COMMENTS AND RESPONSES Clinical Experience and Quality of Health Care

cally flawed, but more important, in our view it is potentially de-structive (1). Behind the mask of “evidence-based medicine, ” the authors reviewed 59 articles, selected by their own peculiar process from hundreds of potential papers relevant to the subject. They then analyzed this sample according to 4 criteria: knowledge; adherence to standards of practice for diagnosis, screening, and prevention; adher-ence to standards of appropriate therapy; and outcomes. They con-cluded that physicians who have been practicing longer may be at risk for providing lower-quality care and may need quality improve-ment interventions. This “systematic review ” was not in the least systematic. Of 245 articles retrieved by an Internet search engine, the authors excluded 167 for various arbitrary reasons and excluded 3 others for reasons that were not characterized. To the 78 papers that remained, the authors added 9 articles from their personal archives and 35 mor