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Generalists' Prudence May Lead to Better Outcomes

Thomas D. Wendel, MD
Arch Intern Med. 1995;155(3):336. doi:10.1001/archinte.1995.00430030134023.
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Markson et al1 have provided evidence of slower adoption of newer therapeutic modalities by primary care providers compared with specialists, using zidovudine in patients with the acquired immunodeficiency syndrome as an example. They imply that such patterns of adoption represent inferior care by primary care providers. Another interpretation of their observations should be offered, however.

Specialists frequently use the latest diagnostic and therapeutic modalities, in some cases prior to demonstration of superior efficacy. The result could be seen as reckless embracement of "newer is better," and the result has often been hazardous to patients. Certainly after the results of the Concorde Trial,2 prudent physicians should take pause at the suggestion that broadly supplying zidovudine to patients with the acquired immunodeficiency syndrome represents superior health care. Other examples of overenthusiastic adoption of new technology might include prostatic serum antigen screening for prostatic carcinoma and the widespread use of cholesterol-lowering


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