{"id":28812,"date":"2013-09-12T14:54:33","date_gmt":"2013-09-12T13:54:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=28812"},"modified":"2015-09-22T14:37:56","modified_gmt":"2015-09-22T13:37:56","slug":"william-cayley-measurement-at-the-expense-of-success","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/09\/12\/william-cayley-measurement-at-the-expense-of-success\/","title":{"rendered":"William Cayley: Measurement\u2014at the expense of success"},"content":{"rendered":"

\"bill_cayley\"\u201cDoc, how\u2019s my blood pressure? What about my cholesterol? How about my weight?\u201d<\/p>\n

\u201cThere\u2019s room for improvement,\u201d I say. \u201cHow much do you exercise? How many fruits and vegetables do you eat?\u201d<\/p>\n

\u201cOh, I\u2019m too busy right now for exercise\u2014and I have to eat what I can get when I\u2019m on the road. But I just wanted to get things checked to be sure I\u2019m OK.\u201d<\/p>\n

That conversation, repeated with some variation over and over, has me wondering how much we\u2019ve taught our patients to focus on the wrong things.<\/p>\n

For years, we\u2019ve advocated the \u201cannual physical,\u201d which has many people expecting some sort of annual checkup\u2014even though there are serious questions about the efficacy of this approach<\/a>. Go to the doctor, get yourself measured and tested, and find out how you are doing. Unfortunately, this focus on testing, checking, and measuring often ends up being just that\u2014tests are done, measures are taken, but often not much else may happen. The behavior change that is essential to changing one\u2019s health status or health risks gets lost in the numbers and the data. The focus becomes \u201chow am I doing,\u201d not \u201cwhat can I do to get better?\u201d<\/p>\n

I think part of the problem is that as physicians, we find it easy to focus on numbers. Vital signs, blood tests, imaging studies\u2014these are all easy to get, measure, and quantify. They also lend themselves fairly well to measurement for \u201cquality\u201d reporting purposes. But the problem with this, then, is that we end up equating quality with obtaining something to measure. So, we focus on surrogate markers of disease, rather than on what the patient may or may not be doing to address the underlying causes or the possible treatments for that disease.<\/p>\n

Patients have learned well from our example. They come for their tests, they come to get measured, but they find it much harder to engage in discussion or exploration of the changes that might help improve their long term risks or their health. For example:<\/p>\n