As it was my turn to produce an editorial for the end of September, I sat down on a number of occasions earlier in the month hoping for some inspiration. What could I write about that wasn’t doom and gloom? We are struggling with a health care system in crisis. Our day-to-day lives as physicians trying to provide excellence in patient care are constantly being challenged by budget cutbacks, lack of funding and resources, increasing waitlists, nursing shortages, and job action. Despite all of this, we go to our offices and do the best we can to do the work we were trained to do.
And then the catastrophic events of 11 September rocked the world, overshadowing everything else. The calamity was not local, it did not discriminate, and it may never end. I felt compelled to write down a few of my thoughts and in my small way to pay tribute to all of those who perished and to the families who lost loved ones—and to seek some explanation that makes sense to my world as a doctor in 2001 in BC, Canada.
I saw the graphic images of the explosions and sickening descent of the buildings and tried to imagine what it was like for the innocent victims on the planes and in the twin towers, not knowing what was happening. I read about the men and women who lost their lives in the sharpest of instants and those who heroically risked their own in attempting to rescue others, and tried to imagine their terror. But my imagination fell woefully short.
Our world has changed irrevocably in ways that we cannot yet fully digest or comprehend. Already much has been written about the fateful events that day, but the events themselves seem to be too overwhelming to grasp, to understand with mere words. What is unarguable is that we must rethink our own lives in light of the kinds of events that surmount us.
What can we learn from 11 September? How can we take something positive into the future? Physicians do not normally face disasters on the scale of toppling buildings or crashing planes, but sometimes our work feels that way. At times we feel much like the rescue workers trying to do the best we can under difficult and possibly hopeless circumstances. I do not wish to imply any comparison at all of our lives to those injured or killed in New York and Washington or that doctors are heroes every day. It is simply that we must recognize that the medical world as we knew it a few years ago is no longer the same world today.
As doctors we now often find ourselves in a position of having to sacrifice quality in order to meet demands. We no longer have the luxury to reflect on what is best for our patients. Like so many others we are driven by the bottom line where none of us were, or wished to be, before. This is difficult for us as we try to adhere to the philosophy, “above all else, do no harm.”
It may be the smallest of things, but from now on, I, in my own small way, will rebel. I will spend a few extra minutes with my patients if that is what they want. I will ignore the petty differences that seem to pass as discussions on health care and health policy. I will not let my view of health care be captured by economic and financial interests. And I will feel blessed for what my profession has given me, for it is infinitely more than I will ever be able to give it.
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