In an eloquent exposition of the structure of clinical medicine, Pellegrino1 has said that health "depends as much on the patient's assessment as the physician's. If full restoration is not possible, then amelioration of suffering, adaptation, or coping with chronic or fatal illness become the ends of the healing relationship." The Medical Outcomes Study (MOS), baseline data from which appear in this issue of The Journal,2-4 examines the means and ends of medical care in the spirit of Pellegrino's blueprint.
The MOS involves prospective monitoring of clinical interactions between hundreds of physicians and thousands of patients over a 2-year period. The investigators selected "tracer" conditions, eg, hypertension, coronary heart disease, diabetes mellitus, and depression, and repeatedly assessed the status of patients with these conditions during the 2-year study. Reports on the longitudinal phase will correlate the structures (eg, organization, payment), processes (eg, hospitalization rate, physician's interpersonal style), and
Riesenberg D, Glass RM. The Medical Outcomes Study. JAMA. 1989;262(7):943. doi:10.1001/jama.1989.03430070091038
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