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Ordering Tests in the United States and England-Reply

Arnold M. Epstein, MD; Robert Hartley, MD; Barbara McNeil, MD, PhD
JAMA. 1985;253(13):1875. doi:10.1001/jama.1985.03350370055008.
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In Reply.—  We agree with Dr Milligan that a comparison of British general practitioners with American general practitioners might have shown somewhat different results. As we stressed in our discussion, the British and American medical system are not directly comparable. In England, all primary care is provided by general practitioners; whereas in the United States, primary care is provided by internists, family practitioners, general practitioners, and physicians with other sorts of training. No single group of American physicians is a perfect match for British general practitioners. We do stress that the American and British patients we studied were very similar. Moreover, the level of test ordering should, ideally, be determined by the patient's disorder and not by what kind of doctor the patient consults. Chronic hypertension is the same disease no matter who the physician is or what his or her training. The difference we found in testing patterns applies


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