The quality assurance dilemma in psychiatry: a sociological perspective.

Tensions between mental health practitioners and their colleagues in quality assurance can be reduced. A sociological view of the evolution of psychiatric practice from the doctor-patient dyad to the therapist-patient-third party triad and of the discontinuity between the new structure and the culture of professional practice frames the discussion. Drawing on approaches to quality developed in business settings, it is argued that third parties as well as patients are "customers" and that a different approach to quality is appropriate to each. Crosby's methodology is recommended as relevant to the management of relationships with third parties.