Abstract
This paper has a logic and clarity that does not seem to belong in the messy world where I and my patients strive, often against daunting socioeconomic odds, to be “co-producers of health.”1 The honourable intentions of the authors are evident, but the notion of defining and using criteria with which purchasers can monitor compliance with agreed guidelines implies levels of coercion and control which are potentially destructive of the fragile good that is the doctorpatient relationship.2 Guidelines are constructed from evidence from research derived from studies of populations and are predicated on the notion of a composite patient which may have little immediate relevance to the troubled person who presents in …
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