Sir.—I read Dr Heifer's interesting comments on primary care1 in AJDC, and it encouraged me to look at the question after 22 years of practice. I believe that primary care is a means to an end, but that secondary care is not the only or even the most important end. When primary care itself encompasses a strong dose of preventive and public health emphasis, it makes its greatest long-term and widespread impact. Although it is obviously important to treat the patient with phenylketonuria or meningitis, this is not when we have our greatest opportunities.
Seemingly mundane things, such as seat belts, immunizations, shifting dietary habits, encouraged healthy child-rearing practices, prevention of smoking and teenage pregnancy, and the awareness of the need for a world without war, are a few of the areas in which we have a potential influence. In the arena, wrestling with these more difficult problems