Stephen R. Baker, MD
Captain Queeg in The Caine Mutiny was a peculiar character. Despite his faults, however, he did make one trenchant statement that cogently summarized what the goal of any sus-tained quality initiative should be. It can be paraphrased: Everything standard is substandard and everything excep-tional should be standard (1). In any medical system, a standard of care that permits within its parameters the persis¬tence of substantial instances of illness or death is in need of improvement even in the face of a consensus about its sup¬posed utility. The bar must be raised. A prime example of the discrepancy be-tween expectations and reality is how radiologists inform referring physicians about the presence of important but non-emergent abnormal imaging results.