Doctors and patients in the health care debate
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* Terry Wuerz

I appreciate Albert Schumacher's eloquent appraisal of Canadian physicians' attitude to their work, which is overwhelmingly to put patients first.1 Schumacher, President of the CMA in 2004/05, writes that Steven Lewis' commentary in the same issue of *CMAJ*2 is “misguided and misleading.” However, it is the CMA's article, not Lewis', that is misleading.

Lewis has invited physicians to play a leading role in accelerating necessary change in our current single-tier health care system. The debate over whether single-payer medicine will continue to be the preferred system in Canada requires knowledgeable champions of our current system (i.e., physicians). Instead of acknowledging this need, Schumacher smoothly shifts focus by quoting several instances of the CMA's support for the Canada Health Act. While this is certainly a related issue, support for the Canada Health Act is not the same as support for single-tier medicine.

Schumacher writes, “Assertions that doctors are leaving people to wait longer for personal gain are untrue and offensive to Canadian doctors.” While fairly confident that no physician would do such a thing consciously, I am less sure that wait lists are being properly managed. Many physicians feel pressured by their health authorities to maintain a wait list that is not significantly below the status quo. Further, as a medical student I am all too aware of the fact that logistical education in such areas as queuing theory is sadly lacking in medical education. Lewis' commentary indicates the glaring lack of a comprehensive set of professional guidelines that would eliminate the need for every physician to have to micromanage these wait lists. Canada would do well if more physicians were to heed his call.

## REFERENCES

1.  1. Schumacher A. Doctors put patients first in health care debate [editorial]. CMAJ 2005;173(3):277-8.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzMvMy8yNzciO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTczLzExLzEzNTcuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Lewis S. Physicians, it's in your court now [editorial]. CMAJ 2005;173(3):275-7.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzMvMy8yNzUiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTczLzExLzEzNTcuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)