This past Sunday, (9/24/12) Robert Pear reported this in the NYTimes: the Obama administration is planning a pilot project to distribute questionnaires in hospitals and doctors’ offices for patients to report “medical mistakes”. These would then be sent to research centers for analysis and, when sufficiently transformed into pure data, forwarded to the White House for…what, exactly?
Your guess is as good as mine. But I’ll give you mine first. I see this as a maneuver that will try to preempt the expected counterattack from conservatives whose goal — or “crusade” if you will — is to repeal the Affordable Care Act. While this may serve a political purpose, its value as a measure of health care effectiveness is zero.
Consider how this data will be used. The article said the questionnaire is voluntary, and the information will be kept confidential. One can only assume, then, that any public report will be pure statistical analysis. Numbers, graphs and the like. It will postulate trends and venture, with caution, that certain kinds of mistakes occur most often with patients of this or that demographic group, and…well, you get the idea. The report will conclude — and of this you can be certain — that the project was a success because it “points the way” (such a useful phrase) for more extensive research into this growing problem .
Growing? Really? Amazingly, this tiny seedling project will get attention, which is its real purpose anyway. I’m sure only the nerdiest congressional staffers will be able to get through the report, but it will inevitably contain enough anecdotal goodies of gory medical ineptitude that the public, as fed by the media, will demand “a full investigation”. Yes, somehow the “pilot” will prompt Congress to bankroll the full miniseries, with “guest star” celebrity research wonks as an added attraction.
Am I being paranoid? Isn’t this only a responsible use of resources in order to better direct medical care?
No, because the project, in its proposed form, could never do that. It tries to translate the real experiences of health consumers into a composite made up of numbers only. It will filter out the individual perceptions of the consumers, which are so varied, and so dependent upon unrecorded details, that no purely statistical breakdown can be accurate. But accuracy is unimportant in politics. The magic of numbers is useful in itself, especially when unpopular programs need to be fortified.
But even if it’s useless, is it really harmful? Yes, because the more citizens rely upon opaque statistical pictures of their own lives, the less power they have to hold their leaders accountable. After all, numbers don’t lie, do they? The well-worn trick is to find some common label to stick on any number of diverse stories, make a count of them, and then you can say they all say exactly the same thing.
So now what? I say do something now, before the project is approved. I propose that we demand that every one of the questionnaires be reviewed by a government professional — not a private nonprofit like the RAND Corporation or ECRI Institute, which are going to analyze the data — so that any reported “mistake” that suggests a serious violation of medical practice, including possible criminal charges, be referred to the appropriate regulatory agency or the DOJ for further investigation.
This is the only proper thing to do with this data. Would we shrug off anonymous lists of bartenders serving underage patrons “by mistake”? That would be OK for tabloid or cable TV exposes, but not for the government. Once admitted into the public record, even the most cursory allegation of injurious conduct must be investigated. How can we accept anything less?
I won’t deny that my proposal may be considered disingenuous. Better yet, I’ll admit it. If these conditions were attached to the project, it would almost certainly kill it. The small agency overseeing it, the AHRQ, has a limited budget and staff. Now the administration would only have the agency transcribe and file the questionnaires, which would likely avoid congressional oversight. But if it had to read and classify every charge of misconduct, and make appropriate referrals for the worst, it could not handle the workload. The administration would also have to create guidelines for classifying the charges. These would certainly require subcommittee review, and risk the entire project’s becoming a very visible test of the ACA’s survival.
But what if the administration accepts the idea? That’s fine with me. I have no problem with serious scrutiny of professional conduct, especially when our health is involved. I just don’t like empty political gestures that exploit the public’s anxiety, that’s all. But as I said, I think the White House would back away from any practical use for this program. They want to flash numbers and labels, and real substance removes all the value from that. They would just as soon let it die.
And good riddance.