Dr. Cowell implies that "dynamic unconscious" is a concept to be relegated to the psychotherapist's couch. In this she makes a crucial error, for it is precisely in the practice of the "hope, kindness and empathy" that Dr. Cowell advocates that an understanding of the unconscious can so much enrich one's clinical effectiveness. It is true that "the crisis of an unwanted pregnancy in a juvenile is a very 'conscious' event". So is the terror induced in a 45-year-old man by a myocardial infarction and none of us would deny that "hope, kindness and empathy" are important ingredients in the management of coronary patients. But it still follows that an understanding of underlying cardiac physiology is crucial and remains so, quite apart from whether or not one intends to upon coronary artery surgery embark D GERALD D. GRIFFIN, PHARM as a therapeutic modality. Assistant professor of clinical pharmacy College of pharmacy Events in the dynamic unconscious Instructor in family and community medicine School of medicine are responsible for the "underlying psyThe University of New Mexico chology" of unwanted pregnancy and Albuquerque, NM the physician who ignores this fact does so at his own and his patient's peril. Acupuncture It is precisely in the field of short-term To the editor: In his article "The acu- counselling, psychotherapy and supporpuncture mess" (Can Med Assoc J tive management that an understanding 112: 207, 1975) Dr. J. D. Wallace very of the dynamic unconscious has proved clearly and lucidly states the current so potent a tool for those of us who position in acupuncture except in one have taken the time and the trouble to acquire such understanding. respect. I have struggled, as have Drs. Cowell We believe that there is in this country "an acceptable clinical educational and Forrester, with the matter of "posiprogram for teaching acupuncture and tive, practical steps" to alleviate such that is the one offered by the Acupunc- crises. A number of us have taken this ture Foundation of Canada. In six in- search into a particular kind of group troductory seminars and one interme- training format wherein a psychiatrist diate workshop, over 300 doctors and meets with family physicians or mental dentists have been given instruction health professionals in an endeavour that is comprehensive and of high to discover those cherished "positive, quality. This program is offered to practical steps".1 We have had some members of the medical and dental success in these ventures. I very much hope that Dr. Cowell and other colprofessions in Canada. To extend our services in research leagues who attend to the "psyche" as and education, a new clinic was opened well as the "soma" will give the conin midtown Toronto on Mar. 3, 1975 cept of a "dynamic unconscious" the to allow doctors to observe and work scrutiny it deserves. under experienced senior members of JAMES HENDERSON, MD, FRCP[C] Department of psychiatry the foundation. The next introductory University of Toronto Toronto, Ont. seminar is scheduled for May 2, 1975. ELIE CAss, SA, MD References President
also remove any financial advantage from dealing directly with the patient. It is a threat and challenge to our own fee schedules. I hope that by the time this letter is published Grant Notley's bill will have been voted down. Nevertheless, the embargo against private practice already exists in Canada in the Province of Qu6bec. (The assassination of Pierre Laporte and subsequent state of national emergency stifled an intended strike by specialists). In January of this year the Saskatchewan government's "package deal" offered some valuable concessions long sought by the Saskatchewan Medical Association. However, it contained a clause to abandon "Mode 3" payments by the Saskatchewan Medical Care Insurance Commission (i.e. partial reimbursement to patients who have paid medical fees). At an extraordinary general meeting the profession overwhelmingly rejected this proposal, throwing out the good with the bad. The upshot of this is yet another lamentable precedent. The government of Saskatchewan will no longer pay, either to physicians or to beneficiaries, 85% of our fee schedule. Indeed, from what one can gather, the SMCIC's payment schedule may bear no visible relation to the SMA's schedule of minimum fees. To the patients who ask what proportion of fees they will be repaid, I can only vaguely reply "about 75%". The trend appears obvious. Under the biting pressures of inflation provincial governments can no longer afford to honour the promises to their beneficiaries to reimburse them a certain percentage of their medical fees. Unfortunately for many years most doctors (myself included) have allowed the public to think of "medicare" as a paymaster of medical salaries rather than a means of providing insurance coverage for patients' medical expenses. The time has come to reverse this trend. Thirteen years of medicare have bred complacence. I urgently recommend to my colleagues that we charge our patients for at least some of the services we render to them.
1. HENDERSON J: Training groups for public health nurses - a multiborough service. Can
Arcola, Sask.
and physician as sources of valid drug information. The pharmacist is the logical member of the health care team for this function. The physician has only to ask for this expertise, for it is readily available. He may be pleasantly surprised. In our clinic and department the clinical pharmacist is available at any time day or night for consultation; regularly publishes a drug newsletter; reviews the therapy of every patient; goes on rounds regularly; and gives lectures to the interns, residents and attending physicians and other department members about new drugs, with evaluation of their usefulness. It is interesting to note that the literature read by clinical pharmacists almost always parallels that perused by most physicians.
Acupuncture Foundation of Canada JOSEPH WONO, MD, s'xcp
Chairman Research and education committee Acupuncture Foundation of Canada Suite 228, 730 Yonge St. Toronto, Ont.
Wilful exposure to unwanted pregnancy To the editor: I would like to comment on the exchange between Dr. Carol Cowell and Dr. R.A. Forrester on the subject of "Wilful exposure to unwanted pregnancy" (Can Med Assoc J 112: 274, 1975).
J.E. MILLER, MD
Meni Health 21: 12, 1973
Extra billing
To the editor: Bill 210 has been introduced into the legislature of Alberta. If passed, it would have the effect of making it illegal for a doctor to charge any patient a fee higher than that paid by the Alberta Health Care Insurance Commission. This would result not only in the abolition of what in Alberta is called "extra billing" but presumably CMA JOURNAL/APRIL 19, 1975/VOL. 112 933
also remove any financial advantage from dealing directly with the patient. It is a threat and challenge to our own fee schedules. I hope that by the time this letter is published Grant Notley's bill will have been voted down. Nevertheless, the embargo against private practice already exists in Canada in the Province of Qu6bec. (The assassination of Pierre Laporte and subsequent state of national emergency stifled an intended strike by specialists). In January of this year the Saskatchewan government's "package deal" offered some valuable concessions long sought by the Saskatchewan Medical Association. However, it contained a clause to abandon "Mode 3" payments by the Saskatchewan Medical Care Insurance Commission (i.e. partial reimbursement to patients who have paid medical fees). At an extraordinary general meeting the profession overwhelmingly rejected this proposal, throwing out the good with the bad. The upshot of this is yet another lamentable precedent. The government of Saskatchewan will no longer pay, either to physicians or to beneficiaries, 85% of our fee schedule. Indeed, from what one can gather, the SMCIC's payment schedule may bear no visible relation to the SMA's schedule of minimum fees. To the patients who ask what proportion of fees they will be repaid, I can only vaguely reply "about 75%". The trend appears obvious. Under the biting pressures of inflation provincial governments can no longer afford to honour the promises to their beneficiaries to reimburse them a certain percentage of their medical fees. Unfortunately for many years most doctors (myself included) have allowed the public to think of "medicare" as a paymaster of medical salaries rather than a means of providing insurance coverage for patients' medical expenses. The time has come to reverse this trend. Thirteen years of medicare have bred complacence. I urgently recommend to my colleagues that we charge our patients for at least some of the services we render to them.
1. HENDERSON J: Training groups for public health nurses - a multiborough service. Can
Arcola, Sask.
and physician as sources of valid drug information. The pharmacist is the logical member of the health care team for this function. The physician has only to ask for this expertise, for it is readily available. He may be pleasantly surprised. In our clinic and department the clinical pharmacist is available at any time day or night for consultation; regularly publishes a drug newsletter; reviews the therapy of every patient; goes on rounds regularly; and gives lectures to the interns, residents and attending physicians and other department members about new drugs, with evaluation of their usefulness. It is interesting to note that the literature read by clinical pharmacists almost always parallels that perused by most physicians.
Acupuncture Foundation of Canada JOSEPH WONO, MD, s'xcp
Chairman Research and education committee Acupuncture Foundation of Canada Suite 228, 730 Yonge St. Toronto, Ont.
Wilful exposure to unwanted pregnancy To the editor: I would like to comment on the exchange between Dr. Carol Cowell and Dr. R.A. Forrester on the subject of "Wilful exposure to unwanted pregnancy" (Can Med Assoc J 112: 274, 1975).
J.E. MILLER, MD
Meni Health 21: 12, 1973
Extra billing
To the editor: Bill 210 has been introduced into the legislature of Alberta. If passed, it would have the effect of making it illegal for a doctor to charge any patient a fee higher than that paid by the Alberta Health Care Insurance Commission. This would result not only in the abolition of what in Alberta is called "extra billing" but presumably CMA JOURNAL/APRIL 19, 1975/VOL. 112 933
