A survey of regulations in New York City's methadone clinics, conducted five years ago, showed why physicians lacked authority in their clinics and had little time to listen to their patients.1 Every therapeutic decision was governed by guidelines laid down in Washington or Albany. Eleven different agencies (federal, state, city, and community) exercised jurisdiction, and each required reports and records. Paper work alone, we estimated, could consume 185 per cent of the physician's time. Remarkably, nowhere in all this procedure was there any measure of benefit to patients. Since that time, efforts have been made to reduce the volume of.
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