We’ve seen sports teams full of All-Stars who don’t win games. These teams have the highest scorers in the league, and the best defensive players. And yet they lose, repeatedly. We have the same thing in medicine.
Who is the best physician?
The answer: You cannot tell from this data which physician is the best.
Look at any physician scorecard and you may think you can quantify contribution and effectiveness succinctly. In fact, you may choose your next physician or manage your next colleague from similar data. However, the data is incomplete and neglects to understand the impact of each physician and their effect on the whole.
The Lost Physician All-Stars
Some colleagues elevate our game. These individuals are often lost in the statistical dashboards that compare us. They may appear as laggards, when in fact it may be the apparent leaders who bring us down.
Physician A may pick and choose the easiest patients and block the most complex; may be burnt out, difficult to work with, and monopolizing of resources; and may spend little time educating their patients.
Physician B may accept the most complex patients and be the first physician the nurses go to during disruptive encounters; may be a pillar of well-being and the best educator of staff, students, and patients; and may elevate the care provided in the entire department the moment they step on to the floor.
Our statistical laggards may be our most valuable players.
Plus-Minus is a sports statistic that measures a player’s impact on the game. It represents the difference between their team’s total scoring vs. the opponent’s total scoring when they are in the game. When a high plus-minus player is in the game, the team scores more points than opponents and the team is more likely to win. On the other hand, a low plus-minus player may score the most individual points, but sink the team. We don’t have this statistic in medicine, but we need it.
Data is Incomplete.
Medicine is complex and ever-changing. We will never find the perfect plus-minus score(s). However, our exploration improves our game. As we seek what is missing from data, we gain a broader perspective from which to make sense of the world. We make better decisions.
Look for the unmeasured All-Stars. Ask: “What is the plus-minus?”