Re: Scope of practice

One has to admire Bill Mackie’s measured tones when an­nouncing yet another nail in the coffin of scientific, Hippocratic medicine in BC [BCMJ 2009;51(1):6]. It is obvious that the government is trying to placate the public’s demand for greater access to medical care, but this is not the way. It might well be quite popular as the ability of the average layperson to evaluate diagnostic and therapeutic interventions critically is limited, yet at the same time many individuals see themselves as well informed after having consulted various Internet sites, many of them misleading and substituting plausibility for evidence. It goes without saying that in the process of allowing naturopaths, optometrists, and chiropractors to prescribe such powerful prescription drugs as antibiotics, antidepressants, and painkillers, the status of physicians in the community will be reduced even further and the quality of medical treatment in BC will be watered down and patients put at risk. As a profession we owe it to the public to prevent this from happening, and we have the tools to do so.

The physicians of British Columbia, as represented by the BCMA, should start a publicity campaign focused on explaining the meaning of evidence-based medicine, contrasting it with unconventional approaches. Throughout, we should remain objective, acknowledging that any intervention may have a non-specific effect. The placebo effect has been proven to make some people feel better, decreasing their anxiety, pain, and frustration. What it does not do is to fight diseases, a distinction rarely understood by the public.

At the same time we should dissuade the government from going ahead with its plans by making contingency plans for the profession as a whole to opt out of the provincial insurance plan and demand payment directly from the patients (which are then to be reimbursed by MSP). One suspects that the resulting uproar from the public, and the costs of setting up the additional bureaucracy, might well bring the government to its senses. The time has come for all good men and women to stand up for our profession and the future of quality health care in British Columbia. I look forward to the BCMA providing the leadership.

—Gerald J.M. Tevaarwerk, MD
President, Victoria Medical Society

Gerald J.M. Tevaarwerk, MD, FRCPC. Re: Scope of practice. BCMJ, Vol. 51, No. 3, April, 2009, Page(s) 105 - Letters.

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