The New York Times ran a great essay titled, When Care Is Worth It, Even if End Is Death, by Peter B. Bach, M.D., who was a senior adviser at the Centers for Medicare and Medicaid Services and currently works as the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center in New York City. The piece is not a paean to the way sick people will appreciate heroic efforts to save their lives, nor is it focused on the importance of allowing survivors to live with the knowledge that they did all they could.
The piece focuses instead on the fact that the angle from which one views data causes such data to give different impressions. This is a point exceedingly valuable for business people to recognize.
In this example, the press is constantly filled with reports pointing out how much money is spent on sick people within the last days, weeks and months of life. The pretty overt message: Society should save the money, let these people die a little earlier, and we would probably not only save money but reduce suffering at the end of life.
The argument is fair enough as far as it goes — although one should always be wary regarding people saying that the last days of other people’s lives have no value. One also needs to distinguish between a public policy choice — how the government will spend funds — and individual choice — how people will spend their own money.
The real issue, though, with this line of thought — that we should spend less money on people right before they die — is that it involves retrospectively going back into records after people died and noting how much was spent.
This is, however, an almost useless exercise. Yes, of course, if we knew in advance that a patient would die the day after a major operation that costs a lot of money and causes discomfort, nobody would do it. But we don’t know.
If we do a particular procedure on 100 people and five people die within 24 hours, sure, by looking only at the records of the five that died, we will see waste — but what about the 95 who lived?
Dr. Bach put it this way:
How could it be that we were prudent with health care dollars because he lived, but would have been described as wasteful had he died? Doctors in an emergency room cannot know which will occur. They do not have divining rods that direct them to patients they can save and away from those they can’t.
Rather, caring for the sick means caring for people who may die. Providing care means reducing the chance they may die — not eliminating it.
This issue, of how a statistic should be looked at, applies in medicine and all other areas of life. If you look at training and only look at the people who quit right after the training, one would conclude the training is a waste. But, of course, one has to balance that statistic with the benefit accrued to the employees who stay.
Viewing data from the wrong perspective guarantees a big mistake, in public policy and the corporate world.
You can read the whole piece here.
