As a physician, I often think about how we lack truely objective assessment of patient outcomes (either in the context of evaluating physician competence or, probably more importantly, assessing and improving upon clinical practises).

I would really appreciate insight on how this could be achieved.

There are several issues which are particularly vexing:

- The distinct lack of verifiable, objective markers of physician competence.

- Each patient's case is unique and cases with the highest levels of difficulty are often treated by the most experienced people. These cases, of course, are likely to have worse outcomes than simple cases which may be treated by less experienced (worse?) physicians.

- Clinical outcomes are largely recorded by the same people treating the patient so reported outcomes are often erroneous or frankly fraudulent.

- This is made worse by the hierarchical nature of clinical medicine and deference to seniority and title.

- Medicine is parochial so clinical practises for the same disorder vary tremendously. You might be treated a dozen different ways for the same disorder and presentation depending on the facility and especially on the specialty that ends up treating you.

- Outcomes are not necessarily determined by clinician ability. There are several other factors at play: the pre- and post-care (such as work-up by ancillary staff or ICU care after a surgery), the cohesiveness of the facility and its efficiencies (or lack thereof), availability and preferences for resources such as medical devices, drugs and hospital equipment which may be largely out of the hands of the physician.