Letters

Dr. Wilkoff suggests in his column "Heresy" that we outsource well-check measurements and immunizations to schools. Implicit here is an assumption that all school-age children attend a well-funded public school system with adequate resources to take on this project. While Maine school nurses may be well versed in best practices regarding blood pressure cuff size and immunization protocols, our Tennessee school nurses (in my county, 1 registered nurse for 11 county schools) do not have the resources to, say, make sure their school’s vaccine refrigerators have VFC-compliant thermometry.

The nature of any well-designed screening program, by definition, is that the number of normals will substantially exceed the number of abnormals. Checkups are screening visits. "Targeted screening" implies that there is a simple, validated prescreen upon which to apply the second-tier targeted screen. Dr. Wilkoff suggests we use a nonexistent prescreen when he writes, "For the school-age child who is growing well and doesn’t have any chronic conditions or genetic predispositions, do annual physical exams make sense?" How, exactly, will I know which children are growing well and don’t have chronic conditions or genetic predispositions unless I’m doing checkups on them?

Suzanne Berman, M.D.

Crossville, Tenn.