Family physicians' cholesterol testing and treatment.

In this issue of the JABFP Eaton et all describe differences in self-reported cholesterol testing, counseling, and treatment among US medical specialists in 1991. Data from the National Ambulatory Medical Care Survey (NAMCS)2 showed that family physicians (23.5 percent) and cardiologists (13.1 percent) reported performing cholesterol testing much less often during annual health examinations than did general internists (43.5 percent). Combining all age groups, female patients had cholesterol testing done three times more often by general internists than by family physicians. For patients between the ages of 18 and 44 years, family physicians reported measuring cholesterol levels in women much less often than men. For men aged between 45 and 64 years, all 3 specialty groups measured cholesterol levels in only about 25 percent of the annual visits. All three specialty groups in the NAMCS reported similar rates of cholesterol counseling. Family physicians (13.4 percent) listed lipid medications for their patients less often than general internists (25.1 percent) and cardiologists (28.4 percent). For patients with coronary heart disease and hypercholesterolemia, family physicians (64.4 percent) reported doing more cholesterol-reduction counseling than general internists (47.1 percent) and cardiologists (35.9 percent, but they prescribed the least lipid-lowering medications (13.9 percent versus. 62.5 percent and 34.7 percent, respectively). \\That are family physicians to think of these findings? As the disheartened boy who confronted ShoelessJoeJackson about his role in the 1919 Black Sox baseball scandal, one's first reaction tends to be, "Say it ain't so!" As the authors point out, their methodology estimates only a portion of these physicians' overall cholesterol-related care in 1991, and it might misrepresent any true differences between family physicians, general intern-