Decisions, decisions: why the quality of medical decisions matters.

Questions about the process leading to particular medical decisions are seldom addressed in discussions of health care quality. In some cases, strict adherence to treatment protocols may overlook important elements in the clinical decision-making process, such as physicians' judgment and patients' preferences. Papers by Annette O'Connor and colleagues and Karen Sepucha and colleagues are welcome additions to this debate because they highlight the importance of the medical decision-making process; they suggest that the quality of this process should be considered when evaluating health care quality. I explore some key limitations and uncertainties that must be addressed before work in this area can become broadly applicable.