"Demanding Medical Excellence" is a groundbreaking and extraordinarily accessible work that reveals how a revolution owing as much to laptops as lab coats is poised to transform medical care. Millenson, a three-time Pulitzer Prize nominee as a reporter for the Chicago Tribune, combines the experiences of real people and evidence from the scientific literature to tell the story of the information explosion and the application of quality measurement techniques to medicine. He both illustrates serious flaws and errors in contemporary medical practice and shows ways we can improve care and save tens of thousands of lives.

Balancing criticism and praise, Millenson analyzes the serious flaws and errors in American medical practice. The current debate over health care generally focuses on finance: How do we contain the cost of care, and how do we ensure that all citizens can afford access to it? The most important issue -- the quality of treatment -- is too often ignored.

Millenson shows that while American medicine may be the most sophisticated in the world, treatment is alarmingly inconsistent. Medicare data, for example, show that in 1996 an elderly man or woman living in Fort Meyers, Florida, was four times as likely to undergo surgery for back pain as a patient with the same symptoms living in Manhattan. Yet Millenson balancesdisturbing stories like this one with optimistic, inspiring accounts of recent improvements in patient care.

Ultimately, Millenson concludes that the major barriers to protecting and systematically improving medical care are cultural, not technical. Patients will not receive the consistently excellent care they deserve until physicians and health care plans are given the proper financial incentives to change, have the clinical information to guide them, and most important, accept the moral responsibility to implement change and make it work.