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An update on an old joke

There’s an old doctors’ joke about 2 doctors discussing an operation that one of them had done and the punchline is something like “Well, the operation was a success but the patient died.”

Yes, I admit, it’s not very funny but it does tell you a lot about the way some doctors judge their successes, or lack of, by which I mean that in far too many situations, we – and I am a doctor so that’s a sort of royal “we” – tend to measure an outcome by how well we were able to change a lab result rather than by how well the patient did after we did whatever we did to them.

And the two – better lab results versus patient improvement – don’t always match up.

Take for example, a recent study published in the journal, Rheumatology, in which the researchers compared how rheumatologists (well, it’s their journal, after all) in the UK were able to improve the lab results of patients with arthritis over the last 30 years – that’s a time span in which the world has seen the introduction of many new and improved powerful drugs to treat inflammation – to how well people with arthritis felt now compared to how well people with arthritis felt 3 decades ago.

No surprise: Based simply on objective criteria like blood test measures of inflammation, the patients are doing much better compared to 30 years ago.

But here’s the kicker: When they got patients with arthritis to gauge their own state of health (never mind what the tests say), there was not much of an improvement in the scores from 30 years ago, or as the researchers put it, compared to scores of patient status from 30 years back, the current scores from patients of “disability did not translate into similar improvements in patient-reported outcome.”

More specifically, “improvements in mental health, functional disability, pain, and fatigue have been relatively stable over the last 30 years .”

That’s certainly not a joke.