All works of art are commissioned in the sense that no artist can create one by a simple act of will but must wait until what he believes to be a good idea for a work comes to him.
In my business if I get too close to you and you die it hurts me. And so you develop a natural inclination not to be close to the patient so that if things don't work out ideally you can still get up the next day and care for the next patient.