From good medical practice to best medical practice.

Medical and other professionals know what good practice is. It is in accordance with ideal procedures and standards of one's own practice. As actors we assess our practices from inside. If questions of quality assessment or quality assurance are raised at all, they are to be raised and answered by the professionals themselves. From that internal perspective, the idea of better or best medical practice is rejected as superfluous; or, perhaps, even nonsensical. This article suggests that concepts of best medical practice, as expressed from outside the profession e.g. economic efficiency, are not adequate in themselves if our interest lies in changing existing practice. Defined from outside, such concepts would be alien to the medical profession. Going from good practice to best practice, the article proposes, can be done on the basis of expanding the metaphor of self-transcendence. In self-transcendence the individual or profession changes or develops strategies and activities by adopting the standpoint of some perspective outside its own practice, and then integrating this perspective into practice. Self-transcendence by the medical profession can be carried out by their integrating a moral ideal from normal life into professional practice-essentially the notion of prescribing support of the weak. Such integration implies, inter alia, that the profession must take account of the scarcity of resources when assessing their practice.