In Reply.—Dr Sparling is misinterpreting our report if he believes that we are trying to detract from the importance of comprehensive care. His reservations may be related to the differences in the practice setting: the prepaid health insurance system that covers more than 90% of all the patients in our study results in a high number of visits per annum, compared with the number of visits in a fee-for-service operation. If most of our patients see the pediatrician on an average of six times per year (as well as separate "well baby" visits to a preventive-medicine nurse four to five times in a year), then review of the patient's total health status at each visit is simply not necessary. So, we could certainly add that our conclusions are conditional on periodic comprehensive appraisal of the patient's problem list, at separate visits.
If our differences of opinion are not related