How do we measure success?
The Pastor and I were discussing the events of the last few months and upcoming events. Elections, the national title game, the end of the church year, the end of the calendar year, the NFL playoffs, the Super Bowl, the upcoming year. Each of these events has many ways in which those involved can measure success. For some, success is equal to winning. For others, success is equal to just being present in something greater than yourself. Success can be measured on a personal level, a team level, a national level. And not all those measurements will come up with the same answer in the same situation. Let’s take employment, for example. If the unemployment rate goes down then, on the national level, it will be counted as a success. But, if you lost your job in that same timeframe and are yet to find new employment I am guessing you would not agree that there was major success in reducing unemployment.
In medicine we measure success in many ways. One of the most common ways is morbidity and mortality. Morbidity refers to disease or worsening health and mortality refers to death. We view morbidity as complications or poor outcomes related to disease or surgical or medical interventions. Mortality is easy to measure. Did the patient live or die?
How does our own nation do? When we look at comparable countries (those with total and per capital GDP rates above average in the last 10 years) we find that we have worse mortality rates for almost all diseases than in those other countries. The US spends more on healthcare than any of these nations. Why the difference? Some of it falls on the healthcare system itself. We have issues that lead to difficulty in accessing healthcare; we have a complex system that contributes to cost, and for many Americans a significant portion of that cost will be spent in their last year of life. But there are also social determinants that impact our health. We have more obesity, a more sedentary lifestyle, and more disease caused by environmental factors. When we evaluate morbidity, or disease burden, we see that despite having a lower rate of smoking and alcohol consumption, we have higher rates of lung cancer, alcoholic abuse and alcohol related liver disease than comparable countries.
Now those are all national statistics. Measuring outcomes in a large scale view. It is not the only way to measure success. A patient might measure the success of their surgery based on when they are able to get back to their yoga class or weekly run and their surgeon might be measuring success based on the time it took to complete the surgery, or by minimizing blood loss or the patient’s hospital stay. Your primary care doctor may measure success by looking at vaccination rates, patient satisfaction, personal job satisfaction or seeing that long time patient achieve their weight loss goals or quit smoking. Your OB might measure success by lowering their c-section rate, improving quality of life in the women they care for or when that patient who has long-suffered with infertility or pregnancy loss finally gives birth.
How will you measure success in 2017? Maybe you will set a personal goal for your health, your business, your family. Maybe you will look at national data like the unemployment rate or what the Dow Jones does. Maybe you will measure success by what your own state does for its own citizens. Hopefully many of us will measure success in ways that are much less “measurable” but in ways that have much more meaning. May we measure success by how we treat our neighbors, how much our children know that they are loved, by how the widow and orphan are cared for and by how we have given away from ourselves in 2017.