Re: Sometimes we need to think of zebras

I would like to respond to the article in the May 2020 issue, “Sometimes we need to think of zebras: An observational study on delays in the identification of bone tumors in children” [BCMJ 2020:62(4):130-133]. Mr Dhinsa and colleagues are to be commended for this informative article highlighting some of the clinical challenges in diagnosing osteosarcoma or Ewing sarcoma in children. However, I take offence with the statement, “increased awareness could reduce delays.” Every patient I see as a family physician (not a general practitioner, which is not a term that should be used in a BCMJ article in 2020) may harbor a life-threatening illness. Is that chest pain unstable angina or a muscle strain? Is that difficulty swallowing reflux or an early esophageal cancer? Is that knee pain growing pains or cancer?

The patient journey illustrated diagnostic and treatment delays partly due to multiple visits to walk-in clinics, not necessarily a lack of awareness among family physicians. Was the patient’s family physician sent a copy of the patient’s visit after each walk-in clinic visit? Was it the same walk-in clinic that was visited? Was the patient advised to follow up with his or her family physician?

I, along with my family physician colleagues, fear missing significant diagnoses—especially in children. Awareness is important, but what is more critical is longitudinal care and communication between providers to ensure that each patient journey map brings the patient the care he or she needs in the most expeditious fashion possible.
—Tahmeena Ali, MD, CCFP, FCFP
Surrey

This letter was submitted in response to “Sometimes we need to think of zebras: An observational study on delays in the identification of bone tumors in children.”

Tahmeena Ali, MD, CCFP, FCFP. Re: Sometimes we need to think of zebras. BCMJ, Vol. 62, No. 6, July, August, 2020, Page(s) 195 - 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