Competencies required for the practice of geriatric medicine as a consultant physician.

Geriatric medicine in Canada is now being viewed not merely as an academic specialty but, rather, more broadly as a service specialty providing consulting support to other physicians. Any redesigning of training programs will have to be done with this fact in mind. We drew up a list of competencies required for consultant practice in the field and presented them to other practitioners of geriatric medicine and members of the Canadian Society of Geriatric Medicine for feedback. We believe that the resulting list of competencies can be used as a starting point for redesigning training programs in geriatric medicine.     

The young physician: types of practice.

An inquiry was conducted into the type of practice (whether solo, group or salaried) entered by young physicians graduating from Canadian medical schools in 1970. Twenty-one percent entered solo practice, 57% joined a group practice or partnership, and 22% became salaried physicians in a number of different categories. Surgeons and psychiatrists, more than other types of specialist, were inclined to select solo practice. Group practice was more popular in the western provinces and in rural than in urban areas. More than half of the physicians recently established in urban solo practice complained of having too few patients. Lack of patients was a lesser problem in smaller towns and rural areas.     

The general practitioner as sports physician.

General practitioners must become more knowledgeable about sports medicine in order both to treat the injured athlete and to provide better rehabilitative treatment and advice on fitness and exercise to other patients. Close involvement with young amateur athletes also helps to keep the older physician "in tune" with the younger generation. Finances remain a major problem for amateur sporting events and sports medicine groups, as well as for the individual physician volunteering his time.     

Implementation of hypocalcaemia prevention programmes in commercial dairy herds: From theory to practice

Hypocalcaemia prevention programmes have been widely studied in experimental settings, but their feasibility has not been assessed under field conditions. The main objective of this study was to evaluate, in the context of small dairy farms in western France, whether and how dairy farmers implement prevention programmes and manage the feeding of dry cows to prevent hypocalcaemia. Seventy-nine commercial Holstein dairy farms in Brittany (France) were enrolled in a qualitative study in 2019. We conducted in-person interviews with the farmers to 1) understand the rationale behind the type and seasonality of prevention programmes they implemented and 2) assess how closely they followed common recommendations when implementing them. Most farmers (80 %) used at least one prevention programme, especially supplying a mineral mix formulated to meet the needs of dry cows in late gestation (53 %), acidifying the diet in late gestation (37 %), and supplying calcium at calving (oral or injectable form, 37 %). The use of programmes depended on whether the diet composition varied throughout the year. Among farmers who provided an acidified diet, 25 % did not supply a specific mineral mix to dry cows to ensure an adequate amount of P, Ca, and Mg, which could decrease the effectiveness of the acidification programme. A lack of reliability in feeding practices, such as not weighing feed or not delivering feed frequently enough, was identified for 61 % of contributing farms. Management practices could result in supplying an unsuitable amount of P, Ca, or Mg immediately before calving; for example, inappropriate batching practices around calving were identified for 22 % (cows) to 32 % (heifers) of farms. In addition, nearly all contributing farmers had no processes in place to monitor the effectiveness of the programmes implemented. Reasons for this overall lack of compliance should be explored.     

The friendship model of physician/patient relationship and patient autonomy

A model of the physician patient relationship based on friendship is evaluated in terms of how it serves the interests of patients. The author maintains that this model violates the autonomy of patients who do not want to be friends with their physicians and also diminishes the autonomy of those who seek friendship with their physicians because such a desire is based on "psychological oppression," that is, the "internalization of intimations of inferiority." Ilingworth concludes that an autonomy enhancing model would be one that is open-ended, that accommodates individual patient preferences, and that embraces patient participation.