What Is Inappropriate Care?

Though wide variations in the application of medical technologies have been recognized for decades, they have only recently become the object of intense scrutiny and debate. Such variations have important implications for the cost and quality of medical care. But these variations also raise specific questions about the process of clinical decision making for patients, physicians, and those charged with the responsibility to gather and disseminate information on which clinical decisions are based. The focus on the decision-making process has been sharpened by the professional uncertainty hypothesis that holds that variations can largely be explained by differences in physicians' beliefs about the value of procedures and practices for meeting patient needs.1 The professional uncertainty hypothesis has sparked its own controversy. Patients have been told by informed commentators that medicine is an imprecise science "at its base, more gamble and guesswork than certainty" (The Boston Globe, Feb 3, 1986). Physicians