The Bell Curve 

Virginia Postrel blogged a little while ago about an article in the New Yorker about how medical centers are sharing details about their success rates, and techniques more than ever before, and what happens when you start comparing them:

Once we acknowledge that, no matter how much we improve our average, the bell curve isn't going away, we're left with all sorts of questions. Will being in the bottom half be used against doctors in lawsuits? Will we be expected to tell our patient how we score? Will our patients leave us? Will those at the bottom be paid less than those at the top? The answer to all these questions is likely yes....

The hardest question for anyone who takes responsibility for what he or she does is, What if I turn out to be average? If we took all the surgeons at my level of experience, compared our results, and found that I am one of the worst, the answer would be easy: I'd turn in my scalpel. But what if I were a C? Working as I do in a city that's mobbed with surgeons, how could I justify putting patients under the knife? I could tell myself, Someone's got to be average. If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them, right?

Its an interesting question. What happens if you are in the middle of the curve? The problem is that the bell curve is mostly used to compare one person to someone else. That's fine if you're competing for bragging rights, or for a spot on a medical review board. It's also great for determining potential growth. If you find that you're in the middle of the curve, and you know that there is someone out there better, you know that it's at least possible to improve yourself. You have a new yardstick to measure yourself by.

But if you're facing a lawsuit... is it right to have "average" held against you? What if average is still pretty damn good? Sure, compared to other people you might not be the best, but what about against a known standard? You're C on the bell curve could still be an A compared with that standard. So what do you do then? Is the standard now too low? Obviously you should still try to improve, but how responsible are you for it? I don't know... but it's not an issue that either Virginia, or the New Yorker article really talks about. They only seem concerned with the bell curve. Any thoughts?