Carefully designed and highly specific standards for medical practice can improve the pattern of practice when applied by interested and committed physicians or by other similarly motivated health care providers. However, this is not popular with the physician, and the improved pattern of practice is dependent on continued feedback. The standards must be designed with a specific population and setting in mind; therefore it is unlikely that an effective operational plan can be devised and implemented that will achieve improved practice patterns in the immediate future. Meanwhile, more general standards might be used to identify a smaller number of cases, which can then be reviewed by other physicians, using professionally accepted but subjective practice criteria.