In Reply.—Dr Banco's points are well taken and deserve comment. The best, or at least a better, design would have been to observe the behavior of the residents without their knowledge and to record whether they actually provided plans for follow-up. However, this costly design was not feasible for us, and this accounts for the specifically defined criteria for follow-up visits outlined in the study.
While we do not doubt Dr Banco's experience with residents' documentations, we know of no study that shows his assertion to be true. Such a study like ours would be subject to the Hawthorne effect, unless the design assured that the residents were observed without their knowledge.
Second, while follow-up visits for otitis media may be debatable, they are generally advised in pediatric textbooks and by the faculty in our clinic, as stated in our study. We were interested in observing the residents' adherence