The capacity of professional medicine to resist change - and also concordance - is impressive, but perplexing. It is one of the issues that the author seeksto address. He suggests that a preoccupation with trying to change the relationship between the professional-patient dyad has deflected attention from the extent to which such relations are embedded in, and constrained by, wider administrative and organisational structures, especially as these relate to the operation of professional hierarchies and interprofessional deference and allegiances.
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