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September 27, 1995

I Am, as Usual, Fuming-Reply

Author Affiliations

University of California, San Francisco

JAMA. 1995;274(12):943-944. doi:10.1001/jama.1995.03530120035033

In Reply.  —Dr Morgan takes issue with some of the clinical vignettes in one of the recent installments in our series Health Care Policy: A Clinical Approach. These vignettes, used to attempt to illustrate basic principles in the series, are usually drawn from our own experiences as clinicians or the experiences of colleagues and patients. The first of the vignettes mentioned by Morgan illustrates the importance of a primary caregiver to coordinate referral services. We did not intend to imply that the primary care clinician in this scenario (a nurse practitioner) necessarily completely supplants the oncologist or gastroenterologist, but rather that she helps to integrate care (eg, by communicating with the different specialists involved in caring for this patient). This coordinating function of the primary care provider is particularly important to protect against fragmentation of care when, for example, patients have multiple medical problems and do, in fact, require the

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