Wilfred Grenfell's followers, who that "computer-generated remindseem to know how to stretch the er systems do improve the delivdollars. ery of preventive services" and that the "physician reminder was William D. Panton, MD the most cost-effective method of 501-1750 E 10th Ave. improving preventive services." Vancouver, BC It is possible that the impact of this article may have been blunted by the use of the word "computer" in the abstract. Preventive medicine probably does reduce disease and prolong life, so Use of reminders all physicians should follow up on for preventive procedures adult vaccinations, elevated blood in family medicine pressure values, regular Papanicolaou tests and so forth (although T n he study by Drs. Walter W. the definition of hypertension and Rosser and Ian McDowell the recommended interval for and Claire Newell (Can Papanicolaou tests appear to be Med Assoc J 1991; 145: 807-812, moving targets!). All physicians, 814) investigated the frequency of however, may not be sufficiently performance of preventive proce- computer-literate to modify the dures for patients in a control software in their office computer group and those who were re- to generate a reminder list. A few minded of preventive procedures physicians may not even have a by one of three computer-assisted computer in the office. methods. The article concluded For those who are more com-
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fortable with paper and pen and who want to remind patients to come to the office I recommend a box of 8-cm x 13-cm cards. At the top of the card write the month and year that the patient should return, on the next line the procedure and on the next the patient's name and office file number. It can be helpful also to write why the procedure is indicated (e.g., Nov. annually, 'flu shot, Armand GA>GNON, file 12345, severe COPD). Keep blank cards handy and use them to write the note after the office visit or while reviewing laboratory data. File the cards by date. Each month, take out that month's group of recall cards and have the receptionist pull the charts. Unless you can remember exactly whom you called for what purpose jot a oneline note in the chart so that you know why a patient shows up. I don't know if the effectiveness of this method has been stud-
ied, but it is certainly greater than not calling patients at all. A box of cards is cheaper than a computer. If the authors of the article supervise an outlying clinic that does not have a computer they might consider including a group using recall cards in a future study on preventive procedures in family medicine. Robert W. Shepherd, MD 37 Beechmont Cr. Gloucester, Ont.
[Dr. Rosser responds:]
We appreciate Dr. Shepherd's response to our article. Several card systems have been evaluated and found to be successful."3 One point to remember is that a systematic method of maintaining a card file requires fastidious attention to be effective. This can often work in a solo practitioner's office, but as soon as a group of physicians congregates around a
number of support staff such systems become very awkward and difficult to maintain. In this setting a computerized system has a significant advantage. Shepherd's point is well taken, and the authors would certainly encourage any practitioner interested in developing a card system rather than a computer system to do so, since we are confident that the level of appropriate screening will be enhanced. Walter W. Rosser, MD Professor and chairman Department of Family and Community Medicine University of Toronto Toronto, Ont.
References 1. Frank JW, McMurray L, Henderson L: Influenza vaccination in the elderly. Can Med Assoc J 1986; 135: 989-991 2. Anderson C, Martin H: Effectiveness of a patient's recall system on immuniza-
tion rates for influenza. J Fam Pract 1979; 9: 727-730 3. Bass MJ: Organizing the office for effective detection and management of hypertension. Can Fam Physician 1985; 31: 35 1-354
Medicine without moralizing is the aim of Montreal's "street doctors"
[correction]
Richard Sutherland's article (Can Med Assoc J 1992; 146: .1.569, 572-573) Dr. Jean Robert is incorrectly described as the chief of microbiology and infectious diseases at Hopital SaintLuc in Montreal. In fact, Robert is chief of the department of community health at this hospital. We apologize for the error. - Ed. T
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n
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5-
9.
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v
l
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fortable with paper and pen and who want to remind patients to come to the office I recommend a box of 8-cm x 13-cm cards. At the top of the card write the month and year that the patient should return, on the next line the procedure and on the next the patient's name and office file number. It can be helpful also to write why the procedure is indicated (e.g., Nov. annually, 'flu shot, Armand GA>GNON, file 12345, severe COPD). Keep blank cards handy and use them to write the note after the office visit or while reviewing laboratory data. File the cards by date. Each month, take out that month's group of recall cards and have the receptionist pull the charts. Unless you can remember exactly whom you called for what purpose jot a oneline note in the chart so that you know why a patient shows up. I don't know if the effectiveness of this method has been stud-
ied, but it is certainly greater than not calling patients at all. A box of cards is cheaper than a computer. If the authors of the article supervise an outlying clinic that does not have a computer they might consider including a group using recall cards in a future study on preventive procedures in family medicine. Robert W. Shepherd, MD 37 Beechmont Cr. Gloucester, Ont.
[Dr. Rosser responds:]
We appreciate Dr. Shepherd's response to our article. Several card systems have been evaluated and found to be successful."3 One point to remember is that a systematic method of maintaining a card file requires fastidious attention to be effective. This can often work in a solo practitioner's office, but as soon as a group of physicians congregates around a
number of support staff such systems become very awkward and difficult to maintain. In this setting a computerized system has a significant advantage. Shepherd's point is well taken, and the authors would certainly encourage any practitioner interested in developing a card system rather than a computer system to do so, since we are confident that the level of appropriate screening will be enhanced. Walter W. Rosser, MD Professor and chairman Department of Family and Community Medicine University of Toronto Toronto, Ont.
References 1. Frank JW, McMurray L, Henderson L: Influenza vaccination in the elderly. Can Med Assoc J 1986; 135: 989-991 2. Anderson C, Martin H: Effectiveness of a patient's recall system on immuniza-
tion rates for influenza. J Fam Pract 1979; 9: 727-730 3. Bass MJ: Organizing the office for effective detection and management of hypertension. Can Fam Physician 1985; 31: 35 1-354
Medicine without moralizing is the aim of Montreal's "street doctors"
[correction]
Richard Sutherland's article (Can Med Assoc J 1992; 146: .1.569, 572-573) Dr. Jean Robert is incorrectly described as the chief of microbiology and infectious diseases at Hopital SaintLuc in Montreal. In fact, Robert is chief of the department of community health at this hospital. We apologize for the error. - Ed. T
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