The Quality of Medical Care

T HE effectiveness of a medical service-no matter how well financed or how broad in scope-is determined by the standards of care that are achieved. The ultimate caliber of the service depends upon the qualifications of the staff, the standard of hospitals, the comprehensiveness of benefits. It is determined by the way in which resources are organized and co-ordinated. The attitudes and motivations of those involved in providing or receiving the service markedly influence its adequacy. A high quality of care inevitably involves a proper fit, as it were, of the medical program into the cultural and economic patterns of the area. Good medical care, therefore, is not simply a matter of physician ratios or aggregates of hospital beds. Neither is it a semimystical attribute of the individual physician's bedside manner. High standards are achieved only when the health needs of an area are carefully analyzed and the medical resources and administrative machinery are designed toward the single goal of protecting the health of the people. Other articles in this series deal with the individual building blocks essential to the structure of high quality, and the administrative principles and practices that constitute the mortar holding the service structure together. The quality of medical care reflects how effectively these basic elements of health service are produced and assembled. It remains for this paper to discuss some of the approaches to this goal

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• Patient stories, narratives of resistance and the ethics of humane care

  Open Access•Elliot G Mishler•Health An Interdisciplinary…•2005

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