Hippocrates reflect

Your “Hippocrates redux” editorial¹ was remarkable, not because it quite rightly concluded that a new vision is needed but because of the hyperbolic and questionable assumptions on which this conclusion was based.

While some members of the profession are doubtless “demoralized,” it is far from clear that the profession is. Yes, the profession is challenged, questioning, stressed and certainly overworked, but I dispute the generalization of demoralization.

Your allegation of “debilitating cuts in health care budgets” is inconsistent with the multi billion-dollar increases in my province's spending. Restructuring issues, structural inefficiencies and inadequate resources exist, but “debilitating cuts” is inaccurate.

It is true that more than a decade ago some experts posited that physicians were cost centres and thus their numerical reduction would save money. Since then I have not seen literature that seriously considers physicians in this light. Instead, they are viewed as scarce expert resources whose skills and knowledge require careful and functional deployment.

No evidence is presented that medical schools graduate their students with a “not-so-shiny degree.” While I dispute this in general, Queen's medical school continues enthusiastically to expend considerable intellectual resources on ensuring access of the best qualified and most appropriate candidates to an enriched and effective MD program. Our students are engaged in a curriculum that prepares these future physicians for a lifetime of critical inquiry, self-directed learning and confident practice. Our application numbers and offer/accept ratio [1.5:1] would suggest a functional program.

Few students graduate with “a debt of $100 000.” We are profoundly concerned about the effect of debt on our students — on access, diversion, fiscal viability and stress, and on debt's effects on career choice. We assess, track and address these influences, while we prioritize maximizing offsetting supports, grants and bursaries to those in need. Support for our students has tripled in the last 3 years to a 2001 total of $1.5 million. In the 2001/02 academic year, with tuition fees of $11 500, 10% of our students received grant/bursary support above $10 000, 25% received support between $8000 and $10 000, and another 36% received substantial support below $8000. Students are also eligible for student loans.

A journal that espouses the centrality of evidence in decision-making might consider the effect on an otherwise sensible conclusion of such mythical, unsubstantiated and incorrect assumptions.

David M.C. Walker Dean, Faculty of Health Sciences Queen's University Kingston, Ont.