Dr Burdette raises a number of interesting points. Perhaps the' most important issue has to do with how patients are classified. We depend a great deal on the concept of the diagnosis as a means for comparing groups of patients. In primary care we must be constantly aware that the diagnoses made are based on few, if any, reliable criteria. To expect a clear definition of a problem entity in a heterogeneous case mix such as that found in family practice may be overly optimistic. We deliberately chose to include all patients with evidence of an acute illness to avoid this trap of false accuracy. We1 have used the diagnoses made by the various levels of provider to examine such differences within subgroups. When one controls for diagnosis, there is no substantial difference in outcome according to provider level. Moreover, there is no specific pattern of distribution
Wright DD, Kane RL. Primary Care-Reply. JAMA. 1977;238(24):2597. doi:10.1001/jama.1977.03280250023005
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