Dr. J. D.
Are
Wallace, CMA secretary general
we
part of the problem?
The "Consumer Viewpoint" on page 83 is timely and to the point. It is written by a person whose profession and experience have enabled her to observe, at close range, the most im¬ portant aspect of medical practice the patient-doctor relationship. She is a nurse in a doctor's office and, unless she has a role different from that of my own office nurse during practice, she acts as both catalyst and buffer. She is undoubtedly a humanitarian and a good judge of people doctors, and nurses, office staff and patients realizes that as people they each have their strengths and weaknesses. The "Way I See It" referred to in her article was intentionally related to the increasing use of science and tech¬ nology in the maintenance of the quality of medical care in Canada. Other ar¬ ticles have stressed that the primary strength of our health care services must continue to be a humane and compassionate relationship between people those that require and those that provide health services. All science and technology can do is provide extra in¬ formation to assist the health profes¬ sional in the personal contact through which "care" and "cure" are provided to people. I certainly have no great desire to ever be treated by a computer or by its operators and masters. There are few in this country consumers or providers with any desire to turn back the clock to the days before our national government hospital and medical care insurance programs. They are the basis of what could be, as other essential health serv¬ ices come to be included, the best health care system in the world. I say this without apology because we have re¬ tained in our system the major element that should ensure humanitarianism freedom of indi¬ and compassion vidual choice by both the consumers of the services and the professionals and technologists who provide them. However, as pointed out so well in .
.
"Consumer
Viewpoint", this has led practices that do escalate costs and perhaps reduce quality overuse by the public and overservicing by some health professionals. Neither of these faults is easily controlled although increasingly effective efforts are being made to do so. Educational programs directed at both the public and the pro¬ fessionals appear to offer the greatest chance of success even though it may be difficult, for example, to convince the self-select patient that he or she may obtain inferior or even dangerous care by "shopping around" without re¬ to two
Incidentally, on that point I wonder long it is since the writer of "Con¬ sumer Viewpoint" really heard anyone say, "Oh, he's just a GP. He doesn't know anything." I used to hear it occasionally from some disgruntled "God Image" specialist when I was a lowly GP and proud to be one, but I haven't heard it recently. The formal basic and continuing education programs for pri¬ mary contact physicians are taking care of that. The GP is not only supposed to be a trained doctor, as stated by our correspondent; to a rapidly increasing degree he has to be a well trained one how
if he wants to continue in active prac¬ tice. The comments on consumer selec¬ tion my gynecologist, my cardiologist, my orthopod and so forth are valid, as are those about there being some health professionals other than MDs included in provincial health care insurance programs and others ex¬ cluded. These anomalies will eventually be worked out through planning and or a megalomaniac could possibly con¬ consultation by provincial governments sider himself or herself to be all things and the provincial health-oriented vo¬ to all people at all times. The advent luntary associations. The framework of medicare has made it most unlikely for activities and the desire for that any good doctor would create a themsuch are already present in many prov¬ "dependency" situation for fear of los¬ inces. ing a patient or two. To the question that heads the ar¬ The medical profession is concerned about the abuse of health insurance by ticle, I would say simply: "If we ever both the public and some of its own were, as an association, part of the members. That is an area in which we problem, I don't believe we are now." do make increasing use of computer Much of the time of CMA and its printouts that provide physician and provincial divisions is spent working patient service profiles. The immense on problems such as those pointed out volume of data now stored in provincial in the article. Because they are people and federal health service computers is problems, involving consumers and pro¬ being used not only to investigate and viders, they can't be solved overnight correct individual indiscretions but also by legislation or decree. But they can to plan better the mix of physicians and must be solved. As they say, Rome produced by educational programs. wasn't built in a day but it was built, There now appears to be too many and it has survived as a great city. doctors in some specialties, an under- We're building our Canadian health care supply in others and a constantly in¬ system in the same way, and it will be at creasing need for good general practi¬ a great people-oriented system least that's the way I see it.B tioners and family physicians. 84 CMA JOURNAL/JANUARY 11, 1975/VOL. 112
.
ferral.
I see no evidence any more of the "Lord God Omnipotent" attitude re¬ ferred to in the article. They stopped giving out halos with medical degrees many years ago. Most physicians are trying under increasing pressure to pro¬ vide good care in an atmosphere of mutual trust. With the rapid develop¬ ment of new medical knowledge and technology in recent years, only a fool
.
.
.
.
Are
Wallace, CMA secretary general
we
part of the problem?
The "Consumer Viewpoint" on page 83 is timely and to the point. It is written by a person whose profession and experience have enabled her to observe, at close range, the most im¬ portant aspect of medical practice the patient-doctor relationship. She is a nurse in a doctor's office and, unless she has a role different from that of my own office nurse during practice, she acts as both catalyst and buffer. She is undoubtedly a humanitarian and a good judge of people doctors, and nurses, office staff and patients realizes that as people they each have their strengths and weaknesses. The "Way I See It" referred to in her article was intentionally related to the increasing use of science and tech¬ nology in the maintenance of the quality of medical care in Canada. Other ar¬ ticles have stressed that the primary strength of our health care services must continue to be a humane and compassionate relationship between people those that require and those that provide health services. All science and technology can do is provide extra in¬ formation to assist the health profes¬ sional in the personal contact through which "care" and "cure" are provided to people. I certainly have no great desire to ever be treated by a computer or by its operators and masters. There are few in this country consumers or providers with any desire to turn back the clock to the days before our national government hospital and medical care insurance programs. They are the basis of what could be, as other essential health serv¬ ices come to be included, the best health care system in the world. I say this without apology because we have re¬ tained in our system the major element that should ensure humanitarianism freedom of indi¬ and compassion vidual choice by both the consumers of the services and the professionals and technologists who provide them. However, as pointed out so well in .
.
"Consumer
Viewpoint", this has led practices that do escalate costs and perhaps reduce quality overuse by the public and overservicing by some health professionals. Neither of these faults is easily controlled although increasingly effective efforts are being made to do so. Educational programs directed at both the public and the pro¬ fessionals appear to offer the greatest chance of success even though it may be difficult, for example, to convince the self-select patient that he or she may obtain inferior or even dangerous care by "shopping around" without re¬ to two
Incidentally, on that point I wonder long it is since the writer of "Con¬ sumer Viewpoint" really heard anyone say, "Oh, he's just a GP. He doesn't know anything." I used to hear it occasionally from some disgruntled "God Image" specialist when I was a lowly GP and proud to be one, but I haven't heard it recently. The formal basic and continuing education programs for pri¬ mary contact physicians are taking care of that. The GP is not only supposed to be a trained doctor, as stated by our correspondent; to a rapidly increasing degree he has to be a well trained one how
if he wants to continue in active prac¬ tice. The comments on consumer selec¬ tion my gynecologist, my cardiologist, my orthopod and so forth are valid, as are those about there being some health professionals other than MDs included in provincial health care insurance programs and others ex¬ cluded. These anomalies will eventually be worked out through planning and or a megalomaniac could possibly con¬ consultation by provincial governments sider himself or herself to be all things and the provincial health-oriented vo¬ to all people at all times. The advent luntary associations. The framework of medicare has made it most unlikely for activities and the desire for that any good doctor would create a themsuch are already present in many prov¬ "dependency" situation for fear of los¬ inces. ing a patient or two. To the question that heads the ar¬ The medical profession is concerned about the abuse of health insurance by ticle, I would say simply: "If we ever both the public and some of its own were, as an association, part of the members. That is an area in which we problem, I don't believe we are now." do make increasing use of computer Much of the time of CMA and its printouts that provide physician and provincial divisions is spent working patient service profiles. The immense on problems such as those pointed out volume of data now stored in provincial in the article. Because they are people and federal health service computers is problems, involving consumers and pro¬ being used not only to investigate and viders, they can't be solved overnight correct individual indiscretions but also by legislation or decree. But they can to plan better the mix of physicians and must be solved. As they say, Rome produced by educational programs. wasn't built in a day but it was built, There now appears to be too many and it has survived as a great city. doctors in some specialties, an under- We're building our Canadian health care supply in others and a constantly in¬ system in the same way, and it will be at creasing need for good general practi¬ a great people-oriented system least that's the way I see it.B tioners and family physicians. 84 CMA JOURNAL/JANUARY 11, 1975/VOL. 112
.
ferral.
I see no evidence any more of the "Lord God Omnipotent" attitude re¬ ferred to in the article. They stopped giving out halos with medical degrees many years ago. Most physicians are trying under increasing pressure to pro¬ vide good care in an atmosphere of mutual trust. With the rapid develop¬ ment of new medical knowledge and technology in recent years, only a fool
.
.
.
.
