In training we learned about pathophysiology, empathetic interviewing, choosing tests, making a differential diagnosis, recommending a treatment, and always supporting the patient to improve quality of life and to postpone death.
In training we learned about pathophysiology, empathetic interviewing, choosing tests, making a differential diagnosis, recommending a treatment, and always supporting the patient to improve quality of life and to postpone death. Many patients would like a half-hour visit, but we have an office to run and overhead to pay, so we have to stay on schedule. Doctors have to keep up to date and sort through what the pharmaceutical companies want us to prescribe and what is good for patients. We must always be polite.
Patients and lawyers and insurance companies demand paper stating that the patient can or cannot work or fly or drive a motor vehicle. Revenue Canada, Employment Insurance, and Veterans Affairs ask for information that we don’t gather. Requests from Pharmacare are like drips on a tin roof at night, interrupting sleep. The 30-page provincial application for persons with disabilities is a nightmare. And the federal government has abdicated its responsibility with regards to marijuana. Marijuana is not approved by Health Canada as a drug. Marijuana is not the first-line treatment for any condition. There is no such thing as “medical marijuana.”
We cannot look after patients while doing paperwork. Dr Albrecht bemoaned the “intrusions into the GP’s office that are beyond the doctor’s control and invoked by government, lawyers, and … the medicolegal octopus of ICBC claims.” He asked, “Where is the carrot for new MDs planning a family medicine career?” I agree. We are in a purgatory designed by Franz Kafka.
Governments and companies should do their own work, not ask for a doctor’s note. Years ago I tried without success to enlist the help of the Canadian Medical Association and the BC Medical Association to convince [Superintendent of] Motor Vehicles to assess older drivers.
The CMA is interested in matters of national interest such as threats to the Canada Health Act. Doctors of BC prepares for the next round of negotiations about fees. The Ministry of Health and the BC College of Family Physicians are pursuing the adoption of the Patient Medical Home. Ambitious doctors or civil servants will not advance their careers by reducing a GP’s paperwork. Bureaucrats and journalists wonder why millions of Canadians can’t get a GP.
—Robert Shepherd, MD
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