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Previous Volume 345:1612-1620 November 29, 2001 Number 22 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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The public has just begun to recognize that despite the enormous achievements of American medicine and the American health care system, the quality of care in this country needs to be and can be improved. Two recent reports from the Institute of Medicine dramatized the need for greater attention not only to potential problems with quality but also to the entire structure of the delivery system.^1,2 The reports also proposed many approaches to improving quality, based to a great extent on the paradigm of the overuse, misuse, and underuse of medical technology (drugs, devices, and procedures).³ Reducing errors has become . . . [Full Text of this Article]

Uncertainty in Medicine

Magnitude of the Problem

Delayed or Obsolete Data from Clinical Studies

Restricted Study Groups

Potential Effects of Institutions and Providers

Variable Interpretations of Data

Rising Costs

Use of Technology

Underuse

Potential Reasons for Underuse

Conclusions

Source Information

Presented as the 111th Shattuck Lecture to the Annual Meeting of the Massachusetts Medical Society, Boston, May 12, 2001.

From the Department of Health Care Policy, Harvard Medical School; and the Department of Radiology, Brigham and Women's Hospital — both in Boston.

Address reprint requests to Dr. McNeil at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, or at mcneil@hcp.med.harvard.edu.

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