The second lesson I learned is that patient-reported outcomes must be tweaked and tuned for each and every individual. I commend Jim Fries, MD, and all the other contributors to the Patient-Reported Outcomes Measurement Information System initiative. These investigators are taking insights from educational testing and creating elaborate decision trees to assess patient outcomes with detail and precision. I cannot help but think of how such a tree could be constructed for the patient that I saw. “Do you have a full head of hair? If no, are you bald? If yes, do you want to look like Kojak? If yes, can you shave your skull?”
People are different and outcome measures need to capture all of this wonderful variety.
Finally, I learned a lesson that is akin to one that was drilled into me when I was in grade school and high school. During that time, I took hundreds if not thousands of exams, and before each and every one, the teacher said, “Read each question carefully before you answer it.”
In my first administration of the HAQ that day in clinic, I learned an equally important corollary: “Read each question carefully before you ask it.”
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.