A CASE OF DWD
Your recent article entitled "Miss Daisy Driving" (Vol 1 No 11, page 14) touches on Odriving while demented¹ (DWD). I believe that removing the license of such patients is a sure way to create an instant enemy who will pester your office staff and you for an explanation. My solution to this problem is to pass the buck to a cooperative neurologist who is quite trigger-happy in reporting demented patients to the Ministry of Transport.

In Ontario, seniors over age 80 aren't required to take a road test unless they have been in an accident. One healthy 90-year-old patient recently lost control of his vehicle and drove at high speed into four parked vehicles, resulting in two fractures and various soft-tissue injuries in the four people in his car. The police officer on the scene convinced him to give up his license.

Dr David Rapoport
North York, ON

LAND OF INEQUALITY
Your article "Canada's comeback kids vs America¹s new sweethearts" (Vol 1 No 8, page 18) poses an interesting question. Here in the US we have a care heavy system where most doctors deal with an enormous amount of paperwork, rushed visits, dwindling reimbursements, and an uneven system of referral. You can never be sure if the doctors you are used to referring to still accept a certain insurance or not.

Despite this, the quality of medical care in certain pockets, such as the top university hospitals, remains quite high. Private interests suck the money out of the system and are driven mainly by profit, as you might expect. So the technology is lavish in many places, but based on the ability to charge a lot for its use. Doctors aren't getting rich here right now, but patients suffer a far worse fate when they can't get adequate care. How does this compare to the current Canadian system? I'm not sure. But at least theoretically, a single payer system should remove a lot of the distortion and self-serving attitudes that contribute the most to the enormous rise in healthcare costs.

Dr Marc Siegel
New York, NY

For more on HMOs see Lie back and think of England

CLOSING UP SHOP
I've been reading your Practice Management section and would like to know if you could write an article on how to close a practice down. I would like it if you could include the steps that this would involve.

Dr Walter R Burgess
Saskatoon, SK

Your wish is our command. For steps on how to close down your practice see Shutting down your practice - Ed