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Why Are We So Obsessed with Outcomes in Medicine?

Op-Med is a collection of original articles contributed by Doximity members.

A colleague told me a story about his monthly nature drives with his mother. She resides in a retirement center and suffers vascular dementia, yet she remains lucid enough to have relatively normal conversations and enjoy the scenery when not complaining about the staff stealing her belongings.

“Is there an outcome to these adventures?” my colleague asks. Must there be?

He then answers his own question in the negative and reflects: “These visits are to spend time with my mother while giving my siblings a bit of a break, and to get her out of her environment.”

I agree with my colleague. If there is one bad habit that we have acquired in practice it is this: We are obsessed with outcomes.

I can already hear the medical pundits pushing back. Outcomes are critical in determining the effectiveness of treatments, interventions, and health care strategies, they will tell me. Outcomes serve as quantifiable evidence of the success or failure of medical practices. They are integral to practice guidelines, policies, and research. And so forth.

I do not dispute that medicine is fundamentally a field dedicated to improving health and saving lives, and that’s why we are laser focused on outcomes. The problem is that medicine seems to be exclusively fixated on the quantitative and scientific foundation of outcomes to the neglect of its humanistic dimensions. Concentrating solely on measurable outcomes can lead to an overemphasis on data and facts, often neglecting the qualitative aspects of patient care such as patient satisfaction, comfort, and overall well-being.

An overemphasis on outcomes can lead to a one-size-fits-all approach, which may not be suitable or effective for all patients. Patients have distinctive needs and require individualized treatment plans. Outcomes are population-based and not necessarily geared to the special needs of each patient. When patients feel neglected, several consequences can occur, including emotional distress, decreased trust in health care practitioners, and harm to the doctor-patient relationship.

Outcomes often focus on a limited set of measurable results, such as lab results or survival rates. This narrow focus can overlook other important determinants of patient health and wellness, such as emotional and spiritual well-being, social relationships, and the ability to engage in activities of daily living and other activities necessary for independent living, so-called instrumental activities of daily living.

The failure to achieve long-term health and wellness goals may result from relying on outcomes that are short sighted or only measured for a short time. This is a common occurrence in the pharmaceutical industry, where most clinical trials designed for initial FDA approval last a period of months rather than years. Yet many medical conditions are chronic and require long-term therapy, leaving clinicians on their own to gather additional information based on their experience, the experience of their colleagues, and the post-marketing surveillance of pharmaceutical companies to identify adverse events that did not appear during the drug approval process. Regrettably, about a third of the drugs the FDA approved between 2001 and 2010 were involved in some kind of safety event after reaching the market, according to a study published in JAMA.

And what happens when outcomes are linked to the wrong variables or, worse yet, tied to financial incentives? It’s simply unethical to design outcomes that are not in the best interest of patients and instead profit drug companies or physicians or health care institutions. This could lead to overtreatment or unnecessary procedures.

There are additional ethical concerns using outcomes to guide treatment, such as discrimination against patients with poor prognoses, or prioritizing patients who are likely to have better outcomes. One of the most egregious instances of outcome-based discrimination was the use of an incorrect method for determining estimated glomerular filtration rate (eGFR) in Black patients that caused them to seem healthier than they really were. As a result, hospitals nationwide had to notify thousands of Black people with kidney disease of the error, which was caused by an unnecessary modifier in calculating their eGFR, and advance them on transplant waiting lists.

Outcomes, even if designed appropriately, can be misinterpreted, leading to incorrect treatment decisions. For example, a temporary improvement in symptoms may be mistaken for a cure, leading to premature termination of treatment. One of the most common mistakes in my field (psychiatry) is quite the opposite of discontinuing therapy early — namely, inappropriately prolonging treatment due to attributing agitation to an exacerbation of an underlying psychiatric disorder when, in fact, agitation is a side effect of a patient’s medication. Increasing the offending psychiatric medication or adding another drug to combat the “agitation” only worsens the situation.

There may be potential risks or side effects associated with certain treatments that could outweigh the benefits, especially if the treatment is aggressive or invasive. If the focus is solely on outcomes, these risks may be minimized or overlooked. Obtaining informed consent from patients may not address the risks given the complexity of the informed consent process and detailed level of information and understanding required to enable an informed decision. This is particularly problematic in psychiatry, where patients may have diminished cognition or thought disturbances that limit comprehension.

Overreliance on outcomes in psychiatry can present several other potential dangers, such as:

  • Overlooking aspects of patient well-being that are subjective and difficult to measure, like self-esteem or personal satisfaction.
  • Aiming for immediate symptom relief but not addressing underlying issues that could lead to relapse.
  • Failing to fully capture a patient's lived experience — knowledge based on their perspective, identity, and insight — beyond their symptoms and diagnosis.
  • Feeling pressured to produce positive outcomes, leading to potential misdiagnosis or overtreatment.
  • Ignoring contextual factors (e.g., poverty, discrimination, or social isolation) that affect a patient's mental health.
  • Shifting the focus of therapy toward achieving specific results rather than building a supportive and understanding therapeutic relationship.
  • Relegating patient-reported outcomes — health outcomes directly reported by the patient without clinical interpretation – to lesser status, especially in clinical trials.
  • Stigmatizing patients who do not show “expected” improvement per outcome measures, which could lead to further deterioration of their mental health. I can’t tell you how many times I’ve heard the phrase: “The patient failed Drug X,” when it should really be: “Drug X failed the patient.”

We cannot achieve the best results for our patients by relying solely on outcomes that are measured. We must also take into consideration the qualitative and interpersonal aspects of medical practice that are vital to patient care but cannot be precisely quantified, like empathy, communication, trust, and understanding. In addition, psychiatric patients’ individual experiences, broader contextual factors, and nature of the therapeutic relationship must be considered. All are crucial for achieving the best outcomes and providing effective health care. Our preoccupation with only measurable outcomes is a bad habit. Let’s break it.

Do you think we rely too much on quantifiable outcomes? Share in the comments.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.

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