Friday, April 4, 2014

Medicine Is Not Euvoluntary: Patient Happiness Metric Edition

Via William Sonneberg, MD: a reminder that the principal-agent problem is real and that what you choose to measure matters in determining outcomes.

The private problem: patients may have a shaky understanding of what counts as quality care, and by matching physician incentives with "happiness," hospitals may end up compromising care to satisfy the narrow self-interests of patients who may not know any better. As an editorial note, consider how this problem may be worsened by third party payments: if patients don't have to pay out of pocket for pain meds, they might be more easily be given out like candy.

The public problem: overprescription of antibiotics. If patients think "antibiotics make everything better", the odds of drug resistant strains increase precipitously, particularly for non-compliant patients. The threat of a post-antibiotic world cannot be understated. Uncontrollable contagion in a world of 7B+ humans with access to air travel is something that should set even the most sanguine optimist's teeth on edge. In a best case scenario, humans will shift to low-contact association. Worst case? Decimated populations become subjugated and exterminated to control the spread of infection.

Medicine is not about vanity. Pretending otherwise puts the entire race at risk. It sounds like an SMBC comic. And since I'm not 100% on Zach's back catalog, I wouldn't be surprised to find he's already described this scenario in zany detail.


h/t Mrs. Spivonomist

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Do you have suggestions on where we could find more examples of this phenomenon?