'Cookbook' Medicine

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Abstract
Traditionally, individual physicians have enjoyed a great deal of professional autonomy in practicing the art of medicine, largely free of external restraint on decisions concerning what course of medical action is most appropriate for a particular patient. Lately, however, there has developed a strong push toward the formal creation, dissemination, and enforcement of explicit clinical standards relating to the quality and efficacy of various medical interventions, standards that would guide the decisions and actions of medical practitioners. This push for formal, explicit clinical standards emanates from a variety of sources for many purposes. Third parties, both public1 (Wall Street Journal. September 8,1989:B2) and private, 2 that pay for health care want to assure that the care they purchase on behalf of their beneficiaries is appropriate and efficacious. Physicians, institutional administrators, and other health care providers have a professional and ethical stake in assuring the quality of care. Clinical standards

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