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By Root 1033 0

personnel. When searching for a specialist, the most frequent referral came from the patient’s primary care physician, in almost seven in ten instances. One in five patients used recommendations from friends and relatives. In seeking either a new primary care physician or a specialist, only a small fraction relied on information from the Internet, magazines, or other media; such information is of two types, subjective and quantitative. Subjective information includes patients’ personal narratives and testimonials about their experiences with specific physicians. For some people seeking a physician, these sources effectively extend their circle of family and friends and influence their choice of doctor. Quantitative information is presented by insurers, government agencies, and nonprofit and for-profit organizations. It’s very appealing to imagine that you could reliably choose the right doctor using numerical data.

Indeed, health policy planners and insurance companies increasingly promote the idea that patients should choose their doctors based on report cards that provide metrics on “quality of care.” We live in a culture where metrics are increasingly touted as essential in evaluating performance. To be sure, there are certain numbers a patient should know. For example, every surgeon follows a learning curve with a particular operation or instrument or technology. The numbers of procedures performed gives a rough idea of how skillfully the surgeon uses these techniques. And information on safety, like the percentage of postoperative infections at a given hospital, is meaningful. Yet the metrics used in rating doctors fail to measure the key attribute of clinical judgment, how a doctor molds care to the individual patient. Rather, the metrics are based largely on lowest-commondenominator care, like whether a doctor regularly checks a patient’s blood sugar level or blood pressure, and also include measures of cost and efficiency. Furthermore, a doctor who avoids patients with multiple medical problems, such as diabetes with kidney failure and heart disease, will have better “outcomes” because he’s cherry-picking healthier patients, leaving the sickest ones to others. We find the famous statement attributed to Albert Einstein apt: “Not everything that can be counted counts, and not everything that counts can be counted.”

Insurers are also developing report cards on so-called higher-cost and lower-cost doctors, assessing the costs of care associated with a particular physician. A recent article in the New England Journal of Medicine showed that these statistics are often unreliable. The same physician can be rated as high-cost on one report card and low-cost on another.

Such limitations have not stopped insurance companies from launching advertising campaigns promising that if you use their metrics and report cards, you will get the right doctor and have the right outcome. This promise cannot be kept.

In one ad, an attractive, athletic woman is running in a sunny park against a background of digits. Across her midsection reads the tagline: KNOWLEDGE IN NUMBERS STRENGTH IN NUMBERS HUMANITY IN NUMBERS COMFORT IN NUMBERS HEALTH IN NUMBERS. SM The message below the image: “STRENGTH: You have a tricky medical condition. You need to make a medical decision. You would like to know you are choosing the right doctor, choosing the right procedure, and will have the right outcome. It’s only human to feel this way.”

As this ad shows, insurance companies understand decisional conflict, the patient’s “only human” fears and anxiety about choosing the “right” doctor and choosing the “right” treatment. The insurers want you to believe that the most agonizing truth of medical care—its uncertainty—is no longer a concern. These companies claim that they can resolve decisional conflict: If you rely on their numbers, you will get the right outcome. But no one can guarantee that you will get the right outcome. The FDA exercises oversight on truth in drug advertising, and we believe the same should be done for claims by insurers about outcomes.