N Engl J Med 2015; 372:1959-1963
May 14, 2015
Here is an excerpt:
Whether our judgments are motivated by fatigue, hunger, institutional norms, the diagnosis of the last patient we saw, or a memory of a patient who died, we are all biased in countless subtle ways. Teasing out the relative effects of any of these other biases is nearly impossible. You can’t exactly randomly assign some physicians to being motivated by the pursuit of tenure, others by ideology, others by the possibility of future stock returns, and others by just wanting to be really good doctors. The difficulty of measuring these other motivations, however, creates the problem that plagues many quality-improvement efforts: we go after only what we can count. It is easy to count the dollars industry pays doctors, but this ease of measurement obscures two key questions: Does the money introduce a bias that undermines scientific integrity? And by focusing on these pecuniary biases, are we overlooking others that are equally powerful?
The entire article is here.