Fourth-Year Medical Student Takes Donner Prize

News and analysis Fourth-year medical student takes Donner Prize When the winner of the Donner Prize for the best book on public policy was announced prematurely last month, many people couldn’t believe who had won — including the author himself. It took a call from a Toronto reporter to convince 25-year-old David Gratzer, who graduated from the University of Manitoba’s medical school this spring, that he had won the $25 000 first prize. His competition included 6 professors, 1 of them a federal cabinet minister. Gratzer’s book, Code Blue: Reviving Canada’s Health Care System, takes an insider’s look at problems besetting that system: hallway medicine, long waiting lists for cancer treatment, a shortage of high-tech equipment, the movement of Canadian doctors to the US. Gratzer’s brother, a psychiatrist, has already relo- David Square cated to the US. Dr. David Gratzer: patients overconsume, doctors overprovide Gratzer said family discussions about the poor state of medicine in Canada and To resuscitate this "very bureau- Gratzer said there would then be in- his own rotations in medical departments cratic, very expensive system,” he sug- centive to spend the money wisely: at the prompted him to write the book. His ar- gests a system of individual medical sav- end of the year, money left in the ac- ticles on health care in Canada have al- ings accounts that is already in use in count might be rolled over into a retire- ready appeared in several newspapers. parts of China, Singapore, parts of the ment savings plan that would continue to A major theme in his book is the US, and South Africa. "In Canada, in- grow. People would also be required to need to improve health care in Canada stead of spending $700 per year on purchase catastrophic health insurance to by improving the doctor–patient rela- health services for a young, healthy cover extraordinary medical expenses. tionship. "The way we've structured male, the Canadian government would Gratzer plans to spend part of his medicare has corrupted this relationship give me that money to put into a sav- $25 000 prize on gifts and birthday par- by allowing patients to overconsume ings account. Out of this account I ties for his niece and nephew; the rest will health services, doctors to overprovide would pay for minor day-to-day ex- go toward covering costs during his psy- services and health administrators to be penses such as seeing my family doctor chiatry residency at Mount Sinai Hospital accountable to no one,” Gratzer says. or getting an x-ray.” in Toronto. — David Square, Winnipeg cern, except for individuals who receive foxes and, more recently, raccoons in the lip by a bat when it flew in her extended or severe exposure, perhaps Ontario are all vectors for the disease bedroom via an open skylight. Two by spending time in a cave filled with — their ability to get into homes and hospitals failed to advise the girl’s par- bats.) cottages makes them a special concern. ents that she should receive immediate But while the method of transmis- Although the prevalence of rabies in RPEP. Fortunately, the parents con- sion may be up for debate, the response bats is less than 1% in random surveys, tacted their local health unit and the is clear. Once exposure has been veri- it is somewhere between 5% and 10% girl received prophylaxis. The bat fied, patients should be offered the in bats submitted for testing, probably tested positive for rabies. standard prophylaxis even if it is many because sick bats are more likely to “We clearly need to get the informa- days after the exposure, because the in- come into human contact. tion out to more health care workers,” cubation period for rabies varies. Still, the message is not always get- Skowronski says of the case. “Rabies is Although bats are not the only car- ting through to physicians. Last year, not a disease you take chances with.” — riers of rabies in Canada — skunks, an 11-year-old BC girl was bitten on Daphne Gray-Grant, Vancouver CMAJ • JUNE 27, 2000; 162 (13) 1863.

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