I think its ok to differ on this issue, but if you read my comments above - I think this is NOT a waste or a charade. I too see patients all day long, 4 days a week and Do metrics on every patient. Ted Pincus studied the time committment. If you do the HAQ or RAPID3 it costs you nothing and takes no time. if you do a 28 joint exam and metric (I do the GAS, its like the CDAI) it takes an additional 90 seconds max. We spend more time reacting to useless labs and plotting LFT trends than we do on a metric. IF the metric = time; and I can attest to the 90 second effort, the real issue is reacting to and using a metric to guide therapy. This is what Rheums are unwilling to do. Largely because they believe they know better and dont need the metric (BTW...no proof that Gestalt ever beats Metrics and T2T) and they are not required to. But you are right - most rheums believe this is a royal waste and thus they do not do it! thanks JC