WAIT TIMES TRY FP'S PATIENCE
Your article "Clement impatient for wait times fix" (February 2008, Vol 5 No 2) is interesting in that neither NRM or the honourable Mr Clement look at the most fundamental problem with our current health care system: wait times to get a family physician!

In Peterborough, where I've practiced for nine years, the wait time to get an FP is measured in years. If wait times are such a huge priority for Mr Clement then why hasn't this situation changed?

I've watched over 38 of my family medicine colleagues leave practice over the past decade to work in emerg or walk-in clinics right here in the city. My own income has fallen and I adjust my activities yearly to rid myself of the least cost-effective tasks as I try to maintain my business.

I think Mr Clement needs to give his head a shake, clear out the cobwebs and get real.

Dr Ronald D Curtis, Peterborough, ON

LEAVE DECISIONS TO DOCS
Confused and muddled thinking surrounds the debate about compassionate end of life care. NRM's article "Who decides DNR cases — docs, families, judges?" (February 2008, Vol 5 No 2) is no exception. While Jocelyn Downie, a lawyer and expert in health law around end of life care, believes physicians do not have the skills and abilities to assess what is in a patient's best interest, I suspect that 99.9% of the time physicians — not lawyers or ethicists — are directly involved in the end of life decision making process and do in fact try to assess what is best for the patient. This assessment often involves shared decision making, but the decision that a medical treatment will not be effective is an expert one that cannot, by definition, be shared — only compassionately communicated to patients and their families.

Dr Stephen Workman, Halifax, NS

ABORTION 'DEATH CULT'
I was saddened to see Henry Morgentaler and his death cult followers in a recent issue of NRM "The Morgentaler decision turns 20" (January 15, 2008, Vol 5, No 1). The Hippocratic Oath taught us never to perform an abortion. Our ancestors understood this was the destruction of life. Unfortunately some physicians have forgotten the ancient prohibitions. Morgentaler has become a wealthy man by his actions. The law in Canada is there is no law. A child can be destroyed up to the time of birth.

I once asked Morgentaler whether abortion for sex selection or convenience was right. He replied it was not. He then went on to say he felt women should be able to abort for any reason. It is ironic that in the process many, many female children are aborted and the radical feminists feel this is some kind of victory.

Most Canadians want some limitations on the slaughter of the pre-born, yet Morgentaler and his indignant death cultists are not satisfied unless they can kill children at any stage of development.

I always find it sad that women, the givers of life, have now chose to assert themselves by destroying life.

Dr Roy Eappen, Montreal, QC

GOVERNMENT MELTDOWN
I have not heard of a single Canadian whose life was lost as a result of the shortfall in diagnostic radionuclides from the Chalk River nuclear plant described in "Political fallout follows isotope-production fix" (January 15, 2008, Vol 5, No 1). The spokesperson for our health district said physicians were excellent at using alternative tools to made diagnoses during the 'crisis.' Crises like Katrina or the tsunami are real; the Chalk River shutdown cannot compare.

The shutdown was in fact for routine maintenance and, as always, nuclear radioisotope reactors from other parts of the world raised their production levels to account for the shortfall. However, if a closure lasts too long the costs are too large to cover. NDS Nordion, the company that markets and sells the isotopes from Chalk River, was going to see considerable losses in an already unfavourable third quarter if the outsourcing continued, so the government ordered the reactor to restart. Was the entire 'crisis' then over money?

What a frightening possibility! Should I be diagnosed as paranoid when I suggest that population health was potentially sacrificed by the hands of politicians, whose hands shake the hands of business?

Dr Dale Dewar, Wynyard, SK

EMERGENCY HONOUR
Regarding "Is there a doctor on board?" (September 30, 2007, Vol 4, No 16), circa 1986 I was bound for LAX from Toronto on board an Air Canada flight. The pilot, notified of a passenger's distress, asked for help from medical personnel on board. Ten people stood up. A quick pre-evaluation conference in the aisle determined that I was the most appropriate physician to take charge. A nurse also stayed near the patient. A brief exam revealed cardiac arrhythmia and a weak pulse. The first medical bag that I was handed was worthless, containing only basic first aid equipment.The second bag could have doubled as a portable CCU, with a cardiac monitor, IV solutions, catheters and medications galore. With the diazepam alone I could have subdued a bull.

With verbal agreement from the heavily perspiring patient, I hooked up the monitor and discovered multiple PVCs. Since the pulse was weak, I decided an anti-arrhythmia drug was in order. It worked quite well, the patient began to look better and everyone was relieved. Relief did not last long. The PVCs returned soáI asked the pilot to take us down to 10,000 feet. He decided that it was 'all or none' — could the patient survive to LAX or not? I opined that an earlier landing would increase the chances of the patient's survival.

Within 10 minutes, we were on the ground in Las Vegas, Nevada. The patient was whisked away to hospital, where a CCU crew took over.

Three weeks later a package arrived from Air Canada, containing an outline of the patient's progress (no myocardial infarction, continuation to Hawaii and safe return home to Toronto)áand a plaque naming me an Air Canada Honorary Flight Surgeon for Service to a Fellow Passenger. That was better than any monetary remuneration.

Dr Clayton L Reynolds, Victoria, BC