are rarely flexible enough to measure accurately the contours of a multidimensional surface whose boundaries may change from one day to another.

Does that sound apt?

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