In Reply.
—Dr Carlen raises important questions that are pertinent to the practitioner and the dilemma of cost containment. It is conceptually easier to reallocate funds for large groups than to deny care to an individual patient. Three observations, however, are germane.
First, there is good evidence that American physicians can practice both excellent and cost-effective medicine. Many recent, well-done studies have shown that "routine" tests, such as the admission chest roentgenogram, may be reduced or eliminated without detriment to the patient, and yet with substantial savings. This procedure alone was performed more than 30 million times in 1980, with $1.5 billion in charges to the consumer.1
Second, as these studies become aggregate and accepted by professional groups, they help modify existing or create new standards of care. The courts not only consider but welcome standards of practice that are supported by professional groups such as the American Medical
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