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Dr Lesser states "Although there is much to be said in favor of nonhospital treatment, the decision not to admit is not, per se, a decision that less experienced trainees should strivefor." I would agree. Dr Lesser misreads our article if he believes that any such recommendation was made. The thrust of our data and our conclusions is that workers should be trained specifically to make these decisions prior to being left alone in an emergency setting. The logical extension of Dr Lesser's conclusion would be to leave the inexperienced worker in the emergency room and accept the fact that he would admit patients unneces sarily because that would be better given his level of training than to make a mistake in not admitting a patient. There is certainly little out come data to support that point of view. Residents without specific training should not be the sole respon