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” NEJM 362 (2010), pp. 1014—1021. Also see Janet Colwell, “Should doctors worry about online ratings?” ACP Internist 30 (2010), pp. 1, 16. Despite such caveats, there is considerable effort to make such metrics primary in patient choices: Michelle Andrews, “Insurers and ratings groups post information to help patients choose doctors,” Washington Post, August 3, 2010. In a notable article in the Sunday New York Times titled “Metric Mania,” a mathematician raised the valid concern that society is too often trying to measure dimensions of experience that are not amenable to calculation: John Allen Paulos, “Metric mania,” New York Times Magazine, May 16, 2010. Also see Gary Wolf, “The data-driven life: Technology has made it feasible not only to measure our most basic habits but also to evaluate them: Does measuring what we eat or how much we sleep or how often we do the dishes change how we think about ourselves?” New York Times Magazine, May 2, 2010.

118 Choosing a physician in some ways has similarities to choosing a companion with whom you can share confidences and trust that your interests are paramount. A related example of metrics in online dating and how they fall short of key elements in relationships is wonderfully presented by Dan Ariely, The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home (New York: HarperCollins, 2010), and Courtney Humphries, “Data mining the heart: How do we choose a mate? What scientists are learning from online dating,” Boston Sunday Globe, August 22, 2010.

118 A number of states, including ours, have begun to post report cards on the Internet on physicians. The validity of these ratings is highly questionable. For example, an experienced pediatrician who works in a poor neighborhood in Boston was given low marks because she did not fulfill several “quality measures” needed to prove her worth. Many of these measures were not meaningful in the context of patient care, and the state agency that ranked her made no effort to assess the clinical outcomes of the children in her practice. The Massachusetts Medical Society featured her plight as an example of the capriciousness of some of the rankings: Tom Walsh, “Physicians cite continuing problems with fourth year of GIC tiering,” Vital Signs 14 (April 2009), http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=29032; Emily Berry, “Challenging your rating: You don’t have to accept what the health plan says,” American Medical News 52, no. 10 (2009), posted online March 23, 2009, http://www.ama-assn.org/amednews/2009/03/23/bisa0323.htm. Also see failure of quality measures to improve patient health: NICE-SUGAR Study Investigators, “Intensive versus conventional glucose control in critically ill patients,” NEJM 360 (2009), pp. 1283–1297; Silvo E. Inzucchi, Mark D. Siegel, “Glucose control in the ICU: How tight is too tight?” NEJM 360 (2009), pp. 1346–1349; Bengt C. Fellstrom et al., “Rosuvastatin and cardiovascular events in patients undergoing hemodialysis,” NEJM 360 (2009), pp. 1395–1407; Robert G. Dluhy, Graham T. McMahon, “Intensive glycemic control in the ACCORD and ADVANCE trials,” NEJM 358(2008), pp. 2630–2633; William T. Cefalu, “Glycemic targets and cardiovascular disease,” NEJM 358(2008), pp. 2633–2635; Action to Control Cardiovascular Risk in Diabetes Study Group, “Effects of intensive glucose lowering in type 2 diabetes,” NEJM 358 (2008), pp. 2545–2559; ADVANCE Collaborative Group, “Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes,” NEJM 358 (2008), pp. 2560–2572; Gregg C. Fonarow et al., “Association between performance measures and clinical outcomes for patients hospitalized with heart failure,” JAMA 297 (2007), pp. 61–70; Timothy Bhattacharyya et al., “Measuring the report card: The validity of pay-for-performance metrics in orthopedic surgery,” Health Affairs 28 (2009), pp. 526–532. Also see Jerome Groopman, Pamela Hartzband, “Why ‘quality’ care is dangerous,” Wall Street Journal , April 8, 2009; Jerome Groopman, Pamela