Book Club: Random Acts of Medicine
Deliberately randomized experiments in medicine and health policy are usually not possible, or even moral. But with increasingly available data and random changes in circumstances, natural experiments can teach us a great deal about what works and what doesn’t. Random events have a huge impact on our health, more than we’d like to acknowledge. Random Acts of Medicine: The Hidden Forces that Sway Doctors, Impact Patients, and Shape our Health, by Anupam Jena and Christopher Worsham, compile the results of such studies, including their own, into a fascinating story about how we can improve care.
Studies summarized in the book found that implementation of EZ Pass tolls reduced nearby rates of premature births, kids with summer birthdays are more likely to get the flu, and fewer patients die in hospitals during Joint Commission inspection visits.
Likely reasons for these results include reduced air pollution from cars idling at toll booths; each year’s flu shots aren’t available until the fall, after annual checkups for toddlers born in the summer, requiring parents to schedule another visit; and the last is obvious, we all behave better when we’re being watched.
The book explains why you shouldn’t schedule surgery on your surgeon’s birthday, heart attack patients have better results when the most highly trained cardiologists are out of town at conferences, and that big birthdays can affect your chances of overtreatment.
I really appreciated that the authors tell the truth about value-based payments – that economic incentives can move scores but do little to improve health outcomes or the quality of care. In some cases, incentives have led to actual harm to patients. But thoughtful, targeted system changes can have a huge impact. I also appreciate that they linked many medical errors to well-studied cognitive biases. This can help identify and prevent the causes of error.
Definitely worth the time to read, no matter your role in healthcare. I will be adding it to the reading list for my students this year.