The recent study by DeBusk and colleagues [1] is as important for its implications as for its findings. Their experiment confirms and extends observations repeatedly made over the past two decades: Nurses are vastly more successful at protocol-driven health promotion than are primary care physicians [1]. This finding should not be surprising, given that doctors are trained exclusively to diagnose and treat disease. Health promotion and prevention require a different set of skills and interests.

What is new in their work is the conclusion that the old message applies to "managed care." The Kaiser-Permanente Medical Clinics are widely recognized to be among the best practitioners of managed care in the country. Yet, at least in patients who have had myocardial infarction, the nurse case-management system proved superior to the preventive care provided by physicians. Further, it is not unreasonable to speculate that in other areas of prevention, such as the control of hypertension or hyperlipidemia, health maintenance organizations might be found equally wanting compared with categorical programs placed in the hands of nurses.

Health reform seems destined to make managed care its chosen model of service. The challenge for policymakers is to build on the lessons of the study by DeBusk and colleagues and to find a better way to deliver to all patients those valuable prevention protocols that have been shown to improve health. It is time to abandon our reliance on doctors and "the sick care system" for these measures. Instead, we should consider developing a complementary approach that brings prevention to the entire population and leaves physicians to do what they do best, that is, to serve the sick.