I strongly object to the inflammatory and judgmental conclusion by Legorreta et al1 in their recent article. They concluded that asthma specialists ". . . provided more thorough care than did primary care physicians . . . " because they complied more closely with the National Asthma Education Program guidelines.
Twenty years ago, "thorough" care in cardiac medicine required that all patients with congestive heart failure be treated with digitalis. Ten years ago, thorough care required that these same patients not be routinely treated with digitalis, and thorough care now suggests that patients with congestive heart failure be treated with digitalis. What does thorough mean?
Stein JJ. Medicine by Numbers. Arch Intern Med. 1998;158(15):1720–1723. doi: