ADVOCACY
CUL-DE-SAC
I'm writing in regard to the article "When
doctors have to play traffic cop" (February 15,
2007, Vol 4, No 3, page 6) about how to deal with patients
who are unfit to drive. As a general and occupational
physician I was very concerned about how the issue of
conflict of interest was dealt with in this article.
You write of the "moral dilemma" of reporting a patient
who the doctor had determined was unsafe to drive and
''trying to advocate for your patient's best interest."
I cannot think of an example where this would ever be
the case. If you've determined that your patient is
unsafe to drive, then clearly any physician advocating
for what is in the best interest of that patient would
not want them to.
This brings up the larger issue
of advocacy, which in my opinion is often misunderstood
by physicians as supporting the wishes of the patient,
when really it's supporting what's medically in their
best interest. This often results in a very different
conclusion.
In the CMA Code of Ethics the first
ethical consideration listed is "Consider first the
well-being of the patient." But the Code also tells
us we must "Recognize the profession's responsibility
to society in matters of public health." Clearly, if
the patient is unsafe to drive, then not driving is
the only decision an ethical physician can make and
there should be no sense of a conflict. If you always
keep in mind that this is also truly in your patient's
best interest it will help you deal with what I fully
acknowledge is an unpleasant situation.
Dr Ian Connell, Vancouver, BC
RateMDs
REBUTTAL
I've threatened to sue the owners of RateMDs.com because
of defamatory posts (See "How do you rate doc?", November
15-30, 2006, Vol 3, No 17, page 1). I just set up a
Google group if anyone wants to leave their thoughts:
http://groups.google.com/group/i-hate-ratemds/web/have-you-been-victimized-by-ratemds-com
Dr Terry Polevoy, Kitchener, ON
Editor's note: Turn
to page 1 for our interview with controversial RateMDs
founder, John Swapceinski.
A
MENTAL CHALLENGE
Here's what some of your colleagues had to say about
our February 15 poll question, "Quebec wants to place
much more of the responsibility for mentally ill patients
in the hands of GPs. Is this a step in the right direction?"
(turn to page 27 for full poll results and this issue's
questions):
- No. This would only work
if the fee schedule were drastically changed to allow
GPs to spend more time with patients.
- Yes. I'm busy, but my patients'
best interest comes first.
- No. I also don't think GPs
are well enough trained to manage mental illness.
Often they're causing as much damage as help by applying
simplistic models or doing a poor job of diagnosis.
They tend to slot patients into the illnesses they
can treat, rather than accepting and treating patients
for who they are.
- Yes. They are family practitioners
and need to be involved.
CORRECTION
Our article on laparoscopic gastric banding ("Gastric
banding woefully underused: ON surgeon," Vol 4,
No 3, p 25) incorrectly stated that the Lap-Band device
is not approved by Health Canada. In fact it is approved
for use but not for public reimbursement in any province.
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