As a hospital physician it is impossible to escape the notion that the difficult medical problems one encounters are also being confronted by other' physicians throughout the world. It is equally apparent that without special effort one's own patient observations will not be shared with others. Without the medical literature there would be almost no meaningful shadng of experience. Medical textbooks and journals contain reports of the latest tests and treatments. from university hospitals and research centers. There are, however, definite limitations to the medical literature. First. the literature records only a miniscule and highly select portion of medical experience. Second, because of this selectivity, it may be difficult to apply the findings and recommendations in the literature to one's own patients. One serious consequence of these characteristics of the medical literature is that patients are largely overtreated. Tests and treatments are over-prescribed, and adverse effe