"We treated the number, not the patient." Still happening?

A 2000+ Word In-Depth Look at Data-Driven Medicine vs. Clinical Wisdom
Written for doctors, by a doctor

“The labs are fine, so the patient must be fine.”

Or:

“Their HbA1c is perfect—ignore the fatigue and dizziness.”

Sound familiar? If you’ve ever practiced medicine in a modern clinical setting, you’ve probably witnessed treatment decisions driven more by data than by the actual patient. Welcome to the paradox of modern evidence-based medicine: we are trained and encouraged to treat the patient—not just the number—but rewarded for achieving numerical targets, clinical metrics, and standardized outcomes.

So, is “treating numbers more than people” still happening in 2025?

Yes. And arguably, more than ever.

Where This Culture Originated

Let’s rewind.

The evolution of evidence-based medicine (EBM) in the 1990s was a pivotal advancement in clinical practice. It replaced anecdotal habits with structured data and research-driven decisions. This shift led to the widespread adoption of:

• Randomized controlled trials
  
  
• Meta-analyses
  
  
• Guideline-driven protocols
  
  
• Emphasis on measurable outcomes
  

As a result, medicine became more standardized, reproducible, and, in many ways, more scientifically grounded.

However, the unintended consequence was a creeping obsession with metrics. Healthcare became increasingly focused on:

• HbA1c levels
  
  
• LDL targets
  
  
• Blood pressure thresholds
  
  
• BMI ranges
  
  
• Serum creatinine
  
  
• Ejection fractions
  
  
• Oxygen saturation levels
  

These numbers became surrogates for quality—even though they rarely capture the full clinical picture.

The Perils of Algorithmic Medicine

Let’s look at real scenarios:

A patient with type 2 diabetes has an HbA1c of 6.5%.
Technically, it’s excellent control. But:

• Are they taking excessive medications to maintain it?
  
  
• Are they skipping meals out of fear of glycemic spikes?
  
  
• Are they experiencing nocturnal hypoglycemia?
  

Or consider an older adult with blood pressure readings of 120/70 on multiple antihypertensives. The textbook says, “Good control.” But:

• Are they frequently dizzy?
  
  
• Are they experiencing near-falls?
  
  
• Has their functional status declined?
  

In both examples, the metric is met—but the patient may be worse off. Clinical protocols rarely account for the subtle yet critical human costs.

Medicine by Numbers: How It Still Happens Today

EMRs and Alert Fatigue

Electronic medical records (EMRs) are designed to flag deviations from normal values. The problem?

• Not every deviation requires correction.
  
  
• Clinicians are overwhelmed with alerts and prompts, often pushing them to react rather than reflect.
  
  
• Alerts are binary: the potassium is 3.4—red flag! But what if the patient is asymptomatic and stable?
  

This form of binary thinking pushes providers to correct every number, regardless of context.

Quality Metrics and System Incentives

Hospitals, insurance companies, and regulators use numeric performance targets as proxies for quality.

Examples include:

• Percentage of diabetics with HbA1c below 7
  
  
• Blood pressure control rates
  
  
• Statin prescription rates for LDL over a certain threshold
  

These numbers directly influence funding, reimbursement, and performance evaluations. So naturally, clinicians feel compelled to adjust medications—even if the patient feels fine or even worse after those changes.

Insurance Documentation and ICD-Driven Diagnoses

Insurance companies demand precise numeric criteria for reimbursement. This leads to situations where:

• A fasting glucose of 101 gets labeled “pre-diabetes”
  
  
• An eGFR of 59 becomes “chronic kidney disease stage 3”
  
  
• A one-time BP spike during stress labels a patient with hypertension
  

The result? Patients carry diagnostic labels that may not truly reflect their health—or may cause harm through unnecessary interventions.

Is This Hurting Patients?

Absolutely. And often in ways that are subtle but cumulative.

Polypharmacy

To bring every lab value into the “ideal” range, many patients—especially older ones—end up on multiple medications. This increases the risk of:

• Drug-drug interactions
  
  
• Falls and fractures
  
  
• Cognitive impairment
  
  
• Hospitalizations from adverse drug events
  

All in pursuit of a textbook-perfect profile.

Overdiagnosis and Medicalization

Diagnostic thresholds keep shifting lower. What was once considered “normal variation” is now labeled as pre-disease.

Examples include:

• Pre-diabetes for marginal glucose elevations
  
  
• CKD stage 3 for minor, transient eGFR changes
  
  
• “Stage 1 hypertension” for occasional borderline readings
  

This medicalization of normal physiology generates:

• Patient anxiety
  
  
• Unnecessary follow-up tests
  
  
• Lifestyle restrictions
  
  
• Unneeded prescriptions
  

Symptom Neglect

Another insidious outcome: patients are dismissed when their complaints don’t match the labs.

Consider:

• A patient with crushing chest pain and normal troponins—dismissed as “non-cardiac”
  
  
• A woman with fatigue and hair thinning but “normal” TSH—told it's stress
  
  
• A depressed patient whose PHQ-9 score is borderline—deemed “not sick enough” for help
  

We’ve grown so reliant on numbers that we ignore the actual lived experience of the patient.

What About Guidelines? Are They the Villain?

Not inherently.

Clinical guidelines are built on evidence and offer helpful frameworks. The problem arises when they’re applied rigidly, without personalization.

Good clinicians use guidelines as tools—not as absolute rules.

Bad practice emerges when:

• Guidelines are treated as checklists
  
  
• Nuance and context are ignored
  
  
• Deviations are seen as failure rather than flexibility
  

Example: JNC 8 recommends a blood pressure target of <150/90 in those over 60. Yet many clinicians still push for <120/80, exposing elderly patients to unnecessary risks.

Guidelines are not meant to override clinical judgment—they're meant to complement it.

The Doctor’s Dilemma

Why do skilled, well-meaning physicians continue to treat numbers rather than patients?

Fear of Litigation

Medical liability culture creates anxiety around “missed abnormalities.” Acting on an abnormal value—no matter how trivial—feels safer than explaining why you didn’t.

Systemic Pressure

Healthcare systems are performance-driven. Providers are graded, compensated, and judged on how well they meet metrics, not how well they listen.

Time Constraints and Habit

With limited appointment time, it’s often quicker to tweak a medication than to explore a complex, nuanced discussion about life context or symptom interpretation.

A Cultural Identity Tied to "Fixing"

Medical training is about identifying problems and solving them. An abnormal lab is a problem to be corrected. But what if it’s a red herring—or doesn’t warrant correction?

It challenges the very identity of what a “good doctor” is supposed to do.

What “Treating the Patient” Actually Looks Like

Let’s shift the frame.

True patient-centered care would look like this:

• You don’t increase the beta-blocker dose because the patient feels faint, even if the BP is “elevated”
  
  
• You affirm a patient’s persistent fatigue, even when every test comes back “normal”
  
  
• You choose watchful waiting when appropriate, rather than knee-jerk prescriptions
  
  
• You prioritize social and psychological context—housing instability, grief, trauma, job stress—just as much as creatinine or glucose
  

This isn’t anti-scientific. It’s more scientific—because it considers the full ecosystem of the human condition.

Patients Know When They’re Being Treated Like a Number

They don’t remember your ACE inhibitor titration schedule. They remember:

• If you looked them in the eye
  
  
• If you asked how they were coping
  
  
• If you considered their life, not just their labs
  

Patients sense when they’re being managed by protocol rather than cared for by a person.

Compassion Is Not Anti-Science

Empathy and clinical excellence are not in opposition. In fact, they strengthen one another.

Modern medicine must teach trainees—and remind veterans—that interpreting lab values is only one part of the job. The harder, and arguably more important, part is interpreting the person behind them.

The Way Forward: Practical Solutions

Rehumanize Documentation

Chart the patient’s story. Not just their labs. A 7-line paragraph about lived experience can mean more than 12 lines of vitals and lab trends.

Challenge EMR Systems

Advocate for smarter alerts that prioritize clinical relevance. Not every deviation from “normal” warrants red flags and urgency.

Push Back on Performance Metrics

Join institutional efforts to shift from quantity-based metrics to meaningful, outcome-based evaluations. Advocate for metrics that include patient satisfaction, shared decision-making, and functional outcomes.

Rethink Medical Education

Residency and medical school curriculums must teach:

• Gray-zone thinking
  
  
• Shared decision-making
  
  
• When not to treat
  
  
• How to listen deeply and slow down
  

Talk to the Patient Before Reacting to the Lab

Labs tell you the what. Patients tell you the why. And sometimes the why is the entire story.

Final Thoughts

So, is “treating the number, not the patient” still a problem?

Yes. It’s not only still happening—it’s embedded in the very structure of modern healthcare. But the solution isn’t to abandon metrics, labs, or guidelines. It’s to place them where they belong: as tools—not truths.

A lab value is a single page. A patient is the entire book. If we want to practice real medicine again, it’s time we start reading the whole story—not just the data.