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December 5, 1977

Problem-Oriented Approach to Practice

JAMA. 1977;238(23):2494. doi:10.1001/jama.1977.03280240040009

To the Editor.—  The SPECIAL COMMUNICATION by Tufo et al entitled "Problem-Oriented Approach to Practice" (238: 414-417, 1977) concludes that changes in the practice were due to use of the problem-oriented system. There was "a sharp decrease in hospital admissions and not in the length of stay. This was most dramatic in the general medical services."The authors state that "with the exception of depression and other behavioral problems that are now being identified more vigorously than before, the same frequency distribution of problems is present in the old patient population as in the new patient population." I believe this is the reason for the reduction in use of medical services and not the use of the problem-oriented system.My experience at the primary care level showed a marked reduction in hospital services as I became more involved and experienced in managing emotional illnesses. Similar experiences have been reported in