April

On 10 February 2014, André Picard’s column in the Globe and Mail describes the case of Margot Bentley, whose explicit directions for how she wanted to have her life end were rejected. What a travesty of common sense this has become. A few days later I was heartened to see that the January/February 2014 issue of the BC Medical Journal had four items on the topic of end-of-life care.

The Canadian National Breast Screen-ing Study (NBSS) should not influence decisions about screening mammography, neither for individuals nor on a  policy level. The recent British Medical Journal publication of the latest update on the NBSS is not new research. It was because of major problems with its design and execution that in 2002 the World Health Organization excluded the NBSS from analysis of the impact of screening mammography on mortality from breast cancer.

Physicians rely on technology more than ever to stay current with rapid advancements in best practice recommendations. This is especially true in the busy general practice environment where physicians need to make efficient, informed decisions about diagnoses and drug interactions, and answer clinical questions that come up during each patient interaction.

For physicians of my generation, many additional chapters in our medical careers have been written since chapter one, medical school. That opening chapter is somewhat of a fading vision. Not the knowledge part, thank goodness, but the circumstances under which that information was acquired and retained.

“Oh, by the way, Dr Richardson, I wanted you to know that I’m doing okay,” the 18-year-old patient said to me as we were finishing up our office visit. She had come in to review her migraine headaches and the possible treatments. We chatted about how she was planning to become a vet and about how her family was doing. She even mentioned that she was in a good relationship and very happy. She was full of life and youthful zest for the future. She said that her comment was in response to the letter I gave her.

“What letter?” I asked.