Although it may be simple to evaluate some elements of clinical geneti
cs, it is difficult to evaluate genetic counselling. We review previou
s studies of the outcomes of genetic counselling; although the methods
used may be valid in research studies, there are practical and ethica
l difficulties in applying them to the measurement of clinical effecti
veness in standard practice. No simple measures of outcomes would be s
uitable. Research evidence will be helpful in deciding what services i
t is appropriate to offer, and the quality of a service can then be as
sured by assessing the quality of the clinical process in three ways:
1) adherence to agreed protocols and standards of care; 2) peer review
and audit of clinical activity; and 3) ongoing review of the satisfac
tion of clients and referring physicians with the service. The assessm
ent of client satisfaction will need to be a sophisticated form of ret
rospective satisfaction with the service provided, and such a scheme h
as yet to be fully developed.