Among the festering issues in the current turmoil of health care policy in the United States, two of the most hotly debated are physician autonomy and the use of outcome measures to assess quality of care. Physicians generally resent intrusions on their professional autonomy and often cite such intrusions by government regulations and managed-care insurance programs as major sources of dissatisfaction. Preserving the freedom to exercise clinical judgments on behalf of individual patients, with enough limitations on that freedom to prevent inappropriate care, is a difficult task that is now being approached through the development of practice guidelines1 (sometimes called practice parameters), often with the hope of avoiding further regulation of medical practice by government or other third parties.
Measures of outcome have long been accepted as essential determinants of appropriate care when they are derived from randomized controlled clinical trials testing various clinical interventions. However,
Glass RM. Benzodiazepine Prescription RegulationAutonomy and Outcome. JAMA. 1991;266(17):2431-2433. doi:10.1001/jama.1991.03470170119035