Quality medical care. A definition

Abstract

This article offers a definition of quality medical care. Quality itself is defined not as consisting of the properties of an object but rather as the capacity of these properties to achieve goals. Accordingly, quality medical care is the capacity of the elements of that care to achieve legitimate medical and nonmedical goals. This definition is compared with other current definitions. I offer answers to the questions of how to choose goals, who chooses goals, and what are legitimate goals. Implications of this definition are discussed, particularly with reference to chart review. Because patient values shape goals and because these values are not always assessed and recorded, it is recommended that a formal assessment of patient values become part of the patient's record.

KIE: The definition of quality medical care as the capacity of the elements of that care to achieve legitimate medical and nonmedical goals is compared with other current definitions. The difficulty of choosing goals is reflected in the contrast between the technical and the interpersonal aspects of care; doctor and patient should work together to achieve "legitimate" goals which integrate scientific knowledge and personal beliefs. Because this definition will affect chart review, a formal assessment of patient values must become part of the patient's record.