What is quality in medical treatment after all?

The German online magazine “Spiegel Online” is reporting on calls for more transparency in health care. I’m tempted to say: … for even more transparency in health care. The article “Patientenrechte: Experten fordern gläsernes Gesundheitssystem

All measures (note the ambiguity!) suggested in the article are interesting, but I’m missing a definition of quality. As a physicist, I know: the more you measure, the more likely you are to measure what doesn’t matter. (German: Wer viel misst, misst viel Mist)

Most quality schemes (such as the infamous ISO 9000) don’t measure the outcome but the repeatability of the procedure. The underlying idea is: if we precisely repeat the procedure, we will get precisely the same results. Unfortunately, this doesn’t work for health care. Every case is different, and it is neither useful nor practical to create equal starting conditions for everybody first.

Quality is usually what you find afterwards, but a lot of the information used in quality “measurements” is not available up front to the treating doctor (i.e. before the treatment).

The outcome? – cover-your-ass treatments as we can see them emerge already in the US and GB. Doctors who primarily tune their treatments to minimize compensations for damages instead of maximizing the benefit for patients. Doctors sticking to standard procedures “just to be safe”, and these standard procedures may fit to the individual case in question, most often they even will – but sometimes, they won’t.

The actual quality of treatments may even go down, but the trap is: because everybody is acting within the procedures of the quality standards, the assessed quality will still go up.

This post is also available in: German

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