Conjecture

The standard remedy for Goodhart capture of a clinical proxy and the standard remedy for off-proxy harm under the same proxy act on one dial in opposite directions, so acting on either forecloses the other. The anti-gaming remedy narrows the clinician discretion to exclude a patient from the measure, by closing and auditing the exemption channel. The off-proxy remedy widens exactly that discretion, by individualising the target where pursuing it harms the patient. Candidate case, unsourced in this corpus: UK Quality and Outcomes Framework exception reporting alongside tight glycaemic targets.

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