The Health Service does not wish to get into a prolonged discussion about the issues raised in the Star letter by Ms. Ruderman, but some comment is necessary. The definition of a medical specialist is “a physician who sees the patient far enough into the illness to make a diagnosis.” Illnesses do not usually appear full-blown. A person can have a negative test one day and a positive test the second. This has nothing to do with competence, only with time. If a person is seen early in an illness at the Health Service, it may not be possible to make a definitive diagnosis. Later in the illness the tests become positive and then the student assumes wrongly that the Health Service failed to diagnose them. If a student returns to the Health Service at that stage, the diagnosis is made.

I stand by the remarks I made in the previous letter except perhaps the use of irony.

Rosemary B. Lane, M.D., M.P.H.

Director

Health Service