personal computer in simplifying the physician's tasks. Finally it seems that computer software designers have been able to provide environments that mimic a user's desktop. The multitasking systems such as Desqview 386 and the latest release of Windows (version 3.0) have eased the task of continually switching between programs. An important technical point is that only computers built with the Intel 80386 (and higher) central processing unit (CPU) are capable of running Desqview 386. Desqview version 2.3 and the new Windows 3.0, however, are capable of multitasking on systems having the Intel 80286 CPU; both can probably run without problems all the programs that a physician would ever likely use, but a comparison of switching speed between Desqview and Windows has yet to be done. It is also important that the computer have at least 1 MB of main onboard memory for each program that you want to run simultaneously (e.g., 4 MB for four multitasked programs). The easiest way to "computerize" a new area is to find an existing system in another office that meets your requirements and transplant that configuration. Setting up a new system should involve a computer consultant to install and configure the hardware and software and a physician with a fair knowledge of computer systems (both hardware configurations and software limitations) to debug and fine-tune the user interface. That physician would also provide a resource for training new users and dealing with immediate system problems. Remember that "to err is human but to really mess things up takes a computer" (anon.). With the advanced and powerful computer hardware and software available today it should be relatively easy to implement computer systems with an appropriate 1162
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user interface to ease the largely is complex. I make no apologies computer-illiterate physician pop- for this. Physicians must abandon ulation into the electronic infor- the idea that there is an easy way mation age. out of this problem. Like any new area of knowledge it will take Allen R. Huang, MD, CM work to learn. Division of Geriatrics In reply to Dr. Kirshen, my Royal Victoria Hospital aggressive use was the path of Montreal, PQ least resistance. The hard disk speed was 16 ms with software [Dr. Davis responds.] cache. The 4-MB extended memoIn reply to Dr. Aizenman, a po- ry was remapped into expanded tent pill is a better metaphor. My with Desqview QFMM386, called natural bent as a physician is to an "expanded memory manager" persuade people that this bad-tast- by the manufacturer. The installaing pill will make them feel better tion program chose 460 K of later! Computers have revolution- memory, but 500 K avoided ized all aspects of our society. It is crashes. On starting Desqview an intellectual arrogance to think opening script loaded all tasks. that medicine is somehow un- Switching between tasks was done
touchable. Multitasking and the 386 computer are major new directions. The September 1990 issue of Byte has 28 full-page ads for the 386 computer. The October 1990 issue of PC Magazine has seven full-length articles on multitasking and productivity. My article shows that multitasking is cost-effective and thus increases productivity. It also improves the quality of practice by decreasing the intellectual energy needed to manage a group of tasks. In reply to Dr. Dindar, the keyboard bottleneck is very significant, but my computer tasks are not secretarial. Having more secretaries and computers won't help me find references, compose letters, make charts or plan treatment. I certainly agree with the KISS principle. My article quantifies the savings in intellectual energy when one uses multitasking and thus measures KISS. However, although control of this system is very simple, its implementation is not. To allow replication I have included technical data on setting up the system. Dr. Petreman need not assure me that all these tasks can take place simultaneously. My article describes my own experience. Unfortunately, like most current "high tech", the implementation
by scripts with the Desqview switch function. Time savings were minimal estimates, showing that the system at least paid for itself. Savings in intellectual energy were much more significant. I fully agree with the possibilities of networking and external databases but have not yet had time to investigate them. I agree with Dr. Huang that a computer consultant and a physician well versed in computers are necessary to install these systems. Gradually more physicians will become adept at managing them. Physicians must understand this technology if they want to use it in daily practice. Alan E. Davis, MD, PhD 302-132 2nd St. E Cornwall, Ont.
Medical ethics and women I n her reply (Can Med Assoc J 1990; 143: 249) to Dr. EikeHenner Kluge's article on ethics (Can Med Assoc J 1990; 142: 876, 879) Dr. Elizabeth J. Latimer disputes that the different views of women on these issues reflect only "gender and biology". She then invokes Gilligan's descrip-
tion of the fact that "women differ significantly from men in their manner of moral reasoning and weighing moral dilemmas".' First, we protest Latimer's use of the word "gender" when she means "sex". Gender is a purely linguistic term used in those languages that divide all nouns into two or more categories and assign names of obviously male creatures to one and obviously female creatures to another, the nouns that have no direct sexual connotation being randomly distributed between the categories. (The many exceptions - la sentinelle, le vagin, la verge; das
Weib, das Fraulein, die Schildwache - prove that the relation between sex and gender is tenuous.) Of more importance is the inconsistency of the feminist viewpoint. We thought that Kluge's position was the feminist one. Isn't it the feminist position that there are no differences between men and women other than those related to the procreative function? Isn't it the political and legislative purpose of feminists to have all discrimination between the sexes outlawed, even by constitutional means? You cannot have it both ways: either the procreative function is an isolated one that has no effect whatsoever on other physical and psychic processes, so that women think and judge in the ways that men do; or sexuality pervades many other parts of the organism (remember the sex hormone receptors in the brain), so that women's ways of thinking and reacting are different from those of men. In that case any attempt to enforce equality by law goes against nature. We wonder if a feminist theoretician could clarify where she stands. Herman J. Van Norden, MD Julia Van Norden, MD 2021 E 49th Ave.
Vanlcouver, BsC 1164
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Reference 1. Gilligan C: In a Different Voice. Psychological Theory and Women's Development, Harvard U Pr, Cambridge, Mass, 1982: 19
[The author responds.] Drs. Van Norden seem to have misunderstood the main point of my letter, perhaps because they are focusing rather too closely on semantics. I used the phrase "gender or biology" to denote the purely biologic aspects of what it means to be female. (My dictionary defines gender as "corresponding roughly to the two sexes".) I had meant to emphasize that this biology is only a part of what it means to be a woman in society (ours or any other). I then went on to refer to women's significantly different psychologic, sociologic and political life experiences, which may have an impact on the way they view, assess and evaluate matters of moral significance. There is no inconsistency in the feminist viewpoint, the goal of which is equality for women in terms of opportunity, choice and responsibility in the conduct of their lives. Various feminist authors will express these values from their own unique viewpoints. In my view sameness with men is not a goal. Equality, however, is fundamental. Drs. Van Norden are confusing the concepts of equality and sameness and their relationship to law. Women and men are not the same either in their biology or, perhaps, in their way of viewing major moral, ethical and other issues. However, they are equal particularly in the legal sense and their difference should form no basis for discrimination in our social structures or before the courts. (This concept is true for all members of society, no matter what differences exist between them.) Equality does not and should not necessitate sameness.
Contrary to Drs. Van Norden I would argue that our society can and must "have it both ways". We must learn to acknowledge, foster and value the differing viewpoints of men and women without fear. At the same time we must guarantee equality, particularly in legal, financial and social matters. "Different but equal" is the phrase that comes to mind. Elizabeth J. Latimer, MD Associate professor Department of Family Medicine McMaster University Hamilton, Ont.
Physician attrition and future manpower needs I n his article "New, validated totals of MDs in each specialty invaluable, CMA says" (Can Med Assoc J 1990; 142: 1419-1420), Patrick Sullivan comments on the projected physician manpower requirements for Canada and on the new, validated CMA database. What amazes me is that despite all the commentaries, studies and projections on the future requirements in Canada, none have seen fit to report an analysis or research on the expected attrition of physicians, particularly as related to age. A medical manpower study done in British Columbia some years ago analysed the number of physicians who were expected to reach the retirement age of 65 years and the effect of the increasing numbers of women graduates, some of whom do not take on a full-time practice.' From this analysis it was estimated that the current annual output of the University of British Columbia's medical school would not supply sufficient physicians to prevent a severe shortage by the year 2000. When a study of the attrition rate related to age was recently suggested to