698 Canadian Family Physician • Le Médecin de famille canadien dVOL 50: MAY • MAI 2004
Letters Correspondance
Maternity Centre and that they have discontinued its use. This seems like a very sensible idea, given that they report the women found the form to be
“intimidating, intrusive, and threatening.” I find these descriptors disturbing and wonder whether they came from many different women or from women with similar risk factors, eg, teenagers and substance users.
Drs Price and Shaw also comment, quite cor- rectly, that the population in PEI is very homo- genous. This made it ideal as a research site, yet, as mentioned in the paper, limited the generalizability of study findings.
Historically, the self-report form owes its gen- esis to feedback received during the pilot test of a very early iteration of the provider ALPHA form in Ontario in the early 1990s. Some immi- grant women, less proficient in oral than in writ- ten English, indicated they wanted a self-report version they could complete and return to their health care providers. Some of the prenatal nurses in the pilot study concurred. And some providers wanted self-report forms because of time consid- erations. Consequently, the self-report form was developed to correspond directly to the provider ALPHA, with scaling questions and space for writ- ten comments rather than open-ended interview questions.
It was never suggested or intended that one ver- sion of the ALPHA form be used to the exclusion of the other. Having different versions meant that providers could assess the women in their practice and determine which form was most suitable. It is my experience that many pregnant women crave time with their obstetrical provid-
ers. Using the provider ALPHA, which takes about 20 minutes to complete, is very satisfying for many women and gives them
“quality time” with their caregiv- ers. Providers can assess women and choose one version or offer women both versions and allow them to choose.
I agree that there are rich research possibilities with respect
to the two forms. I am currently involved in a study of the self-report form with substance-using preg- nant women. I am not aware of any adverse reac- tions in this group to the wording of questions on the form. A replication of the PEI study in the Maternity Centre of Hamilton would be inexpen- sive, fairly simple, and ultimately fascinating. I would be happy to work with Drs Price and Shaw to see whether the same results are forthcoming.
—Deana Midmer, MED, EDD Toronto, Ont
Choosing our values
T
he CFPC Committee on Ethics thanks Dr Alan Katz for his thoughtful and compre- hensive letter1 about our paper Family Practice Concepts and Values: Benchmarks for Health Reform. We would have enjoyed having him working with us on its composition. He pro- foundly appreciates the urgent need to define these issues and work toward their incorpora- tion in the health care plans that will dictate our professional life.His point that the “Ethical Apgar Score” is an oversimplification in that it gives equal point scores to several major concepts and values with- out grading their weight is well taken. But the scoring system is only a tool for initiating analy- sis and discussion. In the Newborn Apgar Score, is muscle tone really as important as heartbeat or respiration? Yet they are all equally weighted as two points out of 10. The Ethical Apgar Score is a slightly ironic introduction to the more formal discussion offered in our website paper.
It is heartening for all of us to know that there are people out there reading as carefully and thoughtfully as Dr Katz.
—Michael Malus, MDCM, CCFP, FCFP, for the CFPC Committee on Ethics Reference
1. Katz A. Debating the values of family medicine [letter]. Can Fam Physician 2004;50:538-41.
