Issues in patient adherence to health care regimens.

This paper examines an important area of personal health behavior in which the possible link between stress and health status is not primarily a biological one but a behavioral one. The review of empirical literature is organized around four topics: 1) the limited payoff from the search for stable sociodemographic and personality correlates of adherence; 2) the inadequacy of our current theoretical formulations; 3) the role of the doctor; and 4) the doctor-patient interaction, which emphasizes mutual expectations rather than a one-way transfer of information. The concluding remarks address themselves to the need for a firmer linkage with the conceptual and empirical literature on stress and coping.     

Surgical care in rural Canada: training and planning for the future.

The survey results reported by Chiasson and Roy in this issue (see pages 1447 to 1452) document a growing problem with the provision of surgical services in rural western Canada. Recognizing the need to improve access to surgical services in rural communities, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada have proposed guidelines for training family physicians in resuscitative and surgical techniques as well as in the safe transfer of seriously ill patients to specialized facilities. It is hoped that these guidelines will provide the basis of a national policy for general-practice training that will improve the standard of surgical care in rural communities.     

Politics of rural health care: recruitment and retention of physicians.

The shortage of physicians in underserviced areas has been defined, and the causative recruitment and retention factors have been identified. The CMA report provides a framework for understanding these factors. Many can be modified, but this requires cooperation between physicians, communities, hospitals, medical schools, medical associations and governments. The development of a rural-practice master plan in each province would facilitate this process.     

Beyond health care reform: immigrants and the future of medicine

Abstract

I first discuss the fundamental responsibilities of physicians and relate them to an increasingly fragmented medical system made even more complex by government regulations. I focus on trust as a vital component in the doctor–patient relationship, and note the difficult conditions surrounding the treatment of poor and marginal populations. Subsequently, I sketch the elements of a new vision to extend medical services to neglected populations. In that pursuit, the part played by physicians is only as important as the willingness of neighbourhoods and communities to support health as a public good.     

Biosafety: future priorities for research in health care

Currently the public interest in biosafety issues has focussed on the discussions surrounding the use of genetically modified organisms, very specifically on the use of transgenic plants in agriculture. Although many of the questions raised in connection with genetically modified organisms are of legitimate scientific interest, attention should be drawn back to a number of other more classical biosafety research areas, namely the problem of control of new and reemerging infectious diseases, the need for new vaccines, control of transport and routes of dissemination, biosafety information exchange and networking, where research results are dearly needed. In the area of modern biotechnology new applications such as gene therapy and transgenic animals will be on the list of future priorities for biosafety related activities and research.     

Realities for change in child health care: existing patterns and future possibilities.

In assessing some of the existing patterns and future possibilities in child health care it was found that the continuing large social class differences in morbidity and mortality may be attributed to continued poverty, both of income and therefore of diet, and also to environmental deprivation. The absence of safe places for children to play, for example, is related to the high accident rates experienced by children. Doctors admit to awareness of these social and environmental causes of unnecessary morbidity and mortality among children but have failed to address the causes directly. While the causes are outside the immediate professional provenance of doctors, it is argued that, aware as they are of this aetiology, they have a moral and professional responsibility to act collectively as a pressure group urging improvements on the relevant authorities (as they have done in the case of smoking and clean air, for example).