Author's reply

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7000.327c (Published 29 July 1995) Cite this as: BMJ 1995;311:327
  1. John McMurray
  1. Consultant cardiologist Department of Cardiology, Western General Hospital, Edinburgh EH4 2XU

    EDITOR,--Laurence O'Toole and colleagues are missing the point. Rapid access and direct access services are complementary rather than mutually exclusive. A patient with suspected heart failure needs echocardiography, and rapid access to a specialist is not going to alter that. The clinical diagnosis in such patients is difficult for both specialists and generalists, as is borne out by the fact that O'Toole and colleagues found left ventricular impairment in only a quarter of their patients. Where our two approaches differ is in deciding whether specialist advice on management is needed. Our local general practitioners do not believe that all patients with heart failure need specialist management; they believe that, with guidelines, most patients with uncomplicated disease …

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