Throughout the era of modern medicine, physicians have constantly risen to the challenge of resolving difficult problems. The process of resolution has provided both intellectual stimulation and the fundamental satisfaction of improving the human condition. Today, medicine faces a more complex challenge, the challenge to engage in meaningful selfexamination.
In this issue of JAMA, Avedis Donabedian,1 widely recognized for his formulation of quality assessment, sets forth in lucid detail the formidable task now facing clinical medicine. Despite exhortations for self-examination from the physician community since early in this century, what we know and have done about quality assessment to date is remarkably little. Students of quality assessment will find the Donabedian construct to be both provocative and useful. So too should practicing physicians, as we all begin to grapple with the convolutions of a different kind of science.
This, of course, is not simply a scientific puzzle. The quality