CORRESPON DENCE
What do family physicians see in practice? To the editor: It is frequently said that at least 75% of the patients seeking help in physicians' offices or clinics have complaints for which there is no organic cause.1 Is there any evidence to support this statement? In the Aug. 20, 1977 issue of the Journal (Can Med Assoc I 117: 354, 1977) I and my colleagues showed, from a 1-year study of the experience of seven family physicians in the North Shore area of Vancouver, that the complete opposite is the case. Letters in response to our article2'3 necessitate further comment on our methodology and results. We did not set out to prove a point or establish any preconceived ideas. We simply recorded our diagnoses. An independent group at the University of British Columbia categorized the diagnoses or problems into those that were purely physical and those that were purely emotional or behavioural. An attempt was made to get an even geographic distribution. Some of the physicians were in solo practice and some worked in association with other physicians. The physicians were selected at random by a project director (Dr. D.J. Ponesse), who did not take part in the recording. Each physician worked independently and had no idea of any of the tallies. The results were remarkably similar. Of the 23 108 problems recorded those most commonly encountered Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
were of physical origin and had physical manifestations (82% to 89%, not including those encountered at repeat and follow-up visits). That only 5.72% of the problems were purely psychosocial was unexpected. However, this figure corresponded closely to that obtained in the Virginia study, in which psychoneuroses, personality disorders and mental illness accounted for approximately 5% of all visits, including repeat and follow-up.4 It would be rather arrogant to imply that asthma has psychosocial origins and that no further knowledge is needed. Emotional distress can aggravate asthma but there is no evidence that it causes the disease; asthma of purely emotional origin does not exist.5 Exercise is also a common stimulus of asthma. It is well known that counselling and psychotherapy are ineffective in the treatment of asthma. The best control is provided by good medical treatment and education of the patient and the family. Probably no one is better acquainted with the emotional factor in physical problems, especially in chronic and life-threatening illness, than the family physician. To record the emotional component as the problem rather than the effect of the disease is to fail to see the biologic trees for the holistic wood. There is no argument that behavioural sciences can greatly contribute to the field of medicine, but I suggest that we must be careful not to overemphasize their importance by spending more time on psychosomatic medicine and behaviour than on the biologic aspects of disease. The best physician must be knowi-
684 CMA JOURNAL/OCTOBER 7, 1978/VOL. 119
edgeable and available, and must show the patient that he or she understands and is concerned. A.M. WARRINGTON, MB, BS 147 West 16th St., 3rd floor North Vancouver, BC References 1. THOMAS L: On the science and technology of medicine. Daedulus 106 (1): 42, 1977
2. LEIGHTON E: What do family physicians see in practice? Can Med Assoc J 117: 1252, 1977 3. BUTTERY CMG: What do family physicians see in practice? Can Med AsSoc J 118: 18, 1978 4. MARSLAND DW, WOoD M, MAYO F:
Content of family practice. Part I. Rank order of diagnoses by frequency. Part II. Diagnoses by disease and category and age/sex distribution. J Fain Pract 3: 37, 1976 5. DAVIES GM: Asthma. The current picture and newer treatments. Health
43 (3): 10, 1977
Ontario psychologists' bill: proposed licensing system To the editor: I congratulate Charlotte Gray on her excellent coverage of the dangers inherent in the proposed Ontario Psychologists' Act (Can Med Assocl 118: 1307, 1978). I hope the readers of the Journal will get involved in stopping such totalitarian over-reactions before they go any further. As governments develop increasing future-shock, they seek more and more control over citizen unpredictability. There is a very real need to protect ourselves from the development of a too cosy and potentially Orwellian relationship between behavioural psychology and the state. It is no accident that dissidents in the Soviet Union are sent to "psychiatric hospitals"; the de-
What do family physicians see in practice? To the editor: It is frequently said that at least 75% of the patients seeking help in physicians' offices or clinics have complaints for which there is no organic cause.1 Is there any evidence to support this statement? In the Aug. 20, 1977 issue of the Journal (Can Med Assoc I 117: 354, 1977) I and my colleagues showed, from a 1-year study of the experience of seven family physicians in the North Shore area of Vancouver, that the complete opposite is the case. Letters in response to our article2'3 necessitate further comment on our methodology and results. We did not set out to prove a point or establish any preconceived ideas. We simply recorded our diagnoses. An independent group at the University of British Columbia categorized the diagnoses or problems into those that were purely physical and those that were purely emotional or behavioural. An attempt was made to get an even geographic distribution. Some of the physicians were in solo practice and some worked in association with other physicians. The physicians were selected at random by a project director (Dr. D.J. Ponesse), who did not take part in the recording. Each physician worked independently and had no idea of any of the tallies. The results were remarkably similar. Of the 23 108 problems recorded those most commonly encountered Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
were of physical origin and had physical manifestations (82% to 89%, not including those encountered at repeat and follow-up visits). That only 5.72% of the problems were purely psychosocial was unexpected. However, this figure corresponded closely to that obtained in the Virginia study, in which psychoneuroses, personality disorders and mental illness accounted for approximately 5% of all visits, including repeat and follow-up.4 It would be rather arrogant to imply that asthma has psychosocial origins and that no further knowledge is needed. Emotional distress can aggravate asthma but there is no evidence that it causes the disease; asthma of purely emotional origin does not exist.5 Exercise is also a common stimulus of asthma. It is well known that counselling and psychotherapy are ineffective in the treatment of asthma. The best control is provided by good medical treatment and education of the patient and the family. Probably no one is better acquainted with the emotional factor in physical problems, especially in chronic and life-threatening illness, than the family physician. To record the emotional component as the problem rather than the effect of the disease is to fail to see the biologic trees for the holistic wood. There is no argument that behavioural sciences can greatly contribute to the field of medicine, but I suggest that we must be careful not to overemphasize their importance by spending more time on psychosomatic medicine and behaviour than on the biologic aspects of disease. The best physician must be knowi-
684 CMA JOURNAL/OCTOBER 7, 1978/VOL. 119
edgeable and available, and must show the patient that he or she understands and is concerned. A.M. WARRINGTON, MB, BS 147 West 16th St., 3rd floor North Vancouver, BC References 1. THOMAS L: On the science and technology of medicine. Daedulus 106 (1): 42, 1977
2. LEIGHTON E: What do family physicians see in practice? Can Med Assoc J 117: 1252, 1977 3. BUTTERY CMG: What do family physicians see in practice? Can Med AsSoc J 118: 18, 1978 4. MARSLAND DW, WOoD M, MAYO F:
Content of family practice. Part I. Rank order of diagnoses by frequency. Part II. Diagnoses by disease and category and age/sex distribution. J Fain Pract 3: 37, 1976 5. DAVIES GM: Asthma. The current picture and newer treatments. Health
43 (3): 10, 1977
Ontario psychologists' bill: proposed licensing system To the editor: I congratulate Charlotte Gray on her excellent coverage of the dangers inherent in the proposed Ontario Psychologists' Act (Can Med Assocl 118: 1307, 1978). I hope the readers of the Journal will get involved in stopping such totalitarian over-reactions before they go any further. As governments develop increasing future-shock, they seek more and more control over citizen unpredictability. There is a very real need to protect ourselves from the development of a too cosy and potentially Orwellian relationship between behavioural psychology and the state. It is no accident that dissidents in the Soviet Union are sent to "psychiatric hospitals"; the de-
