Sir.—The editorial by Fulginiti about standards of practice was thoughtful and provocative. Standards of practice are of particular importance to those of us in primary care as we do want to practice high-quality medicine. Standards also have their medicolegal implications.
However, the means by which these "standards" come into being are of some importance. Dr Fulginiti correctly pointed out the central role of experts in establishing standards and further stated that "practitioners might benefit by knowing that their practices might not conform to some standard held by experts." I would like to add that "experts" might benefit from a review of their "standards" when they do not conform to what is actually being done in primary care practice.
The problem of coin ingestion is a good case in point. Forty-five of 65 pediatricians surveyed do not automatically obtain roentgenograms of an ingested coin. I suspect they would if the