Most readers know that I am obsessed with performance measurement and why it not only rarely works but often causes negative unintended consequences.  As I have pondered this question recently, computers cannot replace physicians as diagnosticians.  And the same misunderstanding of medicine that would advocate such a position drives the performance measure movement.

Physician decision making requires a complex weighing of disease severity, number of diseases, social situation, the cost of medications, the patient’s desires and willingness to address issues and more that you can imagine.  To think that we can apply simple rules to such decision making represents an unjustifiable conceit that patient care is simple and can therefore be broken down into RULES.

The unintended consequences of this movement are many.  We now have nonsensical report cards and, here the author gasps, public reporting.  If we could define excellence, then public reporting would make sense.  But we cannot define excellence through rules that cover only selected diseases and only 1 aspect of doctoring.

How do we stop this madness???