Letters

Letters

Practising Patients; Within the Ranks; Shushed; Fidel Cash-tro; Tusk-Tusk

Illustration by Ryan Snook

Practising Patients

Rachel Giese focuses on in-person communication (“The Errors of Their Ways,” April), but investments in electronic health record systems also greatly improve access to the information patients and clinicians need to make safer care decisions. Drug information systems, for example, help authorized clinicians to obtain a full and accurate medication history, and to catch potential drug interactions before they harm patients. About one in three community pharmacists in Canada uses this type of system, as do half of hospital emergency departments. In a national survey, almost all pharmacists who had access to drug information systems said they made it easier to reduce drug-related problems. Pharmacists also said the systems helped them to work with patients so medications were more likely to be taken as prescribed.

Improving patient safety is an international challenge, one too complex for simple solutions — all the more reason to push forward aggressively in areas founded in solid evidence. Regarding electronic health records, we expect the benefits to grow over time as more of Canada’s clinicians use increasingly advanced systems, making care safer for all of us.

Richard Alvarez, ICD.D
President and CEO, Canada Health Infoway

The term “medical” connotes the roles and actions of physicians, whereas “health care” reminds us of the valuable contributions of other providers, not to mention (gasp!) the patient, family, and community. Giese’s feature provides many examples of how care is provided by teams who successfully coordinate activities and information exchange most of the time.

Physicians may be the centre of the litigation (medical malpractice) universe, but they are definitely not the centre of patients’ health care experience; nor is it fair to suggest that they are at the centre of the patient safety universe. Perhaps the misconception has arisen because so many of the experts Giese consulted were physicians. Constant reference to “medical error” is not only an inaccurate characterization of the patient safety challenge in Canada; it also camouflages the myriad factors leading to unintentional harm.

Dr. Robert Robson
Principal Adviser, Healthcare System Safety and Accountability Canada

Within the Ranks

Noah Richler finds it alarming that Canadian soldiers don’t like to be seen as peacekeepers (“War Games,” April). Is this really a surprise? Canadian soldiers today serve in units that were at Vimy Ridge, Hong Kong, and Kapyong. They don’t like to be cops sent to a gunfight with a knife. When everyone else at the trouble spot is armed with heavy weapons, standing between ill-disciplined belligerents does not lead soldiers armed with just rifles and pistols to a satisfying career.

When sent to a real war, this time under Chapter 7 of the UN Charter rather than under the usual Chapter 6 (and I urge Mr. Richler to study the difference), morale improved in inverse proportion to the chances of being killed in a firefight, or — less “heroically,” in Richler’s estimation — by an improvised explosive device, a friendly Afghan, or an American ally. But the Canadian people do not dwell on actual “battlefield” incidents to decide whether one was truly a “hero.” It is enough to die in the service of Canada, in the face of the enemy: run over by a truck, or on rare occasions even by one’s own hand. And this extends to civil servants and journalists.

Terence Cottrell
Kingston, ON

Noah Richler’s book excerpt is partly predicated on a false assumption: that fighting wars and keeping the peace are separate. In fact, they are intrinsically linked: only a force meant for war also has the necessary equipment, flexibility, and strength to handle situations just short of it.

Moreover, what is peacekeeping? In 1974, blue-helmeted Canadian paratroopers held the airport at Nicosia, Cyprus, against invading Turkish forces. By the time the Turks pulled up, just near the airport, two Canadians were dead and thirty wounded. In the 1993 Medak Pocket incident, our peacekeepers confronted Croatian forces in a fifteen-hour firefight in which twenty-eight died, including one Canadian soldier. Let us not imagine that peacekeeping is necessarily pacific. It has no fixed character, and depends directly on the environment in which it is conducted. In recent decades, that environment has ever more frequently been a violent one.

Ironically, Canada’s military may be better suited to “peacekeeping” today than at any time in the past twenty years. The real question is what uses the government chooses to put it to.

Matthew Willis
Royal United Services Institute
London, UK

Shushed

“Shushing greybeards,” indeed! How long ago was Michael Harris (“Stacked,” April) shushed in a library? The epithet suggesting that librarians are elderly dinosaurs needs correction and an apology. Librarians were accepting of gays, fought censorship, and hired developmentally slow people long before they were accepted by the general public.

Jean Weihs
Toronto, ON

Fidel Cash-tro

I can’t tell you how much I enjoyed Chris Turner’s “On Tipping in Cuba” (April). I only wish I had read it before I stayed in Havana two years ago. I wouldn’t have been so nervous about whether the cab driver was overcharging us, or if we were getting scammed purchasing a Che peso note from a street vendor. Turner’s article brought the entire trip and our relationship as tourists with the Cuban people into perspective.

Annette Groves
Ottawa, ON

Having just returned from Cuba today, I feel this is a must read for those who intend to visit that country in future.

@marinedrive

There’s a great piece by Chris Turner in @walrusmagazine on tipping in Cuba. In other words, moral ambiguity sucks.

@mnguyen27

Tusk-Tusk

Fresh Ingredients” (April) incorrectly identified the number of NDP MPs Quebec elected in the 2011 election; it should have been fifty-four. “The Woman in Fleece” (April) misstated the location of the Pilot Tavern in Toronto. In 1966, the establishment was on Yonge Street. The Walrus regrets these errors.

This appeared in the June 2012 issue.