A 78-year-old man, who was receiving donepezil for dementia, developed paralytic ileus after donepezil was discontinued. The man, who had started receiving donepezil 5 mg/day about 3 years previously, was admitted… he discontinued his donepezil after admission. Three days later, he complained of abdominal distention, pain, and constipation. A radiograph revealed significant gas retention in his small and large intestines.
It was the need to back up clinical decisions with sound medical knowledge that induced the Vancouver Medical Association to form a Library in 1906, beginning the service that would eventually become the College library. What was crucial to clinical decision making 100 years ago is unchanged today: physicians want information that is authoritative, relevant, and rapid, and they want it where the need arises—the point of care.
There is an ongoing concern in Canada and the United States that standards of education are falling. At a grassroots level we have seen a rise in the number of independent schools that focus on basic tasks such as reading, composition, and math. On a broader level, the business community (including Microsoft chairman, Bill Gates[1]) has expressed concern that a decline in science skills[2] will cause North America to lose its innovative and economic edge[3]
How many are aware that the five principles of the Canada Health Act are three fewer than were contained in the 1961 Saskatchewan Medical Insurance Act on which the federal legislation was based? It is perhaps telling that the dropped principles were “effective,” “efficient,” and “responsible.” Perhaps if those had been retained, we would have a much better system today. We have a current funding issue in BC that is just one symptom of a sickness that has overcome our health care system.
At the trading deadline a few days ago the Vancouver Canucks added a couple of players, one of whom had been a previous team member, the other a well-known veteran centre.
