Measuring Subjective Clinical Outcomes

The measurement of subjective clinical outcomes is one of the most perplexing areas within the arena of clinical decision making. When one mentions the word “subjective” to clinicians and researchers alike, two associations immediately come to mind: 1) subjective equals “soft” or unreliable information and 2) to be subjective is to be inherently bad. If these associations are accurate, then we should stop trying to measure subjective clinical outcomes and focus our attention in more fruitful areas. If these associations are inaccurate, we need to determine why, clarify the misunderstandings, and improve our measurements of these clinical outcomes. The first objective of this article is to clarify the meaning of the term “subjective” as it is commonly used in clinical decision making and argue that whether the concept is pejorative depends upon the context in which it is being used. Second, I will review briefly some of the basic scientific criteria we should use in judging the adequacy of clinical measures.