CCFP VINDICATION
I was very excited to see your article on the possible revamping of the CCFP exam for practice-eligible candidates ("A doctor-centred approach to CCFP," Vol 4, No 14, August 30, 2007). As one of the unsuccessful practice-eligible candidates who complained loudly, I would like to thank the National Review of Medicine for exposing this problem back in your January 15, 2005 issue. I am sure this public airing of the issue has helped to encourage this move on the part of the College.

���� Paul Rainsberry [director of the CFPC education committee] states that failures are not endemic among practice-eligible candidates, but in the next breath refused to divulge the College's statistics as they would be "easily misunderstood"! How does he get away with such blatant hypocrisy? And how about some details on these failures? Do these older physicians fail the written medical knowledge part of the test? Or do they fail the oral, politically-correct attitude test? I was told that my failure was due to my "directive attitude"! Contrast this with a failure on any Royal College exam which is presented with statistics and details of exactly what areas of knowledge the specialist candidate is weak in. This allows for directed study and a better chance next time.

At the time of my failure, 2002, I was told that the College was unaware of any courses in my area, available to medical grads in patient-centred care. Now there is one course with 15 places for $1,000 each, fully booked for the foreseeable future. How helpful is that?

�� There is a lot of talk about "patient-centred care," implying that the alternative, which presumably�older physicians practise, is "illness-centred care." But how much of patient-centred care is really a reflection of our culture's current ideas about responsibility and power (both supposedly�completely vested in the physician). My experience of the oral exams was that the 'patient' had a secret that I was supposed to ferret out and deal with. Each examiner withheld information unless certain questions were asked. I have nothing but impatience for that. My patients are adults and capable of telling me what they need me for. I work very hard to be non-judgmental and understanding of all problems. Nothing upsets me, nothing disgusts me. Out here in the real world we respect our patients and their privacy. If you don't want to tell me your trouble, then that is fine with me. We also do not have unlimited time to 'interview' patients and figure out what they don't want to tell us. All of�these views,�I know, make me a dinosaur. And that is why I failed, not from lack of medical competence, or poor attitude. Just an older point of view.

�� The ironic thing is that what I really wanted was the CCFP-EM designation. My understanding of that exam is that you have to know your emergency medicine cold. That I can handle, but I have to be deemed to have the proper attitude before I can attempt the EM. I will be first on the list of applicants if the College actually does something to make it possible for older family docs to get their CCFP, and wish me luck on the EM. For that I'll need it!

Dr Barbara Watts, MD, Orangeville, ON

WHISTLEBLOWER KUDOS
Dr�Kevin Patterson has spoken up�about the trauma of war�in his Mother Jones article "Talk�To Me Like My Father" and I sincerely hope that he will not be disciplined for it (Physician writer faces court martial over story," Vol 4, No 14, August 30, 2007). We need more doctors to speak out. They know all about the suffering brought on by the atrocity that we call war. In fact, I think doctors from both sides of a conflict should get together and jointly issue statements on how horrible war actually�is. And, I almost hate to say this, but it may be high time that the public see photos of�the awful suffering the young men and women in the military endure. Maybe that would shock us out of our apathy.��

Mr Stan Penner,Landmark, MB

EDITOR'S NOTE: For an update on Dr Patterson's situation, please see "MD author off the hook: military".

TAXING SOLUTION
Regarding Dr Chaoulli's comment about doctors' greed in your Expert Roundtable on Michael Moore's SiCKO, "What does he know about our healthcare?" (Vol 4, No 13, July 30, 2007, page 1). Although the practice of medicine is a business, and physicians are business-people (salaried or otherwise), the message I heard in his comments seemed closer to resenting 'government interference'� in the patient-physician relationship as this related to being able to maximize personal profits.

In my view, tax cuts have directly contributed to the reductions in general availability and access to all publicly funded services, including health.�Now, we hear the wise doctors wanting to solve the problem by providing those persons earning the top dollars the opportunity to recoup the losses in healthcare by building a pay-as-you-go system right at home.�

It seems to me that those patients who can afford to pay for healthcare already have access to private investigations and treatments by simply travelling across the border to the US.�That means the real beneficiaries of increasing the potential for private earnings via direct patient billing would be the doctors, the corporations owning the private clinics and the shareholders.

I think that if Drs Gratzer and Chaoulli truly wish to improve access and care for all patients and address the concerns regarding remuneration for physicians, they should be lobbying for increased taxation and much increased government investment in publicly-funded human (particularly RN and MD) and physical resources eg ED, OR, ICU and hospital bed numbers.�Then doctors earning fee-for-service incomes could work to their hearts' content.

Jim Hillen MD FRCSC FRCPC, Kingston, ON

PS. Regarding the photos of the roundtable experts, on page 19:�Psychiatrist Dr David Gratzer, sporting a white coat and stethoscope draped around his shoulders a la med student/resident style, standing somewhere outside a clearly signed hospital emergency department, was particularly amusing.�I have yet to meet a psychiatric colleague dressed in such attire (outside of Halloween parties).�How about some sage 'pre-photo shoot' advice for the young doctor?

OUR STATS SHAME
Once again I take the National Review of Medicine to task for using non-SI units for lab test results in a Canadian publication. In the September 30 issue ("NRM Quiz 'Do you know your stats?,' Vol 4, No 16, page 9), how hard would it have been to divide the mg/100ml by 18 to get the correct SI units (used in Canada and the rest of the�non-US world) in question 3?

The numbers should read: Test A 7.2 mmol/l Test B 8.9 mmol/L

Your publication has a long way to go before it's considered "national" if the nation referred to is Canada.

Dr Mark S Silverman, Ottawa