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Reconsidering quality
  1. J Kisslo
  1. Department of Medicine, Box 3818, Duke University Medical Center Durham, NC 27710, USA
  1. Professor Kisslo. email: joseph.kisslo{at}

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To my friend in echocardiography

Greetings from the 32nd best country in international soccer (that’s football to you).

News of our demise in the Coupe du Monde made the fifth page of the sports section in my hometown newspaper. This failure raised a low grade murmur about the quality of our soccer that will surely continue well into the millenium and extend somewhat beyond our players and ex-coach. President Clinton explained it away saying, “Soccer came late to Americans . . .” Thank you, Bill.

I understand the rules of modern soccer were codified by some Englishmen, probably disgruntled by cricket, in the mid-19th century. The score of the first international game (1871) between England and Scotland was a rousing 0–0. From there all the hoopla spread around the world, skipping North America. The cup web site calls the game the “common destiny of mankind”.1

You say we are a violent culture, but we watched as those young men were tripped by each other (or invisible feet) and fell to the ground in extraordinary pain. Oh the agony we felt, watching those unfortunate players carried off the field by stretcher. We felt relief when they arose miraculously from some unseen cure and came right back into the game. I concluded that most players must compete for Lourdes during the regular season.

How can the US be so far apart from the rest of the world in quality of this game? What is quality anyway? Ah, you say the fans love it and that is plenty reason enough.

I’m just a poor physician thinking about quality in my little world. We’ve talked about it before.2 I can think of three reasons why we physicians worry about quality. The first, and probably the most agreeable, is that we have concern for our patients. …

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