A previous study suggested that patientpractitioner agreement and follow-up in ambulatory care facilitates problem resolution as judged by patients. In this study in another medical practice, practitioner-patient agreement on what problems required follow-up was associated with greater problem resolution as judged by the practitioners regardless of the severity of the problems. In this study, patients did not judge problems mentioned only by themselves to be less improved than problems mentioned by both them and their practitioners. However, in this study more of the problems mentioned only by patients were mentioned in the note of the visit contained in the medicalThe initial process of care, recognition of patients' problems by practitioners, has received little attention in research although it is clear that all other processes (diagnosis, management, reassessment) depend upon adequate and accurate perception of the underlying reason for the visit. A growing literature, much of it from Great Britain,'-3 addresses this issue by analyzing the verbal interactions between doctors and patients and demonstrating patterns of communication that are intuitively considered dysfunctional. There also has been more systematic study of the gaps in recognition of patients' problems and of their impact on patient care. Accurate recognition of patients' problems is associated with better understanding on the part of patients,4'5 more compliance,6'7 and better outcomes.8'9 Practitioners do better at recognizing patients' problems when there is continuity of care.'0 Medical records specifically designed to improve information recognition also facilitate problem-recognition by practitioners. "-'3Roter showed that professional dominance of the practitioner-patient interaction could be reduced by encouraging patients to express their problems niore forcefully.'4 In a

The American Academy of Pediatrics believes that it is necessary to reaffirm its support for the concept of school health education, from kindergarten through grade 12, for all schoolchildren in the United States. A basic concept of pediatrics is prevention, and health education is a basic element in the delivery of comprehensive health care. The public is continually bombarded by the media about the high cost of medical care and the overutilization and incorrect use of medical facilities. The media also writes about the problems of increasing promiscuity and illegitimacy; the money wasted on quackery; practices that are detrimental to the health of people in the United States; and the lag in the dissemination of new health information and facts to the public. The Committee on School Health believes that community health education programs, of which school health education programs from kindergarten through grade 12 are an integral part, are one of the most viable methods to help alleviate these and similar problems. Therefore, the Committee on School Health makes the following recommendations and urges action for them at state and local levels. 1. Health education is a basic education subject, and it should be taught as such. Health education is compatible with other traditional subjects and can enhance the contribution that other basic subjects make to general life experience, understanding, and skills. 2. Planned, integrated programs of comprehensive health education should be required for students from kindergarten through grade 12. Instruction should be given by teachers qualified to teach health education.

No abstract

No abstract

These issues and others are being addressed by projects conducted over the next five years in four states, with the financial support of the Robert Wood Johnson Foundation. Through these projects, the role and effectiveness of the SNP in different geographic and socioeconomic settings in the United States will be better defined and determined. The Committee applauds these efforts and eagerly awaits their conclusions. Because of the increased scope of health care and evaluation practiced by SNPs, which includes some areas of primary health care, the Committee presently endorses SNP participation in school health programs only when they function under the direct supervision of a physician.