Despite the top-heavy emphasis on hospital inpatient care in this country, the vast majority of transactions between our profession and the population we serve occur in outpatient or ambulatory settings. Patients enter the "system" via physicians' offices and clinics. Here, the key decisions are made about investigation, therapy, referral and hospitalization, and the major opportunities occur for health maintenance, prevention, early detection and amelioration, as well as for initiating studies of the natural history of disease.1 Patients do not seek help for categorically labeled diseases; they present themselves to physicians with symptoms, complaints and problems. These are the language of . . .