That would be my takeaway from any number of Atul Gawande’s works, maybe taking canonical form in [book: The Checklist Manifesto]. If you’re looking for a short intro to the idea, how about Gawande’s piece on the Apgar score? According to Gawande, there’s a more or less straight line between the Apgar score and the rise of C-sections. C-sections may be industrial and clinical, but they seem to lead to higher Apgar scores. You optimize for what you can measure.
Boy, did that Apgar-score essay ever irritate an ex-girlfriend of mine, who had had experience with the hospital system and absolutely hated the idea of birth being mechanized, and mothers being routinely subjected to surgery for something that should be natural and beautiful. I’ll even set aside for the moment the whole question of whether the C-section is better for mothers and babies; a lot of people just hate the idea of medical care being turned into this cold, mechanical, capitalist process.
Doctors seemingly hate the idea of being treated as mere cogs in the capitalist machine, churning out the same medical procedure over and over again. They’d probably hate to be penalized for deviations from accepted practice. That would explain the resistance that Gawande encountered among doctors to their merely washing their hands more often. They might like to believe that each patient is a separate entity with his or her own feelings and needs, and that the main thing the doctor brings to the relationship is empathy — deeply personalized empathy.
I want to believe that too. I also want to believe that the data would bear it out: the more empathetic the doctor, the better the care and the better the health outcomes. And maybe that’s true. But it’s just as easy for me to believe that we want to be measuring rates of central-line infection and hand-washing, and that the way to measure these things is to get doctors to spend a lot more time feeding data into the system that confirm they’re running procedures exactly the same way every time. Hospitals become Taylorist factories. Sorry.
That’d be my response to Bill Gardner’s thought-provoking latest piece at The Incidental Economist. Maybe measuring everything is at odds with understanding the patient as a human being. But given that conflict, which do you think will win? Capitalism always wins. The bet isn’t remotely fair.