in Preventive Medicine, agree with this direction for preventive medicine. Our association's 1990 national conference, to be held at Queen's University, Kingston, Ont., from June 28 to July 2, will focus on new patterns of health care emerging in the 1990s. Journey towards healing and wholeness through partnership is the theme. We hope that the conference, like Nova Scotia's participation in the World Health Organi-
zation's Countrywide Integrated Non-Communicable Disease Intervention program, will "facilitate communication . . . develop expertise in preventing noncommunicable disease . . . [and combat] the risk factors common to major chronic diseases". We look forward to an exciting debate. Leonard I. Levine, MD, DPH, CCFP President Canadian Holistic Medical Association
an eye surgeon who will do all of this and not risk having to fend for themselves for postoperative care, especially if they are from out of town. Canadian eye surgeons have been travelling to China to lecture and teach for almost 15 years. Doctors from Third-World countries are being trained on an almost continuing basis at universities across Canada. McGill University as well as other Canadian medical schools have programs for treating the northern native population. All of this without fanfare or feature articles in CMAJ. Marvin L. Kwitko, MD, FRCSC 5591 Cote des Neiges Rd. Montreal, PQ
[Dr. Gimbel responds.]
Dr. Kwitko's questions seem to be raised largely out of misinterpretation and supposition. We have renowned ophthalmologists from around the world visiting routinely. All of them It is 25 000 operations have expressed appreciation for and counting the understanding, compassion, for Dr. Howard Gimbel dedication and high quality of care given to our patients, as well erry Moran's recent article as the efficient systems and wellon Dr. Howard Gimbel trained staff, which maximize the (Can Med Assoc J 1989; physician's time. Many remark on 141: 710-711) raises more ques- the calm pace with which tasks tions than it answers. are performed. A surgeon's first responsibiliOur patients are certainly not ty to a patient is to take a careful left to "fend for themselves" for history and evaluate the chief postoperative care. We are preconmplaint, perform the necessary pared to do the follow-up for all of surgical procedure with care and our patients, and most of them do skill, and assess the patient peri- return for their postoperative odically to detect the earliest signs care. Referred patients often make of complications. Some believe arrangements, for their convethat the follow-up is as important nience, to have the referring ophas the operation. I do not doubt thalmologist do their follow-up. that Gimbel's operations are done Additionally, one of the Gimbel with care and skill, but the other Eye Centre's physicians is availsteps are obviously taken by peo- able to all of our patients 24 hours ple other than the surgeon, for a day, 365 days a year. Quality of who can do 22 operations a day care is an issue that heads the list and still have time to do proper of priorities at the centre, and this will continue for the years to follow-up examinations? Cataract patients must select come. 14
(AN MED ASSO(J 1990; 142 (1)
Finally, with regard to my travels to China and the training of Third-World doctors, I am certainly aware that other Canadian physicians are involved in similar projects. These aspects of the article were selected by the author, and not me, and certainly were not inserted for "fanfare". I invite Kwitko to visit the centre, at his convenience, to confirm any of these points. Howard V. Gimbel, MD, FRCSC Ste. 450, 4935 40 Ave. NW Calgary, Alta.
I ain't no obstetrician W hen reading Dr. Kevin Tompkins' whimsical article "I ain't no dentist" (Can Med Assoc J 1989; 141: 818) several thoughts crossed my mind. First, it was a dentist, Dr. Horace Wells, who discovered and gave to the world surgery without pain. In 1844, so intense was his sincerity to demonstrate relief for his suffering patients, that he instructed that his own molar be extracted while he was under the effects of nitrous oxide. Second, an elderly dental confrere has related to me some of his experiences in Canada's remote northern communities. Occasionally, in those early bush-plane years, the itinerant dentist was the only person available for medical emergencies. On two occasions the dentist was called upon to deliver babies under the most primitive conditions. I am sure my dental friend was prone to think "Why me? I ain't no obstetrician." In our chosen professions each of us is called upon to do what is best at a particular time. We don't always have a choice. P. Ralph Crawford, DMD Editor Journal of the C anadian Dental Association
Ottawa, Ont.
zation's Countrywide Integrated Non-Communicable Disease Intervention program, will "facilitate communication . . . develop expertise in preventing noncommunicable disease . . . [and combat] the risk factors common to major chronic diseases". We look forward to an exciting debate. Leonard I. Levine, MD, DPH, CCFP President Canadian Holistic Medical Association
an eye surgeon who will do all of this and not risk having to fend for themselves for postoperative care, especially if they are from out of town. Canadian eye surgeons have been travelling to China to lecture and teach for almost 15 years. Doctors from Third-World countries are being trained on an almost continuing basis at universities across Canada. McGill University as well as other Canadian medical schools have programs for treating the northern native population. All of this without fanfare or feature articles in CMAJ. Marvin L. Kwitko, MD, FRCSC 5591 Cote des Neiges Rd. Montreal, PQ
[Dr. Gimbel responds.]
Dr. Kwitko's questions seem to be raised largely out of misinterpretation and supposition. We have renowned ophthalmologists from around the world visiting routinely. All of them It is 25 000 operations have expressed appreciation for and counting the understanding, compassion, for Dr. Howard Gimbel dedication and high quality of care given to our patients, as well erry Moran's recent article as the efficient systems and wellon Dr. Howard Gimbel trained staff, which maximize the (Can Med Assoc J 1989; physician's time. Many remark on 141: 710-711) raises more ques- the calm pace with which tasks tions than it answers. are performed. A surgeon's first responsibiliOur patients are certainly not ty to a patient is to take a careful left to "fend for themselves" for history and evaluate the chief postoperative care. We are preconmplaint, perform the necessary pared to do the follow-up for all of surgical procedure with care and our patients, and most of them do skill, and assess the patient peri- return for their postoperative odically to detect the earliest signs care. Referred patients often make of complications. Some believe arrangements, for their convethat the follow-up is as important nience, to have the referring ophas the operation. I do not doubt thalmologist do their follow-up. that Gimbel's operations are done Additionally, one of the Gimbel with care and skill, but the other Eye Centre's physicians is availsteps are obviously taken by peo- able to all of our patients 24 hours ple other than the surgeon, for a day, 365 days a year. Quality of who can do 22 operations a day care is an issue that heads the list and still have time to do proper of priorities at the centre, and this will continue for the years to follow-up examinations? Cataract patients must select come. 14
(AN MED ASSO(J 1990; 142 (1)
Finally, with regard to my travels to China and the training of Third-World doctors, I am certainly aware that other Canadian physicians are involved in similar projects. These aspects of the article were selected by the author, and not me, and certainly were not inserted for "fanfare". I invite Kwitko to visit the centre, at his convenience, to confirm any of these points. Howard V. Gimbel, MD, FRCSC Ste. 450, 4935 40 Ave. NW Calgary, Alta.
I ain't no obstetrician W hen reading Dr. Kevin Tompkins' whimsical article "I ain't no dentist" (Can Med Assoc J 1989; 141: 818) several thoughts crossed my mind. First, it was a dentist, Dr. Horace Wells, who discovered and gave to the world surgery without pain. In 1844, so intense was his sincerity to demonstrate relief for his suffering patients, that he instructed that his own molar be extracted while he was under the effects of nitrous oxide. Second, an elderly dental confrere has related to me some of his experiences in Canada's remote northern communities. Occasionally, in those early bush-plane years, the itinerant dentist was the only person available for medical emergencies. On two occasions the dentist was called upon to deliver babies under the most primitive conditions. I am sure my dental friend was prone to think "Why me? I ain't no obstetrician." In our chosen professions each of us is called upon to do what is best at a particular time. We don't always have a choice. P. Ralph Crawford, DMD Editor Journal of the C anadian Dental Association
Ottawa, Ont.
