In a previous post I wrote about Goodhart’s Law in relation to prohibition. I want to give another example of Goodhart’s Law with addiction, this time with opioids.
In a recent report making the national media rounds, Senators have written a letter to CMS, the government agency responsible for Medicaid and Medicare. The letter states that there is growing anecdotal evidence that surveys regarding pain scores are causing doctors to prescribe more opioids. Well, yeah, but this is Goodhart’s Law. “When a measure becomes a policy, it ceases to be a good measure.”
CMS measured pain scores. They wanted to improve pain scores. So they instituted the policy that pain scores should go down. Pain scores ceased to be a good measure of quality of care, and instead became the driving force for increased prescription of opioids. By the way the same thing is happening with patient satisfaction scores and the intimidation of doctors who actually feel they’ll lose their jobs if opiate seeking patients write bad reviews of them.
The real problem isn’t opioids or pain. The real problem here is the system’s response to the problem. Without ever trying to find the root cause of the problem, they just declared, “Solve the problem.” You just get another problem.
I’ve written before about TOC and its usefulness in addiction here and here. This is another good example of where TOC could help. Instead of fixing what the problem looks like on the surface, we could use the TOC thinking processes to find the underlying common cause. We can then plan out how to affect the change and foresee the negative outcomes. Before implementing, we could address the negative outcomes and create an even better plan for change.
But that, unfortunately, is not how large organizations like government work. And it is unfortunate, because where TOC is used we see remarkable change very quickly. I would like to see addiction go away tomorrow, and while even that isn’t possible with the TOC thinking processes, using them would make it happen a lot faster than it’s happening now.