Sir.—We wish to make a few comments regarding the use of the terms primary, secondary, and tertiary care in the editorial by Dr Helfer entitled "Primary Care: Does It Belong in Pediatrics?"1
The questions Dr Helfer raises in his editorial are very appropriate but will not be discussed here. We are concerned only with his definitions. He defined pediatric secondary care as "services provided to children and their families beyond routine primary care by a specialist trained in pediatrics."1 Now certainly pediatricians interact with patients at several levels of sophistication, and these levels need to be clearly understood. The concept of secondary care is as fuzzy as our concept of the Second World. We all think we know what is the First World and the Third World, but how many of us are confident that we could define the Second World?
We read the medical literature as containing