Medicine

I have been getting lots of requests for ‘my opinion’ about the novel coronavirus pandemic, where we are now, and what is coming.  Here goes:

I precipitated a recent online discussion about healthcare’s obsession with measurement (quality metrics is the current buzz phrase) when I quoted two aphorisms that highlight some problems with metrics and targets:

Goodhart's Law: "When a measure becomes a target, it ceases to be a good measure,"

Campbell's Law: "The more a metric is used, the more likely it is to "corrupt the process it is intended to monitor."

One comment rubbed me the wrong way because it implied that measurement reduces harm:

I’ve always loved satire. The official definition is “…the use of humor, irony, exaggeration, or ridicule to expose and criticize people's stupidity or vices, particularly in the context of contemporary politics and other topical issues.” I like to think of it as weaponized humor. Despite being a target-rich environment, medical writing has far less than its rightful share of good satire. When good medical satire comes around, I enjoy it.

In college you learn to be a college student. In medical school, you learn to be a medical student. In residency, you learn to be a resident. 

In practice, if you let them, patients will teach you to be a doctor.

An important part of medical care is the sharing of information.

It has become fashionable to assess the ‘value’ of medical care with a financial metric: Is this test cost effective? Does that intervention save money? 

The message on my door was: “Mrs. Grantham wants biopsy report sent to dermatologist. None in her chart.” 

Recent events and commentary have led me to revisit and reprocess my personal experience of being the target of sexual harassment, something I have not spoken of for a quarter century.