Medical intervention is intended, for the most part, to maintain or improve functioning and wellbeing, and subsequently to improve quality of life. While such a view may seem unremarkable the medical profession has not traditionally undertaken systematic evaluation of the impact of medi· cal care from the patients' perspective. Undeniably, doctors have often asked patients if they were feeling better or worse, but the attempt to build this into a standardized metric that could take its place beside laboratory and radiological data, or beside morbidity and mortality statistics, is a relatively recent phenomenon. Traditionally a dichotomy has existed between a biomedical model and a more holistic view of health, which includes aspects of emotional and social wellbeing and functioning.