One often hears the claim that in Canada we enjoy the best health-care system in the world. In the same way, one sometimes hears the British National Health Service criticized as an efficient but impersonal and uncaring sausage machine. I regret to say that in its hospital services that may sometimes be true. It was with satisfaction, therefore, that nearly 40 years ago I experienced the establishment in Canada of universal insurance of private practice by the state. As an orthopedic surgeon, working in teaching hospitals in Saskatoon where our present health-care system was introduced, I felt that we had combined the best of two worlds. I have now retired in Vancouver and am no longer a doctor but a patient, and a patient’s relative, and I am beginning to wonder what has happened to that ideal.
It is alarming to discover that one may wait over 3 months to consult a specialist, or 4 months to have a CAT-scan to determine if one is suffering a malignant process. It is demeaning on visiting a specialist for the first time to be taken by the receptionist to a small empty room and invited to take off one’s clothes and wait for the arrival of an unknown doctor. I have not worked in the National Health Service for a long time, but not even in that impersonal scene did patients in the service that I worked in wait that long nor were they treated so inconsiderately.
My wife was recently admitted to a Vancouver teaching hospital in the terminal stages of an illness. She was presumably under the care of a consulting internist, but I do not believe that he ever saw her. She was certainly never seen by him in the 4 days after she was admitted, for members of her family were there every minute of the day and night and never met him. I am satisfied that she was well cared for by the resident physicians in training who may have been guided off-stage in the management of the technical problems encountered. They might have benefited from learning how a trusted physician deals with a dying patient and her worried relatives. Instead they learned how to work the sausage machine.
One hundred years ago the doctor would have had nothing effective to offer my wife. He could have done little more than sit by her bed, hold her hand, and comfort her. He would have reassured and consoled us, her relatives. He might have prescribed some useless potions. Scientific medicine has long discredited those potions, but do we have to throw out the baby with the bath water? There is still a need for the personal touch, the reassurance that the doctor in charge is a friend that is on one’s side in difficult times. There are still times when that is all that is left.
—Michael Alms, MB
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."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org