October, 1975
LETTERS TO THE EDITOR
the candidates who trained in mental hospitals did less well than those who trained in university settings. In Britain it is still possible to train entirely in a mental hospital setting. The proportion of Indian and Arab candidates who did their training in mental hospitals was higher than in some other groups, but this did not entirely account for this group's low pass rate. It is likely that language and cultural difficulties might also be playing a part. However, Mahapatra (2) analysed the results in the Leeds University Diploma in Psychological Medicine examination, and compared indigenous British candidates with foreigners. Furthermore, all graduates whose mother tongue was not English were only accepted for this course after they had passed the Leeds University English test for foreign students. This meant reaching the 66th percentile in reading, comprehension and vocabulary of non-English speaking postgraduates. If language problems handicapped the 'foreigners', then they would be expected to have the greatest difficulty in language-bound tests and proportionately less difficulty in multi-choice question examinations, and possibly the least of all in interviews where the examiner might be able to clarify language difficulties. Also the foreign graduates might have greater difficulty in the more culturally bound subjects, such as psychology and social science, and less in fact-orientated subjects such as neurological sciences. The results of the study showed that the 'foreigners' had significantly lower pass marks and pass rates than the indigenous students in all tests and in all subjects. It is therefore clear that the original hypothesis was not sustained. On present evidence language difficulty alone did not appear to account entirely for the poor performance of the 'foreign' students, which was felt likely to be a reflection of unsatisfactory learning. Michael 1. C. Thomson, M.D. Halifax, N.S.
References 1. Hassall, C. and Trethowan, W. H.: Analysis
of the results of the three examinations for the membership, Br. J. Psychiatry, News and Notes -s-Supplement, April, 1974. 2. Mahapatra, S. B.; Problems of Language in Examinations for Foreign Psychiatrists, Br. J. Psychiatry, News and Notes, Supplement, January, 1975 3. Steiner, B. W., Garfinkel, P. E., and Hunter, R. C. A.; The processes of psychiatric
497
residency trammg, Can. Psychiatr. Assoc. J., 19: 2,193,1974. 4. Thomson, M. 1. C.: Psychiatrists and psychiatry residents in Canada, Can. Psychiatr. Assoc. J., 19: 5, 473,1974.
Medical Charge Card Dear Sir: With the introduction of 'universal' Medicare in Canada, the great majority of physicians have little choice at the present time but to bill the provincial paying agency for medical services rendered. Inevitably the old adage that 'He who pays the piper calls the tune' has proved to be true and government is now dictating to physicians in respect of fees and schedules of benefits, extra-billing, and now in one province the minimum amount of time which must be spent when examining a patient. While there are many advantages in a health care system where the majority of patients have insurance coverage, the economic and political consequences of the provision of a government monopoly health plan are potentially disastrous. The medical profession in Canada is becoming subservient to government bureaucracy and one way to escape from the trap is to deal directly with our patients. In many medical offices it is impracticable to invoice individual patients for services rendered, but with the increasing use of credit cards there is no reason why a group of physicians who are determined to deal directly with their patients should not take advantage of Chargex, Master Charge, American Express, etc. I should be interested to hear from those physicians who support the concept of the use of a medical charge card, or favour entering into some form of association with established credit card organizations in Canada. A. Geoffrey Dawrant, M.B., B.Ch. Edmonton, Alberta
Critique de l'antipsychiatrie Monsieur le redacteur en chef, Je voudrais attirer l'attention des lecteurs de la Revue de l' association des psychiatres du
LETTERS TO THE EDITOR
the candidates who trained in mental hospitals did less well than those who trained in university settings. In Britain it is still possible to train entirely in a mental hospital setting. The proportion of Indian and Arab candidates who did their training in mental hospitals was higher than in some other groups, but this did not entirely account for this group's low pass rate. It is likely that language and cultural difficulties might also be playing a part. However, Mahapatra (2) analysed the results in the Leeds University Diploma in Psychological Medicine examination, and compared indigenous British candidates with foreigners. Furthermore, all graduates whose mother tongue was not English were only accepted for this course after they had passed the Leeds University English test for foreign students. This meant reaching the 66th percentile in reading, comprehension and vocabulary of non-English speaking postgraduates. If language problems handicapped the 'foreigners', then they would be expected to have the greatest difficulty in language-bound tests and proportionately less difficulty in multi-choice question examinations, and possibly the least of all in interviews where the examiner might be able to clarify language difficulties. Also the foreign graduates might have greater difficulty in the more culturally bound subjects, such as psychology and social science, and less in fact-orientated subjects such as neurological sciences. The results of the study showed that the 'foreigners' had significantly lower pass marks and pass rates than the indigenous students in all tests and in all subjects. It is therefore clear that the original hypothesis was not sustained. On present evidence language difficulty alone did not appear to account entirely for the poor performance of the 'foreign' students, which was felt likely to be a reflection of unsatisfactory learning. Michael 1. C. Thomson, M.D. Halifax, N.S.
References 1. Hassall, C. and Trethowan, W. H.: Analysis
of the results of the three examinations for the membership, Br. J. Psychiatry, News and Notes -s-Supplement, April, 1974. 2. Mahapatra, S. B.; Problems of Language in Examinations for Foreign Psychiatrists, Br. J. Psychiatry, News and Notes, Supplement, January, 1975 3. Steiner, B. W., Garfinkel, P. E., and Hunter, R. C. A.; The processes of psychiatric
497
residency trammg, Can. Psychiatr. Assoc. J., 19: 2,193,1974. 4. Thomson, M. 1. C.: Psychiatrists and psychiatry residents in Canada, Can. Psychiatr. Assoc. J., 19: 5, 473,1974.
Medical Charge Card Dear Sir: With the introduction of 'universal' Medicare in Canada, the great majority of physicians have little choice at the present time but to bill the provincial paying agency for medical services rendered. Inevitably the old adage that 'He who pays the piper calls the tune' has proved to be true and government is now dictating to physicians in respect of fees and schedules of benefits, extra-billing, and now in one province the minimum amount of time which must be spent when examining a patient. While there are many advantages in a health care system where the majority of patients have insurance coverage, the economic and political consequences of the provision of a government monopoly health plan are potentially disastrous. The medical profession in Canada is becoming subservient to government bureaucracy and one way to escape from the trap is to deal directly with our patients. In many medical offices it is impracticable to invoice individual patients for services rendered, but with the increasing use of credit cards there is no reason why a group of physicians who are determined to deal directly with their patients should not take advantage of Chargex, Master Charge, American Express, etc. I should be interested to hear from those physicians who support the concept of the use of a medical charge card, or favour entering into some form of association with established credit card organizations in Canada. A. Geoffrey Dawrant, M.B., B.Ch. Edmonton, Alberta
Critique de l'antipsychiatrie Monsieur le redacteur en chef, Je voudrais attirer l'attention des lecteurs de la Revue de l' association des psychiatres du
