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To the Editor: The article by Drs Grumbach and Bodenheimer¹ left me as a family physician quite incensed. The authors state that "Primary care physicians do not appear to properly manage chronic illness." The authors then provide a number of references describing several deficiencies in care. Their references do not contain any well-designed randomized trials comparing primary care with specialists in reference to clinical outcomes. Instead, the reader is asked to make a broad association that most patients being treated by primary care are not reaching more favorable clinical outcomes due to the poor performance of primary care. This is unfair. There are many confounders that determine a patients' outcome, such as socioeconomic status, education, comorbidities, age, motivation, family history, insurance status, access, and compliance.

I believe that a patient's state of health is a partnership. Both a patient and a physician are needed for the successful balance, resulting in . . . [Full Text of this Article]

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