For the Record

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Clinical Epidemiology & Biostatis- who helped establish the private ambu- For the record tics, New Democrat (Ancaster-Dun- lance services company Canadian Med- das-Flamborough-Westdale) ical Response; New Democrat Peter Ju- Apology measures • Dr. Eric Hoskins, general medicine/ lian (Burnaby-New Westminster), epidemiology, War Child Canada executive director of the Western Insti- proliferate president, youngest ever recipient of tute for the Deaf and Hard of Hearing; United Nations Association in New Democrat Brian Masse (Windsor Canadian physicians seeking to im- Canada’s Lester B. Pearson Peace West), a long-time activist for the dis- prove the way they communicate with medal, Liberal (Haldimand-Norfolk) abled; and Bloc Quebecois Jean-Yves patients who’ve been harmed are get- • Dr. Benson Lau, family physician, Laforest (Saint Maurice-Champlain), ting plenty of assistance this year as Conservative (Scarborough Agin- former psychomotor rehabilitation spe- provincial governments and national or- court) cialist at the Trois-Rivières Regional ganizations unveil measures to promote • Dr. Robert O’Connor, family physi- General Hospital. accountability and transparency. cian, Green Party (Bonavista-Gan- Among newcomers to the House Ontario and Alberta will likely be- der-Grand Falls-Windsor) with a measure of health-related experi- come the fourth and fifth provinces, re- • Dr. André Sylvestre, family physi- ence are: Liberal Kirsty Duncan (Etobi- spectively, to pass “apology acts” after cian, Green Party (Pontiac) coke North), associate professor of introducing legislation in October. • Dr. Lionel Traverse, pediatrician, health studies at the University of And earlier this year, guidelines for Liberal (Abbotsford) Toronto; and New Democrat Glenn disclosing harm to patients were re- • Dr. Georgina Wilcock, chief of the Thibeault (Sudbury), a former manager leased, separately, by the Canadian Pa- Scarborough Hospital Department of residential programs for the handi- tient Safety Institute and the Canadian of Obstetrics and Gynecology, capped. Medical Protective Association. Green Party (Don Valley West) Almost as sparse as health profes- • Dr. Martha Jo Willard, pathologist, sion representation in the House of Liberal (Brandon-Souris) Commons were actual health policy Faring even less favorably than commitments made on the hustings, physicians were nurses. Of 22 candi- particularly from Harper’s Conserva- dates with a nursing background, just tives, who essentially took no stance on one, Conservative Cathy McLeod 10 health issues during a CMAJ election (Kamloops-Thompson-Cariboo), the survey (CMAJ 2008;179[8]:757-8). former mayor of Pemberton, British Among the few commitments made Columbia, prevailed. by the Conservatives were modest As health professionals, physicians measures to address the shortage of

and nurses will lag well behind lawyers doctors and nurses, including: Photos.com (50) in Parliamentary representation. • $10 million per year over 4 years to They also trailed political aides (32), fund 50 new residency spots in Apology legislation aims to promote “open and frank” discussion. teachers (17), farmers (16), journalists teaching hospitals (7) and restauranteurs (5) but matched • A $5 million fund to attract Cana- policeman (4) and chiropractors (4). dian physicians practising abroad to The guidelines and the provincial The 4 chiropractors all served in the return to Canada. The Conservatives laws complement each other, since the past Parliament: projected the fund would result in intent of the latter is to “remove con- • Colin Carrie, Conservative (Os- the repatriation of 300 physicians cerns about potential legal liability and hawa) over 4 years other sanctions” when health profes- • Ruby Dhalla, Liberal (Brampton- • $5 million over 3 years to “develop sionals tell patients about harm, says Springdale) recruitment and retention strategies Brent Windwick, chair of the Institute’s • Gary Goodyear, Conservative for the nursing profession.” legal and regulatory affairs advisory (Cambridge) Other Conservative commitments committee. He warns that apology leg- • James Lunney, Conservative were extremely broad in nature. islation doesn’t remove the need for ef- (Nanaimo-Alberni) Harper’s platform promises to “continue fective and thorough training for health Dentist, Christian missionary and to take creative measures to tackle major professionals about how to tell patients Conservative Harold Albrecht (Kitch- lung, heart and neurological diseases.” about adverse events, but it will “re- ener-Conestoga) was the only other The new government also vows to end move a significant source of hesitation” health professional elected to Parliament. discriminatory life insurance practices about speaking to patients who’ve suf- But several other Members of Par- and crackdown on tobacco advertising fered harm. liament do have at least a measure of in print and electronic media reached by British Columbia was the first experience in dealing with health is- children. — Wayne Kondro, CMAJ province to pass an apology act, in sues. Re-elected were: Conservative 2006, with Manitoba and Saskatchewan Diane Finley (Haldimand-Norfolk), DOI:10.1503/cmaj.081688 following suit in 2007.

It’s too early — and may never be The report, Primary Health Care: est countries, where governments spend possible — to credit Canadian legisla- Now More Than Ever, asserts that up to 300 times less per person on tion with having a clear impact on the many nations view health care prima- health care. The WHO claims the gap in number of medical–legal cases, says rily as the delivery of biomedical inter- access to care is greatest in areas that re- Dr. William Tucker, president of the ventions and largely ignore the value of gard health care as a commodity for protective association. effective prevention. The WHO claims generating profit. Another problem, the But expressions of sympathy can im- this is why health care inequalities be- report claims, is that health care organi- prove relations, he adds. “Families feel tween and within nations are greater to- zations in many countries tend to focus better if there is an acknowledgement that day than they were 30 years ago. too much on individual diseases. — there has been an adverse event” and, af- According to the report, people in Roger Collier, CMAJ ter expressing regret and sympathy, it the richest countries can expect to live may be easier for a physician to carry on 40 years longer than people in the poor- DOI:10.1503/cmaj.081677 the therapeutic relationship. Canadian apology legislation is broader than legislation in some Aus- tralian and US states where laws deal National health human resources only with “expressions of regret” and stop short of addressing the issue of plan “a hard sell” apology, says Windwick. In August, the Canadian Medical amping up the number of med- Health Care Renewal has been ear- Association and its provincial and terri- ical school spots without devel- marked for education. torial counterparts voted to jointly Roping a national health human re- What’s needed is a mechanism to lobby governments for appropriate sources plan could perpetuate the monitor the number of trainees, conduct apology legislation in all Canadian ju- boom-and-bust cycle of the past few research and “provide careful recom- risdictions. — Ann Silversides, CMAJ decades, says the president of the Associ- mendations to help us plan our health ation of Faculties of Medicine of Canada. human resources into the future.” Simply hiking enrolment doesn’t an- The European Union is working to WHO report swer vital questions such as how to in- harmonize its health human resource tegrate doctors into team-based models planning and Australia, where health Countries must focus on primary care of care or determine the appropriate care responsibility lies at the state level, to address the growing gap between the scope of practice for health care work- has taken a federal approach to plan- world’s rich and poor in health care ac- ers in order to avoid overlap, says Dr. ning, Busing notes. cess, costs and outcomes, the World Nick Busing. But the federal leadership In the early 1990s, medical school Health Organization (WHO) says in its and support that is needed to develop a spots were cut without adequate analy- annual report on world health. central planning mechanism is missing sis of issues such as the aging physi- “The world health report sets out a and developing a national plan “is a cian workforce, shifting morbidity pat- better way to manage and deliver hard sell with this government.” terns and changes in doctors’ roles. health care,” said WHO Director-Gen- “For them, health care is a provin- “I’m concerned that now we are eral Dr. Margaret Chan at the report’s cial issue, but I would argue they ramping up again, but we still haven’t Oct. 14 launch in Almaty, Kazakhstan. should be leading the discussion.” done the analysis. We are reacting to “Primary care is a people-centred ap- Busing says medical school teaching legitimate needs, but again we aren’t proach to health that makes prevention resources are already strained, because doing this in an evidence-based way,” as important as cure.” of recent increases in the number of stu- says Busing. dents and the shift to regional campuses. The need for a pan-Canadian ap- First-year medical school enrolment proach to health human resource plan- spots increased by 63% in the decade ning was emphasized in the final report ending in 2007-08 (to 2569 spots from of Task Force Two, the multi-stakeholder 1577), and the satellite campus ap- 2006 group that examined physician hu- proach has meant a “bringing on board man resource strategy for Canada (CMAJ a whole new cohort of teachers.” 2006;174[13]:1827-8). About one-third of Canada’s doctors “Jurisdiction-specific policies are already assume clinical teaching roles, appropriate where systems of health but many lack formal training in peda- care are completely separate. However, gogy, and support and remuneration are Canadian health care systems have a Reuters / Beawiharta variable, according to the association. high level of inter-dependency,” the re- The 2008 world health report says Busing notes that none of the federal port states.— Ann Silversides, CMAJ health inequities among nations are money transferred to provinces under growing. the 2003 First Ministers' Accord on DOI:10.1503/cmaj.081710