To the Editor.
—In his October Archives article entitled "The Physician-Patient Accommodation: A Central Event in Clinical Medicine" (1982; 142:1899-1902), Siegler attempts to define a concept of physician-patient accommodation in which the patient chooses to be cared for by a particular physician and the physician agrees to care for that patient. Siegler argues that this accommodation is a negotiated settlement arising after analysis of the patient's condition by the physician. The physician makes a differential diagnosis from his data base and then attempts to decide whether there will (or will not) be an assumption of care.The most telling argument against this arrangement, however, is Siegler's own statement thatLegally, a physician-patient accommodation probably exists from the first encounter with the patient; morally, a therapeutic relationship has begun at the moment physician and patient first see each other, or perhaps at the moment the patient makes an appointment.Thus an