Selective Omission of Data to Judge Physicians, Lower Costs, and Improve Health Outcomes
Not only our actions, but our
omissions become our destiny.
Abraham Verghese, MD, Cutting for Stone (Vintage Books, 2009)
May 31, 2012 -
“Lies, damned lies, and statistics " is an overused phrase describing the persuasive power of
numbers, particularly the selective use of data to bolster weak arguments.
I prefer a variation of
Mae West aphorism, “It’s not the men in your life that matters, it’s the life in your men.”
In the case of
health care, desicatted data does not tell the story of what's occurring on the front lines of care, in the lifes of people or thier doctors.
I would paraphrase the Mae West line to
read,“It’s not the data that matters, but how the data is used that matters."
Health system and
physician critics selective omit data to
condemn the U.S. health system.
That the U.S. compares unfavorably to other
nations in longevity. True enough, if
you omit the fact that if you include our homicide and accident rates. If you include these statistics, we rank right up there.
the U.S. lags behind most other nations in overall care, when in fact we do
better in prompt access to specialists and high tech care and in our outcomes
in treating diabetes, heart disease, and cancer.
American physicians make more than physicians in other nations is often
bewailed. Again, this is true, unless
you include the prohibitive costs of U.S. medical education, often resulting in
$200,000 medical education indebtedness of doctors entering practice, and malpractice premiums, often exceeding $100,000 for high tech
specialists. Subtract these costs from
American physician incomes, and you get an entirely different pictureI
The selective use of data
is often used to subtly portray American physicians as fee-for-service gold
diggers prospecting for money by doing more unnecessary procedures to bolster their income(Joe Klein, “Accountable Health Care,”
Time Magazine, May 29, 2012).
The argument for
accountability goes: If only we could make physicians more “accountable” by
placing them on salaries, devoid of personal gain' if only they would practice in accountable
care organizations as part of teams delivering coordinated, continuous data-based
care based on comparative outcomes, all would be well. U.S. health cost statistics
compared other nations would improve, incomes for doctors would drop, health
outcomes would improve
This is persuasive stuff.
It is the essence of Obamacare and the regulations, mandates, and sanctions it
would impose upon physicians, But it
creates tensions among the policymakers, academics, and progressive-minded journalist who would
have physicians do things their way.
Kevin Pho, MD, America’s foremost physician blogger,
beautifully captures the the dilemma is this blog post.
The Tension between Physicians and Health Policy Experts
By Kevin Pho, MD, in KevinMD.com
"There’s an underlying tension
between physicians and health policy experts."
"Health policy experts take subtle
jibes against physicians in their analyses, with many feeling American doctors
are overpaid, which exacerbates health costs. They tend to be politically
progressive, and generally dismiss the issues that most doctors care deeply
about. Medical malpractice, tort reform and the cost of medical education, for
"And doctors can be antagonistic to
policy experts. As most wonks are not physicians themselves, doctors generally
discount their opinions, since they haven’t gone through the rigors of
physician training, and are shielded from the day to day realities of
"Yes, I’m generalizing, but those are
the themes I’ve observed from the health reform conversation over the past few
"But if we are to fix our health
system, both sides need to come together."
"Consider a recent NEJM piece, which asks the following:"
Are U.S. physicians sufficiently
visionary, public-minded, and well led to respond to this national fiscal and
ethical imperative? It’s a $640 billion question.
The short answer, of course, is no.
If they were public spirited, would they lobbying as hard as they are to
restore physician pay — the so-called “doc fix” — which will cost the
government another $300 billion for Medicare over the next decade."
I"t’s a subtle physician-antagonistic
response that policy wonks on the progressive side — Goozner, Ezra
Klein, Maggie Mahar, and Paul Krugman,
to name a few — occasionally make that only exacerbates the discord."
"Yet, to successfully reform our
health system, doctors need to be at the forefront, not policy experts. And I’m
not saying that because I’m a physician myself. The data says so."
"A Gallup poll, conducted in 2009, found that
physicians garnered the highest level of public trust when it came to health
"Patients still trust their doctors.
Which is why it baffles me when policy experts don’t give doctors many olive
branches when making their health reform arguments. Given the rancor
surrounding the debate, it seems that reformers could use all the support they
"Take the contentious issue of physician salaries, for instance. Most
progressive wonks feel that American doctors are overpaid, and in their ideal
world, would like a single payer system where doctors are on a salary in line
with the rest of the world. Ezra Klein, for instance, continually points to France to illustrate this point."
Well, it’s no surprise that doctors
are hostile to that worldview. Of course, no one likes to get their pay cut.
But, why not balance the argument by including the cost of American medical education? Yes, American
doctors are paid more than any other physician in the world. But look at what
it costs to train them:
policy experts included medical education reform (or medical malpractice
reform) with their arguments for paying doctors less, it would be better
accepted by the medical community. I’ve written before that more than a few
doctors would exchange medical school debt relief in exchange for a strict
salary. Or medical malpractice reform in exchange for less pay."
"I appreciate the data-driven
arguments that policy wonks present to illustrate, and potentially solve, our
dysfunctional health system. But charts by themselves cannot convince the
public, whose acceptance is key to any variation of health reform."
"To do so, health reformers need
doctors on their side. Why policy experts don’t make more of an effort to sway
more doctors is a mystery to me, and a tragically missed opportunity."
Tweet: Health policy makers selectively omit data to
put the U.S. health system in a bad light.
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