Anonymous and Narcotics Anony- mous; nutrition, exercise, relax- ation, and group and individual counseling; and education. Educational and societal.
VIEWPOINT * CONTACT ........................
Reference 1. ForsterJ, Rosser W, Hennen B, McAuley R, Wilson R, Grogan M. New approach to primary medical care [Special Report]. Can Fam Physician 1994;40:1523-30.
Quality of care is paramount Istrongly support the opinion expressed by Dr Childs' that "thoughtful, caring, and unhurried medicine not only is good for patient and doctor, but also pays dividends to the taxpayer," taking to task the assumption that "productivity equals numbers of patients seen." A wonderful example of the lack of recognition of the quality of medical care in British Columbia is the non-existence of psychotherapy in the fees paid to nonpsychiatrists combined with poor psychiatric specialist availability (other than in Vancouver or Victoria). When they are available, psychiatrists often see themselves strictly as consultants, and family physicians must deal with the most challenging part of the psychiatry: creating the therapeutic alliance within which compliance is possible, even when using a strictly biological approach. To top it all off, the British Columbia Medical Association board recently moved from its apparently unwavering support of the Relative Value Guide, after 10 years of work, $22 million, and a quasi-judicial process to ensure non-partisanship, and reverted to the bad old days of vested interest politics and pressure from the section of specialists. We must speak up if the detractors of allopathic medicine are not to be proven right. Dr Andre' Piver, MD, CCFP Nelson, BC Reference 1. Childs C. High-volume physicians. Can Fam Physician 1994;40:15 19.
Holistic approach is key to treating alcoholismn
Anonymous and Narcotics Anonymous; nutrition, exercise, relaxation, and group and individual counseling; and education. Educational and societal resources are provided for families, employers, and others involved with the addicted patient. These clinics have restored many people to health, sanity, and joy in living. At present they are too few in number and generally underfunded, given the magnitude of the problem. This simple approach has produced far greater results than any other to date. One would hope that governments, recognizing this fact, would direct more health care resources to those physicians and their allies who are struggling in this very difficult, but immensely rewarding field. Dr Peter Sullivan, MB, ChB Barrie, Ont
read with considerable interest Ithe symposium on addiction in the September 1994 issue of Canadian Family Physician. Although much excellent information is contained in this symposium, particularly in the study of physician attitudes to alcoholism presented by Dr Brian Rush and colleagues,' I was disappointed: * that there was no definitive assessment of the recent studies on the causes of addictive disease, particularly the role of inheritance; * that no clear-cut definition was given of addiction itself, which to me generally means loss of control and abuse of mood-altering substances or behaviours; and * because I would like to see a Reference much clearer study of the rela- 1. Rush B, Ellis K, Crowe T, Powell L. tionship between physicians' own Detecting, preventing, and managing alcohol use, experience .of alco- patients' alcohol problems. Can Fam holism in their families, and atti- Physician 1994;40:1557-65. tudes toward alcoholism in their a a a
patients. Obviously this is a most perplexing problem, with widespread ramifications for victims, their families and friends, for the workplace, for governments, and for all strata of society. There is a solution. It is practised in many excellent clinics in the developed world, here in North America (in particular by the Homewood Health Centre in Ontario, under the direction of Dr Graeme Cunningham), and in the United States by the centre for treating alcohol and drug problems in Atlanta under the direction of Dr Douglas Talbot. These clinics present a holistic approach to the problem based on total abstinence; daily attendance at the community self-help groups of Alcoholics Canadian Family Physician VOL 40: November 1994 1903
