CORRESPON DENCE
Educate doctors about their worth To the editor: I would like to respond to the Ottawa File article by D.A. Geekie (Can Med Assoc J 116: 710, 1977). The dollars and cents (or sense) of the practice of medicine in Ontario can be described as follows: a monopolist purchaser (the government) must purchase medical services from many vendors of these services, who are in competition with one another. As long as there are physicians who wish their practices to grow larger this will be true. It is the responsibility of government negotiators to purchase these services (or any other goods and services) as cheaply as possible. Would any physician go to the market and offer the merchant more for his oranges than the selling price? Of course not! Physicians, on the other hand, would like to receive much more for their services than the government is offering. This is an amount based on what physicians have earned in the past, as well as what other members of society are earning today. However, when one looks at reality, one can see a dichotomy. On one hand, doctors state that they are underpaid. On the other hand, doctors have willingly sold their services for the present fees to the government. Hence, do not say that doctors are underpaid. If doctors as a group are willing to work for peanuts, then this is all that they deserve. Don't bother to try to educate government negotiators about how much doctors are worth. If you want to raise the income of doctors, then edticate the doctors to what they should be worth, so that every member of the contributions to the Correspondence section are welcomed and if considered suitable will be published as spa. permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
group raises his expectations. Then, and only then, will the medical negotiators be able to say to the purchaser, "We refuse to sell our services for such low wages.., Government payment for doctors' services must always be an amount greater than the amount for which the group refuses to work. As the individual doctor raises his expectations of income, so will the group as a whole earn more. I am an opted-out physician. Louis TRAIN, MD 1260 Lawrence Ave. E Don Mills, Ont.
Communication short-cut To the editor: I believe we should encourage greater communication with patients by letter. Much time is wasted for patients who must return to physicians' offices and clinics for test results and the advice that follows. Unless the physician wants more information from the patient there is little point to these return visits. Provided the patient can read, the results of tests, their importance and their therapeutic consequences can be conveyed in writing, a copy of the letter being sent to the family physician. The patient is spared a journey, a wait, and lost time off work, and he has a record of the information. For many, a major objection to this practice innovation would be that it does not entail a fee. This need not be so. It uses the time of the physician and his secretary, as well as stationery and postage. Unlike a telephone call, a copy of the record is available as proof that the service was carried out. I therefore suggest that the Canadian Medical Association consider the possibility of supporting this potentially useful practice module or at least studying its feasibility. W.C. WATSON, MD Department of medicine and gastrointestinal unit Victoria Hospital London, Ont.
Food-borne disease in Canada To the editor: In the light of your recent articles on diarrhea and gastroenteritis (Can Med Assoc J 116: 737, 776; 1977) we bring to your attention a new publication series by Health and Welfare Canada entitled "Food-borne Disease in Canada, Annual Summanes During recent years Canada has developed a food-borne disease surveillance program that involves a national system for the regular collection and dissemination of data on incidents of such disease. This program should be useful in evaluating the impact on human health of various contaminants identified in foods, and in detecting the sources and means of dissemination of infection, including the mishandling of food. The one report published so far pertains to the year 1973. It is available, free of charge, in English or French, from Dr. E. Todd at the address given below. The 1974 report is currently in preparation. The 1973 report contains data on 378 food-borne incidents, consisting of 343 outbreaks (3312 cases) and 35 single cases. In 24% (89) of the incidents and 48% (1614) of the cases the cause was discovered. It was microbiologic in most instances. Staphylococcus aureus was the most frequent agent, and Salmonella and Clostridium periringens were also important; the three types of organisms were responsible for 54 incidents and 1476 cases. C. botulinum, though causing only five incidents (eight cases), produced sufficient toxin to kill three patients. Five incidents of trichinosis involved game meat and pork products. Plants and chemicals caused a few intoxications. The main foods associated with the 378 incidents were meat (118), poultry (41), vegetables and fruit (34) and bakery products (29). Other foods included Chinese food (23), sandwiches
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Educate doctors about their worth To the editor: I would like to respond to the Ottawa File article by D.A. Geekie (Can Med Assoc J 116: 710, 1977). The dollars and cents (or sense) of the practice of medicine in Ontario can be described as follows: a monopolist purchaser (the government) must purchase medical services from many vendors of these services, who are in competition with one another. As long as there are physicians who wish their practices to grow larger this will be true. It is the responsibility of government negotiators to purchase these services (or any other goods and services) as cheaply as possible. Would any physician go to the market and offer the merchant more for his oranges than the selling price? Of course not! Physicians, on the other hand, would like to receive much more for their services than the government is offering. This is an amount based on what physicians have earned in the past, as well as what other members of society are earning today. However, when one looks at reality, one can see a dichotomy. On one hand, doctors state that they are underpaid. On the other hand, doctors have willingly sold their services for the present fees to the government. Hence, do not say that doctors are underpaid. If doctors as a group are willing to work for peanuts, then this is all that they deserve. Don't bother to try to educate government negotiators about how much doctors are worth. If you want to raise the income of doctors, then edticate the doctors to what they should be worth, so that every member of the contributions to the Correspondence section are welcomed and if considered suitable will be published as spa. permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
group raises his expectations. Then, and only then, will the medical negotiators be able to say to the purchaser, "We refuse to sell our services for such low wages.., Government payment for doctors' services must always be an amount greater than the amount for which the group refuses to work. As the individual doctor raises his expectations of income, so will the group as a whole earn more. I am an opted-out physician. Louis TRAIN, MD 1260 Lawrence Ave. E Don Mills, Ont.
Communication short-cut To the editor: I believe we should encourage greater communication with patients by letter. Much time is wasted for patients who must return to physicians' offices and clinics for test results and the advice that follows. Unless the physician wants more information from the patient there is little point to these return visits. Provided the patient can read, the results of tests, their importance and their therapeutic consequences can be conveyed in writing, a copy of the letter being sent to the family physician. The patient is spared a journey, a wait, and lost time off work, and he has a record of the information. For many, a major objection to this practice innovation would be that it does not entail a fee. This need not be so. It uses the time of the physician and his secretary, as well as stationery and postage. Unlike a telephone call, a copy of the record is available as proof that the service was carried out. I therefore suggest that the Canadian Medical Association consider the possibility of supporting this potentially useful practice module or at least studying its feasibility. W.C. WATSON, MD Department of medicine and gastrointestinal unit Victoria Hospital London, Ont.
Food-borne disease in Canada To the editor: In the light of your recent articles on diarrhea and gastroenteritis (Can Med Assoc J 116: 737, 776; 1977) we bring to your attention a new publication series by Health and Welfare Canada entitled "Food-borne Disease in Canada, Annual Summanes During recent years Canada has developed a food-borne disease surveillance program that involves a national system for the regular collection and dissemination of data on incidents of such disease. This program should be useful in evaluating the impact on human health of various contaminants identified in foods, and in detecting the sources and means of dissemination of infection, including the mishandling of food. The one report published so far pertains to the year 1973. It is available, free of charge, in English or French, from Dr. E. Todd at the address given below. The 1974 report is currently in preparation. The 1973 report contains data on 378 food-borne incidents, consisting of 343 outbreaks (3312 cases) and 35 single cases. In 24% (89) of the incidents and 48% (1614) of the cases the cause was discovered. It was microbiologic in most instances. Staphylococcus aureus was the most frequent agent, and Salmonella and Clostridium periringens were also important; the three types of organisms were responsible for 54 incidents and 1476 cases. C. botulinum, though causing only five incidents (eight cases), produced sufficient toxin to kill three patients. Five incidents of trichinosis involved game meat and pork products. Plants and chemicals caused a few intoxications. The main foods associated with the 378 incidents were meat (118), poultry (41), vegetables and fruit (34) and bakery products (29). Other foods included Chinese food (23), sandwiches
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