Many physicians think about quality of care the way Justice Stewart characterized his ability to recognize pornography:
I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description [hardcore pornography]; and perhaps I could never succeed in intelligibly doing so. But I know it when I see it....1
A growing armamentarium of new quality assessment tools renders this proposition dangerously obsolete. Their application has resulted in a growing body of literature that documents significant quality problems in American medicine.
Quality problems come in three varieties: overuse, underuse, and misuse. Overuse is the provision of health services when their risks outweigh their benefits; underuse is the failure to provide health services when their benefits exceed their risks; and misuse occurs when an appropriate health service has been selected but is then poorly provided, so
Chassin MR. Quality of CareTime to Act. JAMA. 1991;266(24):3472-3473. doi:10.1001/jama.1991.03470240094040