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Stoned by lack of evidence

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Correspondance  Letters

In larger cities and towns, surely it makes more sense to have hospitalists, up-to-date and skilled in the appropri- ate areas, see patients in hospital.

I understand and agree with the idea of continuity of care for patients. I recognize that this is an important value that the proponents of “full” comprehensive care espouse.

But I’m surprised that there is no dialogue about equivalent values of prudent resource management and excellence and how to balance these within our system.

What is a family doctor? Someone who provides con- tinuity of care across all illnesses and age groups, or someone who focuses on ongoing care, with expertise in chronic and preventable illnesses? Or both? There must be room for more discussion, respect, and consid- eration than we have had in the past.

—Sophie Wilson MD CCFP Guelph, Ont by e-mail

Moving story

T

oday I saw a patient in the office for her annual checkup and Pap test. That was nothing unusual, except that she lives in Portage la Prairie, Man, and my office is in Victoria, BC. She had moved from Victoria to Portage la Prairie in August and had tried to find a family doctor.

She visited the 3 family doctors who were accepting new

patients, only to be told by all 3 that she was “too compli- cated.” This patient is a friendly 31-year-old woman. She had a nephrectomy (for a non-functioning kidney) and she had a stroke 3 years ago (from which she recovered fully).

She would like to start a family with her husband, but she believes she cannot do this because she has no family doctor, and therefore no medical care, in her community.

She had to come back to Victoria for her checkup, and she is probably going to leave Portage la Prairie to move back to Victoria because she cannot find a doctor.

This got me thinking. I know that she is not the only person in Canada in this situation. What has our medi- cal system become? What happened to universal health care? What about the Hippocratic Oath? I am ashamed that there are so many doctors who refuse to see patients just because they have health problems—aren’t they the patients who need doctors?

—Melina Thibodeau MD CCFP Victoria, BC by e-mail

Stoned by lack of evidence

I

n the debate on medical marijuana in the December 2006 issue,1 Dr Ware wrote, “Cannabis has not yet been formally evaluated in clinical trials.” His conclusion that “there is solid scientific rationale for therapeutic use

FOR PRESCRIBING INFORMATION SEE PAGE 360

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218

Canadian Family PhysicianLe Médecin de famille canadien Vol 53:  february • féVrier 2007

Letters  Correspondance

of cannabis” is therefore not supported by the informa- tion that he provided.

Robert Shepherd, Victoria, BC by fax reference

1. Ware M. Is there a role for marijuana in medical practice? Yes [Debate]. Can Fam Physician 2006:52:1531-3 (Eng), 1535-7 (Fr).

Response

D

r Shepherd is correct to point out the gap between sci- entific rationale and clinical evidence, and physicians certainly need more information than was permitted in the debate to formulate their own positions on medical mari- juana. My contribution should not be interpreted as defini- tive, but should be seen for what it was: one perspective suggesting that cannabis has potential therapeutic value.

More clinical research is needed to determine the true risk- benefit ratio for clinical use of cannabis.

—Mark Ware, MB BS MSc Montreal, Que by e-mail

Correction

U

pon review of our recently published article, “Cancers related to genetic mutations. Important psychosocial issues for Canadian family physicians” (Can Fam Physician 2006;52:1425-31), we realized that we had neglected to include the option of transvaginal ultrasound examina- tion within the ovarian cancer surveillance options in Table 1. As ultrasound examinations are standard surveil- lance practice among high-risk women, recommended by Cancer Care Ontario (management options for heredi- tary cancer at www.cancercare.on.ca), the US Preventive Services Task Force, and the National Society of Genetics Counselors, we thought it important that readers be made aware of our error.

We apologize for any inconvenience.

—Tara Power, LLB, PhD

—John Robinson PhD RPSYCH, Calgary, Alta by e-mail

Make your views known!

Contact us by e-mail at letters.editor@cfpc.ca, on the College’s website at www.cfpc.ca, by fax to the Editor at 905 629-0893, or by mail.

Canadian Family Physician

College of Family Physicians of Canada 2630 Skymark Ave, Mississauga, ON L4W 5A4

Faites-vous entendre!

Communiquez avec nous par courriel : letters.editor@cfpc.ca, au site web du Collège : www.cfpc.ca, par télécopieur au Rédactrice à 905 629-0893, ou par la poste.

Le Médecin de famille canadien

Collège des médecins de famille du Canada 2630 avenue Skymark, Mississauga, ON L4W 5A4

FOR PRESCRIBING INFORMATION SEE PAGE 342

January / janvier 2007

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The College of Family Physicians of Canada Le Collège des médecins de famillle du Canada Canadian Medical Association • Association médicale canadienne

The Royal College of Physicians and Surgeons of Canada Le Collège royal des médecins et chirurgiens du Canada

Canadian Family Physician

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