Time’s up, Doc

Issue: BCMJ, vol. 60, No. 4, May 2018, Page 186 Editorials

If you have ever ordered a pneumoencephalogram, administered an aminophylline drip, cross-eyed stereo-viewed a cerebral angiogram, or used Tensilon to convert paroxysmal atrial tachycardia, then you are likely retired or in the retirement-contemplative stage. So it is with me. After 40 years in medicine it’s time to retire and also step down from my 10-year membership on the BCMJ Editorial Board, which of all the committees I’ve served on has been my favorite.

The membership of the Editorial Board is composed of a diverse group of talented physicians and staff who, while not always like-minded, have always been able to achieve consensus on which articles would be of value and interest to BC physicians. The fact that the BCMJ is celebrating its 60th anniversary is a testament to its continued popularity.

It is always interesting to reflect on one’s past view of the future, versus today’s reality. For instance, I never saw the coming of plastic water bottles, Starbucks coffee, yoga, or that being tattoo-positive did not equate with being MSP-negative. I’ve always believed that patient autonomy and self-determination would extend to the end of life, and am relieved that medical assistance in dying has finally been decriminalized. I never saw the value of medical marijuana, but never saw the harm in decriminalizing marijuana, even if I don’t like the smell of a skunk. For many decades my dream was to have a fully functional integrated EMR complete with lab and diagnostic imaging results, patient scheduling, data tracking, and prescribing software. Many years and dollars later I came to sympathize with the builders of the Tower of Babel. I’m hopeful for the day that all physicians can truly say that their EMR has resulted in delivery of safer and more efficient care.

If I may also reflect on the future of medicine, I see it as promising, exciting, and somewhat daunting, particularly with regard to technological changes that will challenge most physicians’ ability to remain current. Advances in laboratory medicine, genetics, diagnostic imaging, and informatics are staggering, but in all its marvels we must remember that technology is our servant, not our master. We serve our patients, not our computers. No technology will ever replace our care.

There are also political, economic, and societal pressures that will change the way we practise medicine. For instance, our role in being accountable to only our own patients is increasingly being challenged. We must be cognizant of the provincial government’s frustration that despite huge financial expenditures there is a perception that collectively we sit on the sidelines while patients are unable to access timely medical care. In Quebec this has resulted in draconian incursions into physician autonomy by the introduction of Bill 130, which includes physicians having to guarantee availability of service. While in BC we may feel that we are doing enough by collaborating with government on initiatives such as the General Practice Services and Specialist Services committees, there are many poorly accessible services. We must vigorously promote and publicize our collaborative engagements, and barriers when they exist, “in matters relating to public health, health education, environmental protection, legislation, function, and improvement of health services.”[1]

Just as I never envisioned retiring from medicine, someday, if you are lucky, that day will arrive for you. It might seem far away for some, but it’s not. Plan for it just as diligently as you planned your career. Ask yourself, aside from medicine, what gives you the joy, excitement, and purpose that will fuel your retirement years.

I have been very privileged to have been part of this Editorial Board. Thank you.



1. Canadian Medical Association. CMA code of ethics (2004): 42. Responsibilities to society. Accessed 19 March 2018. www.cma.ca/En/Pages/code-of-ethics.aspx.

Willem R. Vroom, MD. Time’s up, Doc. BCMJ, Vol. 60, No. 4, May, 2018, Page(s) 186 - Editorials.

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.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
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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

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