ronidazole was still considered the new wonder drug, and by extrapolation I advised oral metronidazole therapy. The effect was dramatic, with a major change in the level of care from family and professionals. However, the inevitable outcome was unchanged. In the intervening years I have from time to time suggested and used the same approach, with variable success. The gel formula-, tion should, if it works at the same rate as the oral or parenteral formulation, continue to provide excellent relief for caregivers and
patients. Maurice T. Dalton, MB, FRCPC Director of clinical bacteriology Victoria General Hospital Halifax, NS
Preventive care and practice funding A ccording to their paper "Do health service organizations [HSOs] and community health centres have higher disease prevention and health promotion levels than fee-for-service practices?" (Can Med Assoc J 1990; 142: 575-581) Julia Abelson and Jonathan Lomas were unable to demonstrate much difference in the approach to disease prevention in differently funded types of practice in Ontario. Although it is assumed that there are differences in the philosophy of care between HSOs and fee-for-service practices there is no mandate for this in the contract with the Ontario Ministry of Health. Since physicians are exposed to much the same training before entering any particular practice setting it is probably not surprising that they offer much the same service to patients. Some of the preventive approaches studied by Abelson and Lomas are billable under the fee-for-service system, so that an incentive is
provided, and it would not be surprising if physicians working under other funding arrangements were less inclined to use approaches of questionable efficacy. Abelson and Lomas fail to give sufficient emphasis to the approach to prevention that is distinctive to HSOs and has attracted many physicians to them. With their enrolled population being well defined and identified on a computer database HSOs allow a unique opportunity for a community-based approach to epidemiology. Rather than resulting in routinized disease prevention services, capitation funding in Ontario provides a strong incentive to move toward the "anticipatory care" advocated by Tudor Hart.' Robert Frankford, MD 166 Main St. Toronto, Ont.
Reference 1. Tudor Hart J: A New Kind of Doctor, Merlin, London, 1988
"Health care security"? Not in Alberta either
temporarily elected politicians but those that will show the true state of affairs in the health care system. Amirali Nanji, MD 240 Adolphus St. Cornwall, Ont.
Abbs. in Js I enjoyed Dr. William G. Green's witty letter (Can Med Assoc J 1990; 142: 287, 290). For those of us who love literature but must write articles in the language of science, I offer a semilimerick that addresses the problem. Since ancient times we've loved the language flow: Words upon words, newly fashioned aeons ago. Wond'rous words, whate'er the source, Spring with meaning clear, to course Along, a fresh and warming glow. In any accent, clipped or brogue, Peasant, philosopher, judge or rogue, For objects material Use words ethereal, Archaic words or words in vogue.
However,
I read Dr. Brian A. Shamess's letter about the waiting lists for cardiac surgery in Ontario (Can Med Assoc J 1990; 142: 798) with great interest. If Dr. Ronald Gregg, president of the Alberta Medical Association, is trying to mislead the Americans he should look in his own backyard. My father, who lives in Edmonton, had three-vessel coronary artery disease; all three vessels were more than 80% stenosed. He was told that the minimum wait for coronary artery bypass surgery in Edmonton was 1 year and in Calgary 6 months. He elected to go to Calgary, where he waited 8 months. Please, Dr. Gregg, present the facts -not those that please the
The tongue to science is brevity, we opine, And turgid pleonasm we eradicate or redefine. Reviewers we entice By showing we're precise, With acronyms filtered out, as anodyne. We cut "in close proximity" to "near", Change "females" to "women" to make it clear. We avoid review decision By writing with precision In language succinct, spartan and sincere. Frank I. Jackson, MB, ChB Cross Cancer Institute Edmonton, Alta. CAN MED ASSOC .J 1990; 142 (12)
1363
patients. Maurice T. Dalton, MB, FRCPC Director of clinical bacteriology Victoria General Hospital Halifax, NS
Preventive care and practice funding A ccording to their paper "Do health service organizations [HSOs] and community health centres have higher disease prevention and health promotion levels than fee-for-service practices?" (Can Med Assoc J 1990; 142: 575-581) Julia Abelson and Jonathan Lomas were unable to demonstrate much difference in the approach to disease prevention in differently funded types of practice in Ontario. Although it is assumed that there are differences in the philosophy of care between HSOs and fee-for-service practices there is no mandate for this in the contract with the Ontario Ministry of Health. Since physicians are exposed to much the same training before entering any particular practice setting it is probably not surprising that they offer much the same service to patients. Some of the preventive approaches studied by Abelson and Lomas are billable under the fee-for-service system, so that an incentive is
provided, and it would not be surprising if physicians working under other funding arrangements were less inclined to use approaches of questionable efficacy. Abelson and Lomas fail to give sufficient emphasis to the approach to prevention that is distinctive to HSOs and has attracted many physicians to them. With their enrolled population being well defined and identified on a computer database HSOs allow a unique opportunity for a community-based approach to epidemiology. Rather than resulting in routinized disease prevention services, capitation funding in Ontario provides a strong incentive to move toward the "anticipatory care" advocated by Tudor Hart.' Robert Frankford, MD 166 Main St. Toronto, Ont.
Reference 1. Tudor Hart J: A New Kind of Doctor, Merlin, London, 1988
"Health care security"? Not in Alberta either
temporarily elected politicians but those that will show the true state of affairs in the health care system. Amirali Nanji, MD 240 Adolphus St. Cornwall, Ont.
Abbs. in Js I enjoyed Dr. William G. Green's witty letter (Can Med Assoc J 1990; 142: 287, 290). For those of us who love literature but must write articles in the language of science, I offer a semilimerick that addresses the problem. Since ancient times we've loved the language flow: Words upon words, newly fashioned aeons ago. Wond'rous words, whate'er the source, Spring with meaning clear, to course Along, a fresh and warming glow. In any accent, clipped or brogue, Peasant, philosopher, judge or rogue, For objects material Use words ethereal, Archaic words or words in vogue.
However,
I read Dr. Brian A. Shamess's letter about the waiting lists for cardiac surgery in Ontario (Can Med Assoc J 1990; 142: 798) with great interest. If Dr. Ronald Gregg, president of the Alberta Medical Association, is trying to mislead the Americans he should look in his own backyard. My father, who lives in Edmonton, had three-vessel coronary artery disease; all three vessels were more than 80% stenosed. He was told that the minimum wait for coronary artery bypass surgery in Edmonton was 1 year and in Calgary 6 months. He elected to go to Calgary, where he waited 8 months. Please, Dr. Gregg, present the facts -not those that please the
The tongue to science is brevity, we opine, And turgid pleonasm we eradicate or redefine. Reviewers we entice By showing we're precise, With acronyms filtered out, as anodyne. We cut "in close proximity" to "near", Change "females" to "women" to make it clear. We avoid review decision By writing with precision In language succinct, spartan and sincere. Frank I. Jackson, MB, ChB Cross Cancer Institute Edmonton, Alta. CAN MED ASSOC .J 1990; 142 (12)
1363
