advocated a smoke-free society; however, I would like to move toward a smoke-free and a cleanair society. Working together we may attain this goal, as long as we can control the criminal spin-off resulting from excessive taxation. Edward Napke, MD Nepean, Ont.

Training physicians to be administrators Tn he article "Can physicians afford not to get involved in hospital administration?" (Can Med Assoc J 1992; 146: 751-754), by Dr. Peter P. Morgan and Lynne Cohen, makes many references to the master's in health administration (MHA) pro-

gram at the University of Ottawa. Yet not a single current full-time professor in the, program was quoted or interviewed for the article. I strongly resent the unexamined and gratuitous denigration of the MHA program by people who are basically nonentities or passe in our field. Most of the physicians who have gone through our program would concur with the view of Dr. Catherine McCourt (one of our alumni) that the program "offered her everything she wanted, and exposed her to the expertise and points of view - of other medical and nonmedical professionals." Our MHA program is currently being taken by two physicians and a dentist. Managerial and administrative positions in health care should be filled by people with the requisite knowledge, experience, skills and competence. In general,

such people do not need to be physicians. However, in any job calling for the direct management of a clinical function the person with both the clinical background and the managerial training would have a decisive edge over someone without clinical training. For such specialized and focused positions, the training program run by the Physician Manager Institute may be preferable and is certainly cheaper than a 2-year MHA program. In general, managerial or administrative positions in health care should not be reserved exclusively for physicians, since a broad range of nonclinical skills and experience is required for effective performance. Physicians who have broadened their base are eagerly sought, but there is no single best way to train them for such positions. Morgan and Cohen fail to

Benadryl Children's Liquid 100 mL (6.25 mg/5 mL). Itch relief for children of all ages. Color, sucrose and alcohol free!

j ±

DIPHENHYDRAMINE HYDROCHLORIDE CAPSULES U,SP. Benadryl95mg cpsules. Adult itch relief in packages of 12 and 24.

Rapid Relief of Itch from Allergic Reactions and Hay Fever

26519

Recommend

provides rapid reliable relief with an onset of PHSCA'HOLN®B n d y action of under 30 minutes and peak activity in 1-0-6-81(diphenhydramine hydrochloride) sca h one hour.2'3So when patients, big or small, areStrsfo PARKE-DAVIS~~~'1 itching for relief, Benadryl can treat them all! Ontario M1L2N3 Scarborough, Wre-Lmer omay Pre-ai DiiinWanrLm fCndic.uhue

For prescribing information see page 1 00 JULY 1, 1992

CAN MED ASSOC J 1992; 147 (1)

19

appreciate the purpose and nature of MHA programs in Canada. They are not "hospital administration" programs, as labelled in the article. The hospital content has diminished rapidly over successive redesigns of the curriculum in keeping with current and anticipated changes in the health care system and policies in Canada. Furthermore, MHA programs are required to meet the content areas specified by an international accrediting body. This means that we cannot focus exclusively or overly on, for example, health policy and cost-effectiveness studies, as a centre of excellence set up for such purposes can. Curricula rarely satisfy everyone fully, and there is always some disagreement over content and emphasis. Clearly physicians are increasingly interested in a wider range of issues, including management, administration, policy analysis and development, program planning and evaluation, economics, financial management, ethics, law, information systems, labour relations, system design and organization, the multifaceted determinants of health, epidemiology and so on. The MHA programs have a much wider mission than the article implies, selecting the business and specialized courses most relevant to the future health care system in Canada. The Ottawa MHA program has recently extended its number of compulsory and optional business administration courses. The article "Taking care of business: MDs in search of management skills turning to MBA courses" (ibid: 743-747), by Anne Gilmore, noted the growing interest among physicians in master's in business administration (MBA) or executive MBA programs. The Faculty of Administration at the University of Ottawa is offering an executive MBA commencing September 1992. The market response has been 20

CAN MED ASSOC J 1992; 147 (1)

excellent, and four physicians are parents cannot be counted on to included in the first class. care for their children and that all parenting decisions would have to Pan Manga, PhD pass through some filter of advoProfessor cacy to ensure that parents are Colin M. Lay, PhD acting in the best interests of their Associate professor children. Clearly, we do not govMHA Program Faculty of Administration ern our society that way but, rathUniversity of Ottawa er, have a system that identifies Ottawa, Ont. those children at risk and provides a structure for appropriate intervention and caretaking. Besides being an onerous, inand technically cumbervasive Ontario's proposed some piece of legislation, Bill 743 consent laws: is based on assumptions that con2. Advocacy flict completely with the reform of long-term care. The latter assumes W M , ' r. Sujit Choudhry and that family members will be and Dr. Peter A. Singer were presumably should be more revery generous in their sponsible for the caregiving recriticism of the Ontario govern- quired to maintain physically and ment's proposed Advocacy Act cognitively compromised frail el(Can Med Assoc J 1992; 146: derly people in the community.4 1165-1168). They noted some imAt a time when there is proportant points: a lack of true fessional controversy as to the knowledge of the numbers of benefits and drawbacks of discusspeople who are vulnerable and for ing the diagnosis of dementia with whom there are no committed people so afflicted' the Advocacy caregivers, the potential need and Act unnecessarily and clumsily ineffectiveness of universally ap- vades this complex and sensitive plied legislation, and the substan- field. The legislation as written tial associated costs at a time should be deleted. The companion when there are major deficiencies bills, on consent to treatment6 and in many parts of the health care substitute decisions,7 should be modified to meet the needs of and social service systems. I believe that the authors those without dedicated and commerely touched on the most com- mitted caregivers who are recogpelling reason to oppose the legis- nized as being vulnerable and at lation as conceived and written. risk. The Advocacy Act assumes the very worst of families and health Michael Gordon, MD, FRCPC care professionals."2 It presumes Head Geriatric and internal medicine that most families and physicians Baycrest Centre for Geriatric Care cannot be counted on to care for, North York, Ont. with dedication, commitment and honesty, people who have demen- References tia and similar disorders without the intrusion of government- 1. Gordon M: Exploring the impact of proposed advocacy legislation. Ont Med appointed advocates. It paterRev 1992; 59: 37-39 nalistically discredits the essence 2. Ontario, Legislative Assembly, Standof the family structure in Ontario ing Committee on Administration of Justice: Advocacy Act, 1991 and comand minimizes the dedication that panion legislation. In Hansard, no. physicians traditionally have had J-1797 to J-1802 (Feb 13, 1992) to vulnerable patients. 3. Bill 74, An Act Respecting the Provision The-principles espoused in of Advocacy Services to Vulnerable Persons, 1st Sess, 35th Leg Ont, 1991 the Advocacy Act imply also that LE ler JUILLET 1992