- © 2008 Canadian Medical Association
From: The Ministry of Health
Dear Doctor:
A few months ago a survey by the Centre for Perpetual Surveys reported that physicians identify job stress as the primary obstacle they now face in the provision of quality health care for their patients. Furthermore, the centre noted, mental health-related disability claims on behalf of physicians rose to unprecedented levels last year. Sadly, suicide rates among physicians have also jumped and are approaching dentist-like numbers. A crisis is upon us, the Centre for Perpetual Surveys concluded, and although crises have been prematurely claimed before, this time they're pretty sure about it.
Physician societies and associations nationwide took note of this somber news. In response, the interested parties sat down together over a 3-martini lunch and, in a jaw-dropping show of co-operation, put differences aside and agreed to a multi-partisan task force to examine the issue.

Photo by: Fred Sebastian
The delegates set off to the tranquility of a countryside resort with a simple purpose: devise a plan to avert the gloomy Al Gore-type predictions, namely, a total health care meltdown, and to lower their handicaps into the single digits.
The conference opened with back-slapping optimism among participants. Nevertheless, security was tight — food tasters were brought in prior to each buffet meal — and, so as not to unduly alarm the public, shrouded in secrecy; reporters (actually there was only the 1 fellow) were barred from the resort. Fortunately, problems were averted by quick-thinking officials who crossed their fingers while announcing that the proceedings would be held in camera, which the scribe luckily took to mean that he could go home and watch the thing on DVD later at his convenience.
Unfortunately, the congratulatory mood did not last much longer than the first fairway where, according to eyewitness accounts, a nasty golf club swinging incident with matching 5-irons broke out between representatives from a prestigious medical association and an international non-governmental organization. In addition, hotel employees told us, the delegates' movie-on-demand and mini-bar bills were “spiraling hopelessly out of control.” Home offices were growing increasingly concerned and were flooded with 1, maybe 2 calls a week from a public demanding action.
That's where we came in. The Ministry ordered the task force down. Since no government funding had as yet been thrown at the problem, the Centre for Perpetual Surveys was given a blank cheque and asked to remedy the situation.
Herein you will find a copy of the Physician's Mini Sanity Scale, an ingenious self assessment tool that uses a series of seemingly incongruous questions, which, we have been assured, will precisely determine a practitioner's attitudinal and clinical makeup. In other words, the questionnaire assesses what the Centre for Perpetual Surveys calls “physician mental readiness” to perform their functions, thus identify which physicians are crumbling faster than crackers going into soup.
Please complete the attached questionnaire. It will take between 5 minutes and 4 hours to complete. In order to save time we ask that you not make any additional remarks in the comments section since they very rarely get read anyway. Further, we recommend that you not eat 2 hours before or 1 hour after taking the questionnaire as pilot studies have indicated a small but statistically significant increase in retching and vomiting among some participants. For symptoms persisting longer, please consult your family physician, if you have one.
You will be compensated for your time. For each unstained and completed questionnaire, you will receive a 2007 leather-like bound Day-Timer. We're well aware that it's now 2008, but if you simply cross out the calendar numbers for each day of the month and move them 1 square over until March, and then 2 squares over thereafter, since 2008 is a leap year, you should be fine.
Physician's mini sanity scale
Please fax or email your questionnaire to us immediately upon completion. All responses will be held in strict confidence. We do ask that you include your name, address and whereabouts for the next 24 hours.
Please circle 1 answer for each question. At the end, add up the numbers from each corresponding response to give you your Physician's mini sanity score.
Section 1: Attitudinal profile
A. My practice can best be described as:
1. Solo
2. Group
3. Mayhem
B. Which of the following statements best describes your feelings towards health care delivery?
1. Health care functions best when all providers work together with mutual respect.
2. The health care system operates well; it just requires a little tweaking.
3. I focus primarily on my patients and let the fancy-pants worry about it.
4. Every night before I go to bed I pray to the Almighty that lab test results ordered a month before somehow find their way into the correct file for a change.
C. Government can best support the health care system by:
1. Consulting frequently with physicians.
2. Funding the system based on best practice guidelines.
3. Appointing a committee chaired by a former premier to produce another inch-thick report that almost no one you know will read.
4. Privatizing the thing so we can start making some serious dough.
5. See 4 above.
Section 2: Clinical profile
D. In an effort to stay current on the latest trends in health care, I:
1. Set aside time every week to review medical journals.
2. Attend continuing education conferences and seminars.
3. Arrange for visits from pharmaceutical reps during my lunch break, providing they bring those veal sandwiches from the Italian joint down the street.
4. Watch House MD.
5. What's the difference, the world is going to end in a cataclysmic explosion any minute now.
E. The term “Loops of Henley” refers to:
1. Part of the complex filtration system of the kidney.
2. Let me put it this way: I made a decision early on in medical school. I was either going to study nephrology or neurology, but not both. I'll give you 2 guesses which one I picked.
3. The circuitous pass patterns run by former Hamilton Tiger-Cat receiver Garney Henley.
4. The Loops of who?
F. If a patient tells you that they are suffering from “their worst headache ever,” you should:
1. Arrange for an urgent CT scan in order to rule out a ruptured aneurysm.
2. Conduct a thorough neurological exam and treat accordingly.
3. Prescribe narcotic analgesics that the patient will never want to get off of.
4. Tell them it's nothing compared to the doozy you've been walking around with for the last year.
Section 3: Comments (OPTIONAL!)
Please limit your comments to the space provided_____.
PMS Score: ___
6-12 points: Fit for practice.
13-18 points: Counselling recommended. Repeat the questionnaire in 3 months.
19-25 points: Stop everything you are doing. Do not move a muscle. The authorities are on their way.
Thank you for your participation.