Air transport cover

I would like to express my strong objection to your depiction of a psychiatric patient on the October cover. Totally inappropriate and unfeeling for a medical journal.
—Roy C. Schofer, MD

I have never really approved of the artwork on the front cover of your Journal, but I have held my peace as artists should have freedom of expression and I can always rip off the cover and simply read the material inside. Poor taste on the part of the Editorial Board for many issues, yes. But, live and let live. 

However I feel someone has to write to you about the appalling cover on the October 2009 issue. If the face on the cover is supposed to represent a psychiatric patient, what on earth are you trying to say? That psychiatric patients are some sort of Halloween ghoul? Would the artist have depicted a renal dialysis patient the same way? If so, why not?

If I was the author of the other­wise fine article, “Criteria for sedation of psychiatric patients for air transport in British Columbia,” I would have pulled the article rather than have it published in a journal which, if judged by its choice of cover, treats psychiatric patients so callously.

How would you feel having this journal in your waiting room and having your psychiatric patients see it? Or your depressed mother-in-law or schizophrenic brother?

Please, editors, you’d be better off with a plain white cover and BCMJ than to continue with grotesque cartoons which undermine the articles in the Journal.
Thanks for letting me sound off.
—Cecile A. Ryder, MD
North Vancouver

I received your October issue of the BCMJ with anticipation knowing I had an article published within it, so when it arrived in the mail I eagerly removed it from its packaging and looked at it to see if there was any reference to my article on the cover. It took several seconds for it to register that I had made the cover and that the cover illustration was about my article. I had not seen the illustration before this. 

Once it registered I knew immediately it would create strong feelings. The illustration is a bit unsettling; when you look behind the mask you can see the pain that lurks below the surface. I, in no way feel that it derides psychiatric patients, but it effectively expresses what patients themselves often cannot express. 

As was stated in the article, the BCAS and the physicians who provide medical advice for patients all consider psychiatric patients full and equal recipients of our care. It has been because of this that we have spent so long and had many difficult discussions on how best to provide safe transport for them. It is the reason we worked so hard to create the policies for transporting psychiatric patients. 

In the 1970s and early 1980s the air ambulance did not transport psychiatric patients, period. Not only is this not ethical but with good medical management there is no reason why an air transport of psychiatric patients cannot be done safely, which is the point of the article.

I have no doubt that the cover will assist in the aim of the article, which is for as many BC physicians to learn about the risks of air transport and how best to prepare their patients for a safe flight. The cover will have many people looking inside for the article. Thank you for publishing the article and making it your cover topic.
—Stephen Wheeler, MD

When asked to respond to the negative letters about his artwork, artist Jerry Wong wrote the following:

To be publicly prejudged by a stranger for lack of morals and lack of heart saddens me, and reminds me of how little it takes for us humans to be offended by something, or someone. It kept me awake for a few hours last night, pondering and reviewing (monitoring myself) to assure myself that I made every effort to honestly represent the agonizingly hopeless feelings of psychiatric patients I have known and loved (while balancing the needs of the air transport staff).

The members of the Editorial Board would like to thank Jerry Wong and express their full support of the October issue cover. 

Roy C. Schofer, MD,, Cecile A. Ryder, MD,, Stephen Wheeler, MD. Air transport cover. BCMJ, Vol. 51, No. 10, December, 2009, Page(s) 424 - Letters.

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.

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