November

I am writing in response to Dr Ralph Jones’ letter published in the July/August issue of the BCMJ (2005;47[6]:282).

Two years ago the passport office in Richmond called and told me that the key word when signing a patient’s passport is “personally.” I asked what defines “personally” and was told that a 2-year doctor-patient relationship is not enough; you must know the applicant on a personal basis and be familiar with things such as his or her work, house and home, hobbies, etc. Also, by signing the passport application, you are liable for all the answers on it.

I was pleased to read the editorial by JAW in the September issue of theBCMJ (2005;47[7]:344-350) entitled, “Who will be the gatekeeper?” It was a well-written, nostalgic, and accurate commentary on the current sad state of family medicine in British Columbia. The article truly reflects the atmosphere of quiet resignation that now pervades not only our association, but also affects many physicians who still hang onto their practices against all odds.

The articles on chronic kidney disease in the July BCMJ (2005;47[6]:286-311) confirmed my experience managing 90 patients in my practice with stage three and four renal failure. I used the guidelines and protocol recommendations to investigate and treat patients. This has resulted in significant alterations and improvements in their care. I have found several calcium phosphate and parathyroid hormone abnormalities and several untreated hyperlipidemias. I have found two asymptomatic renal cancers and one solitary kidney by doing routine renal ultrasounds.

I am concerned that the recent recommendations of the GPSC, who were charged with the task of strengthening family practice, have weakened the incentive to continue with an important responsibility of GP work.

At present a number of GPs do more than their proportional share of nursing home care because some GPs have opted out of most nursing home work. They don’t like it or it doesn’t pay. A care coordinator for a home who cannot get GPs to accept care because of the inadequate fee confirmed this.

Following the lead of Dr A.S. Relman, editor of your competing journal the New England Journal of Medicine,[1] the BCMJ appropriately places a statement on “competing interests” in any published research paper. In the Guidelines for Authors is the statement that clinical papers will not be reviewed without a statement of competing interests.

In 1990 Dr Relman extended these rules for the New England Journal of Medicine to include editorials.[2]

References