The First Metric: How Are You Feeling?

Of all the routine requests I get from clients, the one I find most difficult to deal with is this: "Help us choose a metric so we can tell if things are going well." the problem is that "numbers as health indicators" is so deeply embedded in our worldviews, so deeply correct on paper, and so deeply counter-productive in every case i’ve seen in practice.

Think about your own health for a minute. Is it a 9 or a 3? While you sputter away trying to answer that, let me point out some of the difficulties in making such an assessment.

  • Difficulty: my “health” rests in a huge variety of factors, some easily measured and some not so easily so. In order to come up with one number, or even five numbers, we will have to do make some pretty sophisticated judgments after some pretty sophisticated analysis.
  • Difficulty: my “health” varies temporally due to externalities like recent injury, the flu, the six straight weeks i’ve spent in a hotel, and so on. We’ll have to make sophisticated judgments after sophisticated analysis.
  • Difficulty: my “health” includes factors not one person on earth knows how to assess objectively, like whether i’m nearing the borderlands of churchill’s black dog, or whether my mom just died. Hmm. We need some sophisticated judgment after sophisticated analysis.
  • Difficulty: *my* “health” has key indicators that are not the same key indicators as *your* “health”. If we’re to compare these, dagnabbit, sophisticated judgment & analysis will be required.
  • Difficulty: for a 100 years, several times in the last twenty years, a variety of expert-consensed health indicators have been challenged, overturned, abandoned, and replaced. Parsing that turmoil to settle on figures would need, you know, sophisticated judgment after analysis.

Anyway, if you’re done sputtering, just give us the number. Is it a 3 or is it a 9? Is it 3.782 or 3.105? C’mon, c’mon, kid, I don’t got all day here, I have powerpoint to edit.

  • Difficulty: knowing my “health” is 6.322 tells neither me nor you what we want, could, or should, actually do about it.
  • Difficulty: the relevance of a health metric depends entirely on the relationship between me, my health, and the origin of your interest in it. You guessed, sophisticated judgment after analysis.

If you’re reasonably good at assessing trends, you might have noticed a trend in all these difficulties. (if you’re not, then why did u even ask me for these numbers?) that trend is towards sophisticated analysis followed by sophisticated judgment.

Well, is anyone good at assessing health? Yes. I can think of two groups that are quite good at assessing health: medical professionals and health insurance companies. (Neither is perfect, both are quite good at it.) How do doctors & nurses assess health?

Well. They build relationships with their patients, and make delicate subtle judgments using 1) experience & preference, 2) your reports, and 3) some extraordinarily expensive & complex local detailed tests.

Insurance companies do it differently. They use huge aggregates and monte carlo analysis and data-mining and staggeringly complex mathematical models to do it.

These differences make sense. Insurance companies care about your health because doing so lets them maximize their gambling profits across a huge range of bets. Doctors & nurses care about your health because of other reasons.

Still sputtering? Lord help me, it’s a simple question. WHAT IS THE NUMBER OF YOUR HEALTH!??

Let me ask a question. When you "don’t feel good", are you more likely to see a medical professional, or more likely to see a health insurance company?

I thought so.

Notice two things about going to your medical advisor.

First, your medical advisor is a full-time expert on health who invests heavily in an actual ongoing relationship with you, and that costs money. (if you’re an american, it normally costs more money than you have.)

Second, your medical advisor begins virtually every interaction in one simple & straightforward way, by asking a question: "how are you feeling?" so. I have a client right now who is asking me — all clients with more than three geeks ask me this sooner or later, sooner at the vbca’s, later at the smaller outfits — how can I get a number to tell me our health?

"How are you feeling?"

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