To the Editor.—
Dr Eddy1,2 must be praised for seeking to define, or perhaps divine, a rational methodology to control and fine-tune practice policies, for patterns of practice are at the root of the inexorable and seemingly uncontrollable rise in this nation's health costs.
In a private practice, fee-for-service system, it is impossible to ignore the fact that physicians will perform or request the services that maximize their income within the broad limits of legal, ethical, scientific, and clinical parameters.
All practicing physicians are aware of and engage in useless and usually harmless activities, without which the patient's health would be unaffected.
The litany of such practices is endless and cuts across all medical and surgical disciplines. The vast majority of such practices involves gray areas. If, using the global subjective judgment approach (Dr Eddy's term) to monitor a procedure, a panel unanimously agrees that it is unnecessary for
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