To the Editor.
— Few events in medicine illustrate the difference between theory and practice as well as a real case. Bigelow and Trees define the "Access to Care" program as one that "... is preventive in that it helps keep people out of the hospital and, particularly, out of the emergency department. "1 The case of a patient seen in our general internal medicine office last week more accurately defines, and more particularly, challenges the dialectic of the Access to Care program.
Report of a Case.
—A 42-year-old man presented with 7 hours of acute, knifelike right lower quadrant abdominal pain that radiated to the right groin and lower back. The pain had awoken him from sleep at 3 AM; he had taken no analgesics, had moved his bowels without relief, and felt anorexic. There was no history of previous abdominal surgery, nephrolithiasis, hematuria, fever, chills, nausea, vomiting, or a
La Puma J. Access to Care. JAMA. 1991;266(20):2832-2833. doi:10.1001/jama.1991.03470200044024