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January 12, 1990

The Challenge

Author Affiliations

Duke University Durham, NC

Duke University Durham, NC

JAMA. 1990;263(2):287-290. doi:10.1001/jama.1990.03440020121046

MEDICAL practice is in the middle of a profound transition. Most physicians can remember the day when, armed with a degree, a mission, and confidence, they could set forth to heal the sick. Like Solomon, physicians could receive patients, hear their complaints, and determine the best course of action. While not every patient could be cured, everyone could be confident that whatever was done was the best possible. Most important, each physician was free, trusted, and left alone to determine what was in the best interest of each patient.

All of that is changing. In retrospect, the first changes seem minor—some increased paperwork, "tissue" committees, a few more meetings. These activities were designed to affect the presumably small fraction of physicians who, in fact, deserved to be scrutinized, and the scrutiny was an internal process performed by physicians themselves. But today's activities are aimed at all physicians, are much more