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July 25, 1986

Two Consultations: Cognitive Services vs Procedures-Reply

Author Affiliations

University of Illinois College of Medicine at Chicago

JAMA. 1986;256(4):473-474. doi:10.1001/jama.1986.03380040046024

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In Reply.—  Dr Brewer identifies the issue that first prompted me to write "Two Consultations." Cognitive services such as hospital care and consultation are sometimes poorly performed, but it is difficult to evaluate the quality of a cognitive service. I believe that this issue needs to be addressed before the imbalance between cognitive and procedural fees can be corrected.A common cognitive service is to assess a patient's problems by obtaining a history, performing a physical examination, and evaluating the information that is obtained. This service, if rendered by a second-year medical student, will probably be tedious, by rote, and, in the end, erroneous in both content and inference, while the same service rendered by an experienced physician may be efficient and comforting to the patient and yield correct diagnoses and effective therapy. Everyone knows the difference between these services "when they see it," but it is difficult to draw