Delightful editorials—Letter 2

Issue: BCMJ, vol. 53, No. 4, May 2011, Page 161 Letters

I so felt a kinship to Dr David Rich­ardson and Dr Cynthia Ver­chere who wrote about two issues I have felt quite unhappy about for some time now. 

Privileges, those which our “older generation” doctors were part of, and which are no longer the norm, have degenerated to such a level that I no longer am attracted to such insti­tutions and have distanced myself from them exactly because of all the poignant details outlined in the piece. 

As a GP, I no longer feel welcomed, encouraged, or supported in a manner conducive to embrace this part of care, and more often feel frustrated and embarrassed to explain or justify the fragmentation of care my patients experience, or the many tales of disrespect accorded my patients there—being shuttled about with little explanation, being simply pawns in a game of financial struggles. 

I do understand the unfortunate pressures the heroic staff struggle with, and who do try to regain the nobility of the past to little avail, and yes, I do fear when it will be my turn to be a patient needing such care. I agree that many an institution has become “a shadow of its former self,” per Dr Richardson. 

I myself often still use the phrase we bantered about during those days I was actively involved in trying to preserve better care: “Hospital administrations would be so happy and efficient running hospitals if only without patients!”

This conundrum may well be mirrored in the editorial by Dr Verchere opining the days where postgraduate streams, having started with the general rotating internship, produced better clinicians with a broader feeling and comprehension of the wide diversity of care that is needed. The pressures on medical students to stream their focus and studies starting in the third year of medical school must be taking a toll as explained so eruditely by Dr Verchere. 

She outlines the near impossible task of selecting with wisdom and compassion the optimum candidates for any particular residency, the hopes dashed of those who miss the one and single chance at their holy grail. What a Gordian knot, and I am sure many nights of headaches! Any outsider would say we have gone backward in medical education, but this shouldn’t be accepted, and the powers-that-be should fully revisit this sad state of affairs. 

Often the comment is made by more experienced clinicians that the better-rounded specialists have some GP experience because they understand the spectrum of care from primary care/family practice through to the level of specialty. 

I cannot help but see the connection to Dr Richardson’s editorial as the compartmentalization engendered by too early streaming leading to fragmentation of outlook, empire-building, and difficulty in cooperative, multidisciplinary efforts. Is there truly hope for our profession?
—John de Couto, MD
New Westminster

John de Couto, MD,. Delightful editorials—Letter 2. BCMJ, Vol. 53, No. 4, May, 2011, Page(s) 161 - Letters.



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

BCMJ Guidelines for Authors

Leave a Reply