Can we appropriately measure appropriateness?

A few years ago, at a national interventional cardiology meeting, the speaker regaled the audience with an anecdote that may have been apocryphal but was entirely believable. At some earlier meeting, this speaker had challenged his audience with 3 sequential questions to which he invited a show of hands. The first was, “Have any of you witnessed an inappropriate coronary intervention?” in response to which virtually all of the hands in the room were raised. The second was, “Have any of you witnessed someone else in this room conduct an inappropriate intervention?” The vast majority of hands shot up. And finally, “Which of you yourselves has performed an inappropriate intervention?”