The Dartmouth Institute for Health Policy and Clinical Practice had its beginnings in a very routine and unexciting medical procedure – the tonsillectomy. Why, wondered Dr. John E. Wennberg, were rates of tonsillectomies in two neighboring Vermont communities so radically different? Why were 70 percent of children in Stowe having their tonsils removed when the rate in neighboring Waterbury was 20 percent? Were the Stowe children sicker? The Waterbury children neglected? Was the procedure necessary? Was it effective?

Those questions led to the very first paper on geographic variation in the practice and delivery of health care. From that first publication has come the internationally known and respected Dartmouth Atlas of Health Care.

And from that has developed an entirely new discipline: the evaluative clinical sciences, measuring and evaluating health care. Ideas once considered heretical – that more care is not better, that geography is destiny in determining how much care you receive – are now accepted as fact. Shared decision making, health policy reform, demonstration projects to prove new models of care, and a whole new dialogue about health care are some of the results of that initial curiosity about the humble tonsillectomy.