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ACP Governors briefed on Canadian health care issues

From the November 1996 ACP Observer, copyright 1996 by the American College of Physicians.

By Deborah Gesensway

TORONTO—During its fall meeting here last month, the College's Board of Governors learned about the upheaval underway in Canada's single-payer health care system and debated the pros and cons of evidence-based medicine.

During the three-day meeting, ACP's 90 Governors and Governors-elect also discussed College policies and priorities that ranged from the need for a position paper on gun violence to debate about whether ACP should develop a political action committee (PAC).

Canadian health care. C. David Naylor, FACP, of the Institute for Clinical Evaluative Sciences in Toronto, analyzed research on the effects of cutbacks now being made in Canada's national health care system. While the rationale for creating a national system was to provide equal access to health care for all, he said that the system is actually becoming more and more "uneven," with longer waits for procedures and less access to physicians and hospitals.

Although most Ontarians still report "good access to primary care," Dr. Naylor said, researchers have evidence that "those with higher incomes and education are more likely to receive specialist care." In addition, drug coverage varies from province to province, he said. Studies have found that Canadians who have prescription drug insurance see the doctor more and use more health care. Growing waiting lists for procedures such as catheterization, bypass surgery and hip replacement are also becoming a concern.

Nonetheless, Dr. Naylor said, the differences between the haves and have-nots when it comes to access—particularly to elective procedures—remain significantly narrower than those experienced in the United States. "The conclusion is that you [U.S. doctors] are doing too much, and we [Canadians] should be doing more," Dr. Naylor said.

Evidence-based medicine. At a presentation on the clinical informatics network used at McMaster University in Hamilton, Ont., internists discussed the pros and cons of evidence-based medicine.

According to R. Brian Haynes, FACP, editor of ACP Journal Club and a professor at McMaster, the goal of evidence-based medicine is to use "current best evidence from medical care research in making decisions about the medical care of individuals." He explained that putting evidence-based medicine into practice requires that physicians have quick and easy access to evidence when they are seeing patients.

While physicians try to incorporate evidence into their practices, however, they should remember that the evidence is frequently "necessary but insufficient" to help in the care of individual patients, explained Jonathan M. Ross, FACP, the College's Governor for New Hampshire. Evidence-based medicine can "result in simplistic algorithms of care that aren't helpful," he said.

The internist's public image. The Governors also had an opportunity to comment on the College's proposal to conduct a public relations campaign to improve the public image of internal medicine.

Janet Arneson, ACP's Vice President for Marketing and Communications, described market research showing that the majority of Americans do not know the difference between internal medicine and family practice. Only slightly more than half of all individuals surveyed said they thought it was appropriate to go to an internist for a routine physical, and only a third of women questioned said they thought women should go to an internist for women's health issues. The College plans to kick off the campaign this spring.


Resolutions: access, end-of-life care

As part of an evolving process for advising College leadership on matters of policy, the Board of Governors approved five resolutions.

The resolutions will be presented to the Board of Regents, the College's policy-making body, for follow-up or other action.

The Board of Governors recommended the following:

  • The College support "the elimination by all nations of nuclear weapons an other weapons of mass and indiscriminate destruction" and that this policy, if adopted be disseminated widely, including through such groups as the International Physicians for the Prevention of Nuclear War and the World Health Organization.
  • The College "continue to emphasize...through its various education programs...appropriate care at the end of life," including control of pain, family and other needs.
  • ACP endorse "the principle that health care plans should strive to provide mental health benefits comparable to coverage for other medical problems."
  • The College "reaffirm its present policy for universal access to and coverage for medical care" and "continue to participate in the health system reform debate."
  • Each future resolution include a financial impact estimate so Governors are aware of the financial impact of recommendations they vote to adopt.

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