Saturday, August 18, 2012

The Delusional Art of Statistics

 ‘There are three kinds of lies: lies, damned lies and statistics.’

The quote is attributed to the 19th century British Prime Minister, Benjamin Disraeli. What, I wonder, would he therefore make of the new iPhone app called ‘GP Ratings’, or indeed the expansion of statistical data now available on the Department of Health’s website, NHS Choices (

Statistics are only helpful if they compare like with like, compare data that is meaningful, and are sourced from unbiased data. Sadly, the aforementioned App and website fall down on all three counts, being drawn from a fundamentally flawed annual review called the GP Patient Survey. As a result, practices are now given a score out of ten based on patient experiences.

Now, speaking as a GP and from a personal basis, I have nothing I wish to hide from my patients or my peers. I strive to be the best GP I can. However, I am not, and can never be, perfect. That I frequently fall short of perfection is down to many different factors; an increasing number of which are totally outside of my control (lack of funding for the NHS, inflated Governmental and patient expectations, the number of hours in the day, imperfect therapies, and the mysteries of health and life that are yet to be answered by science, to mention a few). I therefore do not mind my work being compared to another GP, as long as the comparisons are fair and meaningful. Sadly, there is very little of that within the Government’s new ratings system.

Many writers in the medical press have condemned the new scores as simplistic, lacking detail and running the risk of overwhelming patients with unhelpful information. They are quite right. In many important areas, such as how well a doctor manages chronic or life-threatening illness, the information provided does not allow for meaningful judgements. Instead, the main comparisons are on factors such as how easy it is to obtain an appointment at a convenient time and how long one waits in the waiting room.

Not for one moment am I saying that these issues do not matter; of course they do. However, I would rather wait for an hour to see a doctor who is going to take my problem seriously, diagnose me accurately, treat me appropriately, explain the details to me in language I can understand, and, somewhere amongst all of that, show me a little compassion, than be whisked in and out on time, but left feeling that my issues have not been properly addressed.

Unfortunately, many of the issues the Department of Health measures doctors against are ones which are easily managed if one works in a well-resourced private institution, but will always be wishful thinking for large, underfunded, overloaded, NHS practices whose staff are trying to juggle the complex demands of patient care with training medical students and new GPs, commission local NHS hospital services, balance the NHS budget, and contribute to numerous other demands from the world of medical politics. Read the data by all means, but treat it for the crude information that it is. If it is of little use to me, in my capacity as the medical director for a Primary Care Trust, then I seriously question what real use is it to you as patients.

As Albert Einstein once said, ‘Not everything that can be counted counts, and not everything that counts can be counted.’

(First published in the Scunthorpe Telegraph, Thursday, 5th July 2012)

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