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    Doctors are rarely accountable for the average quality of their work in terms of outcome. They have to answer for exceptional events, unexpected disasters lying outside the normal range of experience, but rarely for assessment of average process, and virtually never for average outcome. If disasters don’t occur, or don’t reach the ears of authority, quality of work is assumed to be satisfactory. Even if it is so obviously unsatisfactory as absolutely to demand enquiry, that enquiry will use process rather than outcome measures. For example, the expected mortality of a planned operation for repair of inguinal hernia in a […]
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    Though most thoughtful and well-informed GPs now accept the need for more staff, equipment and postgraduate train­ing, they are uncertain about what new investment is needed, and even more so about how it should be made. The only answer fully consistent with autonomy in the Osier paradigm would be that GPs should invest their own money as entrepreneurs, selling their services as commodities in an open market. In Britain, though not in many other developed countries, this had lost majority professional support by the 1920s and after 1948 its few remaining adherents became isolated. So long as the State was […]
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