It is with interest and some disappointment that I read your study by Thommasen and colleagues, “The relationship between physician visits and some quality of life indicators” (BCMJ 2005;47(4):188-192).
As a family doctor who practises in remote and rural areas, I often observe what I perceive to be poor quality of life among my patients. I often wonder what more I can do for them. Indeed most problems cannot be solved by a prescription for ramipril or another pharmaceutical, but one does what one can. A good community resource is like a godsend to a GP. I certainly cannot solve the vast majority of these problems on my own. But often little is available and one gives moral support and tries to address the social problems that often exist alongside diabetes management or what have you. I read this study with optimistic hopes.
Instead, the authors draw conclusions I do not see in their data in the methods and results sections. It says in the conclusions section: “perhaps the best way to deal with this problem is not by ordering hundreds of medical tests, but by examining issues….” I read this as the Bella Coola Valley doctors are treating quality of life problems with multiple tests. This is something that sounds unfortunate and I did not see in the results section of the paper. In my experience, people with multiple life problems go to their doctor because they sometimes perceive that they have nowhere else to go and psychological stressors often manifest in a physical symptom they can take to their doctor. Sometimes I order tests. Sometimes they help.
I cannot help but feel there is a tone of causality as opposed to correlation in the data. That the doctors are somehow causal to the problems is implied here. I see a correlation only.
—Darren Jakubec, MD, CCFP
P.S. There once was a communist country that had an area of great disease. This area had the most doctors trying to address the problem. The dictator had the doctors executed seeing them as causal to the problem, as opposed to correlative. That would never happen here, but you do see the point.
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