Sir.—At our border clinic the circumstances outlined by James and Ackerman1 justifying "paternal and protective" clinic practices are more the rule than the exception.
Our clinic population is poor; the most commonly cited reason for missed appointments is the inability to pay ($5 minimum fee). If we failed to provide subsidized care, many patients would not come.
We do spend a tremendous amount of time and energy in attempting follow-up. However, the majority of our follow-ups relate to cases in which failure to follow up could result in "serious and irreparable harm to the child."
Additionally, in attempting to prevent harm we sometimes choose to accommodate the parents' wishes for unnecessary medicines. After exhaustive attempts to educate our patients regarding the treatment of common colds, they now demand penicillin less often, but if they do not receive some tangible treatment, they may well end up receiving chloramphenicol or