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August 23, 1985

Consensus or Coercion

Author Affiliations

Primary Healthcare Practices Macon, Ga

JAMA. 1985;254(8):1077. doi:10.1001/jama.1985.03360080089037

There is an emerging issue that I have not heard much discussed, but that seems to me to pose a significant question. That is, will medicine be practiced in the future on the basis of the individual decisions of each physician and his patient, or will we see the development of a system of medical practice by consensus? Intrinsic to this question is the corollary: Which would be preferable?

Medicine is practiced today by a host of individual physicians, each free within the broad constraints of reason to choose the most appropriate path to the diagnosis and treatment of each patient. At every decision point, a choice is made from a range of alternatives. In most cases, there is at least the theoretical possibility that one choice would represent the "best" among that particular set of alternatives. But, as the selection is influenced by the knowledge and experience of the