This will be my last BCMJ editorial. The editor has politely refrained from asking if I’m thinking of leaving the Editorial Board . . . but now it’s time. To everything there is a season.
As well as bringing freedom, stepping away from something often brings regret. In my case, I regret—among other things—not having used the BCMJ editorial bully pulpit as effectively as I could have. I wish I’d done more to try to bring rationality to our system of delivering care. Canadian politicians and medical political activists are too cowardly (or too controlling) to permit real discussion about ways to introduce private care into the country. The arguments in favor of a mixed public-private system, as used in every other sensible country, are widely known, and I know that they make sense to all but the most blinkered among us. If you or anyone close to you has been a patient within our system of care, you know that there are—and always have been—multiple tiers of health care for Canadians. It all depends on who you are, who you know, and how much money you have. And that’s not right if we are also to be restricted by a legislated universal system of care.
My parents lived their whole lives in Australia. In their later years they were able to direct the level of care they wanted, and to die at home, because the Australian system permits its citizens (if they wish) to pay for the level of care they want. If Canada is going to allow medically assisted dying at a patient’s request, why will it not allow patients to determine the care they will receive while alive? It flies in the face of logic. And the arguments used by governments and activists to sustain the status quo simply don’t make sense—worse, they reek of hypocrisy. We’ve all heard the stories of politicians and bureaucrats quietly arranging to have their own elective procedures done privately, while they publicly denigrate those who provide such care. To denigrate sincere people like Dr Brian Day, as has happened, is simply appalling. But my fear is that nothing will change until someone in a position of real power finds that, like the majority of the population, they must wait—and wait—for care. Sadly, because Canadians are ridiculously tolerant and forgiving, that may never happen. Still, I can hope.
But allowing private-pay care in Canada is the only thing I regret not shouting about. I don’t like lecturing people. For me as an aging clinician to tell others, colleagues and trainees, how they should practise is largely inappropriate and unnecessary. I have spent enough time with medical students, residents, and fellows to know that essentially we are all responsible for our own education, and most of us have the smarts to know this. Nevertheless, please indulge me as I make one final related point.
The cleverest people I know are not afraid to admit that they don’t know something, or to enter a discussion knowing they could be wrong. Appearances don’t bother them. So, as I disappear out the door, my parting advice is this: never be afraid to ask, even publicly, for clarification of something that puzzles you, or to speak up knowing that you may well be wrong. We must trust our more knowledgeable colleagues to have the same motivation that we do: to keep learning and sharing knowledge. The future of our profession depends on our basing what we do on evidence and constantly trying to improve. We have to be honest with one another to do this.
I’ve enjoyed every minute of being on the BCMJ Editorial Board, and I’ll miss not being part of it. And to those of you who have told me that you read what I wrote: thanks! I believe you. Honest.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org