Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The obsession with numbers in medicine: It’s time to stop

Shirie Leng, MD
Physician
March 25, 2015
Share
Tweet
Share

Medicine is obsessed with numbers.  Or rather, journalists and medical administrators are.  Here are two related examples of how large a grain of salt one must put on numbers.

Cardiac surgical procedures, like everything else in medicine, have quality indicators.  One of these is what we doctors call “30-day mortality.”  What this term means is that surgeons are evaluated in part on how many of the patients they operated on died within a month of having surgery.  Presumably a surgeon whose patients rarely die within 30 days is a better surgeon than one whose patients die all the time.  The American Academy of Hospice and Palliative Medicine, whose members deal frequently with the elderly, thinks this number, 30, harms old people. The problem, according to Paula Span of the New York Times, is that surgeons refuse to operate on people who are more likely to die within 30 days, and that they keep patients alive in ICUs until day 31 to keep their numbers up.  Bad doctors!

The problem with the number 30 is not that it’s too short or too long, it is that it is a terrible metric for quality.  Patients die despite everyone’s best efforts, especially patients who are at higher risk for dying to begin with.  We need to find a metric that actually reflects quality of care.  Of course doctors are going to be leery of operating on really sick people if their jobs are at stake!  I know people would like for doctors to be saints who take care of everyone all the time with nary a pecuniary thought, but I’m sorry, doctors are not saints.  Neither are patients.

Speaking of risk, here’s number two reason numbers are evil.  A recent article in the Journal of the American Medical Association reviewed the current literature on how accurate patients assessments of risks and benefits are.  The authors found that 65 percent of the time patients overestimate the benefits and 67 percent of the time they underestimate the risks.  The problem, according to Austin Frakt and Aaron Carroll of the New York Times, is that doctors don’t give patients adequate information about risks and benefits. Bad doctors!

The problem is not that doctors don’t give people the numbers.  The problem is that the numbers don’t influence patient’s decisions.  Reams of research as well as best-selling books by people like Nobel Prize winner Daniel Kahneman tell us that risk assessment has little to do with statistics.  Humans estimate risk based on things like what is most prominent in the news, how they feel about the risk in question, and how closely they compare to others who have undergone the event in question.  For example, women who have had bilateral mastectomies after a breast cancer diagnosis were asked how much the surgery had decreased their risk of recurrence.  The average response was women felt their risk had gone from 76 percent to 11 percent.  The actual risk before surgery is actually only 17 percent, so the surgery reduces the risk of recurrent breast cancer six percentage points. (This is for women who don’t have the BRCA gene.)

I’m sure women are told what the risk of recurrence is and how much the surgery decreases the risk.  I’m sure they are.  But the numbers are being told to women who are scared out of their minds about breast cancer and just want it to go away.  They don’t hear nor care what the statistics are.

That’s called being human.  Pick a subject.  Vaccinations: gross overestimation of risk because the guy down the street has an autistic kid.  Dying in a plane crash: Driving in your car is way more dangerous but the newspaper just had a big story about a horrific plane crash.  Ebola: One case in the U.S. but everyone is afraid they will get infected because it’s a really bad disease.

Please.  No more numbers.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

Prev

Remember the psychological harms of cancer screening

March 25, 2015 Kevin 3
…
Next

Top stories in health and medicine, March 26, 2015

March 26, 2015 Kevin 0
…

Tagged as: Infectious Disease, Primary Care

Post navigation

< Previous Post
Remember the psychological harms of cancer screening
Next Post >
Top stories in health and medicine, March 26, 2015

ADVERTISEMENT

More by Shirie Leng, MD

  • The choice between medicine and nursing

    Shirie Leng, MD
  • New technology might help us become more empathetic to others’ suffering

    Shirie Leng, MD
  • Does practice really make perfect?

    Shirie Leng, MD

More in Physician

  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • International doctors blocked by visa delays as U.S. faces physician shortage

    Arthur Lazarus, MD, MBA
  • How I redesigned my life as a physician without abandoning medicine

    Ben Reinking, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The obsession with numbers in medicine: It’s time to stop
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...