The letter from Dr Michael Alms [BCMJ 2001;43(2):68] raised a matter that should concern all medical educators. It is even more timely now that the BCMJ recently commented on the problem and the media had a field day alarming Canadians about what was going on in their medical schools. Like Dr Alms, I too have been in the patient situation and am disgusted at the non-professional, egotistical, impersonal attitude displayed by many consultants and department heads under whom patients are admitted in teaching hospitals. I understand the necessity for training in history taking, physical examination, etc., and patient encounter is essential. But a study has revealed examinations without patient consent or on comatose or unconscious patients, as well as procedures carried out by junior staff with little or inadequate training. Investigation has confirmed that admitting consultants often never see these patients. Resident staff is the only contact, and even that may be episodic and insufficient. Quite forgotten is the duty of senior staff to personally monitor and visit patients under their care.
What has happened to our ethics that one no longer feels an obligation to live up to the duties and heritage of the medical profession? Surely the prestige of an academic appointment carries with it a responsibility for the personal touch and reassurance that are so vital for the sick and ailing. I recall with admiration and gratitude the grand ward rounds that were an important part of the postgrad experience. The role models were right there with the students and trainees at the bedside. Too bad this tradition is no longer considered necessary in the era of medicare.
—Manning L. Mador, MD
Past President, Ontario Medical Association
Past President, College of Physicians and Surgeons of Ontario
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