Quote:
“what gets measured gets managed”
- unknown source
When you measure something you become aware of it and can objectively manage it.
Potential Pitfalls: The right things must be measured. Measurement must be accurate.
What is a Report Card:
- an evaluation of performance
Benefits of Report Cards:
- attempts to measure strength and weaknesses
- allows for awareness of weaknesses (so they can be targeted and improved)
- provides objective measures of performance normalized to the rest of the group (lets one know exactly how they measure up)
- allows outsiders to evaluate and make decisions
Negatives of Report Cards
- can hurt feelings (who fucking cares, life is tough, competitive, and requires constant improvement)
- can leed to discrimination (of course….people, companies, and things with bad reports should be discriminated against). Discrimination = pressure to improve
- the wrong things are often measured or given too much importance. If not, you will manage things that don’t matter. Importance of asking the right questions.
- the things measured may be wrong or inaccurate. This is a big deal! Measuring things inaccurately is probably worse than not measuring things at all
- subject to the bias of those creating report cards. We all remember that teacher that just didn’t seem to like us…..
Imagine
- kids at school not being assessed or told what things they are good at and need work on….
- investing in, consulting for, or managing a company without performance metrics
- assessing an athlete or team without stats
- training an AI algorithm without telling it how it is doing
- having a government that does not measure the outcomes of its policies (oh wait we have this….shit, well look at government performance…..not so great)
So in healthcare
We have the annual physical that consists of
- some questionnaires about mental health and maybe lifestyle
- height, weight, BMI
- blood pressure and heart rate
- some basic labs (CBC, CMP, a1c, lipid panel)
- a doctor to listen to your heart and lungs
- a 5 minute conversation about how things are going
While this is a reasonable way to screen for a few common medical problems, it does nothing to assess functional performance, rate of aging, or even really health.
Meanwhile the average person is weaker and less fit than ever, more obese and metabolically unwell than ever, and more likely to have a chronic disease than ever before in history.
So, what is the plan for improving health.
Mandatory gym class for adults. This would get us some exercise, force social interaction on our lonely asses, let us know how fit we are relative to our piers, and be fun. I can only dream……
But back to the report cards……We might start by attempting to measure health.
I believe:
- A Health Report Card is desperately needed to improve our performance as individuals and a society.
- All people should have their physical fitness and cognition measured regularly throughout life (in addition to screening for disease)
- aging should be measured. People should be ploted on nomograms for aging and aging trajectory, just as we chart height and weight for kids. We need to build this.
- Traits and behaviors associated with longevity and performace should be monitored, measured, studied, and eventually personalized and recommended.
This would
- let people know where they stand from a health, longevity, and aging perspective
- allow medical practitioners to target areas of weakness, understand patients, and provide better care
- provide a framework upon which interventions could be studied
- improve communication
- and more
- communication is the hallmark of any good report card – what is medicine so bad at in 2024…..communication
Right now (I estimate) doctors spend 90% of time figuring patients out. They then only have 10% of the time left to make decisions and plans as well as educate patients. A good report card, and some help from large language models could flip this upside down. 10% of time data gathering, 40% of time to make decisions, and 50% of time to educate. What a bright future that could be for healthcare. Might that help the burnout epidemic experienced by healthcare workers? Absolutely
My product at Longetrics is “Your Longevity Report CardÓ” What I describe above is what I am trying to build and why. I hope others will join me as getting this right will likely take a village. I am starting with the best hypothesis I can come up with based on research, personal experience as a doctor, and my intuition. But constant improvement will be needed to fine tune any Health Report Cards proposed. If you are interested, check it out at Longetrics.org. We are executing a clinical trial based on this very idea.
My conflict of interest – I own, operate, and some day hope to support my family with Longetrics
Thanks again,
Bill Brandenburg, MD
References
The internet and my logic center (e.g. brain). This is how we start to answer all big questions. Next comes the research.
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