History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1953 Vancouver Medical Association Oct 31, 1953

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 THE
NJUEHN
VOLWMEXXX.
OCTOBER, 1953
NUMBER 1
VANCOUVER MEDICAL ASSOCIATION
AND OFFICIAL PUBLICATION OF
British Columbia Division - Canadian Medical Association
1 r_
CULATIOM
In This Issue:
OFFICIAL PROCEEDINGS OF THE ANNUAL GENERAL MEETING AND THE
GENERAL ASSEMBLY - CANADIAN MEDICAL ASSOCIATION - B. C. DIVISION
SEPTEMBER 22nd AND 23rd, 1953-HOTEL VANCOUVER-VANCOUVER, B.C. Here's the most comprehensive
x-ray supply catalog
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No x-ray department can affy
to be without General Electr
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And here are two unique cj
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der cards also save time — i
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Ask your G-E x-ray represex
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GENERAL® ELECTR
GENERAL ELECTRIC X-RAY CORPORATION, LIMITED
Direct Factory Branch: Resident Representative:
VANCOUVER — 645 Hornby Street VICTORIA __ L. C. Martin, 3913 Winton Street HOSPITAL CLINICS
VANCOUVER  GENERAL  HOSPITAL
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.
Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
Thursday, 9:00 a.m.—Medical Clinic.
12:00 noon—Clinicopathological Conference on Newborns.
Friday, 9:00 a.m.—Paediatric Clinic.
Saturday, 9:00 a.m.—Neurosurgery Clinic.
ST. PAUL'S   HOSPITAL
Regular Weekly Fixtures
2nd Monday of each month—2 p.m Tumour Clinic
Tuesday—9-10 a.m. Paediatric Conference
Wednesday—9-10 a.m Medical Clinic
Wednesday—11-12 a.m Obstetrics and Gynaecology Clinic
Alternate Wednesdays—12 noon i r Orthopaedic Clinic
Alernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion)
Friday—8 aim. i Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m Surgical Conference
Friday—9 a.m | . Dr. Appleby's Surgery Clinic
Friday—11  a.m Interesting Films Shown in X-ray Department
SHAUGHNESSY  HOSPITAL
Regular Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology. Monday, 11:00 a.m.—Psychiatry.
Wednesday, 10:45 a.m.—General Medicine. Friday, 8:30 a.m.—Chest Conference.
Wednesday, 12:30 p.m.—Pathology. Friday, 1:15 p.m.—Surgery.
BRITISH  COLUMBIA  CANCER  INSTITUTE
2656 Heather Street
Vancouver, British Columbia
SCHEDULE OF CLINICS—As at June,  1953
MONDAY: 9 a.m.—10 a.m - Nose and Throat Clinic
TUESDAY: 9 a.m.—10 a.m ...Clinical Meeting
THURSDAY: 11 a.m.—12 a.m ..— Gynaecological Clinic
(not during summer months)
FRIDAY: 9 a.m.—10 a.m.  . - j Skin Clinic
9 a.m.—10 a.m.  Lymphoma Clinic
DAILY: 11:45 a.m.—12:45 a.m _&. . m Therapy Conference
Page 5 § for peptic ulcer...
si  rapid relief from pain and other ulcer symptoms
^2 ^accelerated healing
9 3 outstanding freedom from side effects
4 dosage forms that individualize therapy: /*j\
\   PRANTAL Injection            | PRANTAL Tablets (plain-        1 PRANTAL Repeat Action
|   for acute episodes.                 | scored), for adjusting       1 Tablets, (coated—no taste)
1 therapy.                                   1 — for prolonged effect—
I (8 hours or more).
^/xm£   .'  "I^ANTAL  '" *"}
Wrt*/V/        W      Tablets with Phenobarbital 16 mg.
*f\X5\Ju>   / (coated—no taste) —for combined seda*
tive and anticholinergic effects.
CORPORATION LIMITED,
MONTREAL GREATER VANCOUVER PUBLIC HEALTH
Metropolitan Health Committee
Dr. Stewart Murray, Sr. Medical Health Officer, City Hall, Vancouver, B.C.
Population
(Estimated)
Vancouver   390,325
Burnaby Municipality   61,000
North Vancouver City .    16,000
North Vancouver District Municipality  16,000
West Vancouver Municipality f .'_  14,250
Richmond    ... 19,186
University Area  . _. '. .  3,800
District Lot 172 1  1,469
TOTAL  1     522,030
SUSPECTED FOOD POISONING
There may be some physicians in private practice who are unaware of the assistance that is available
through the Health Department in arriving at a correct diagnosis in suspected food poisoning and also
in determining the causative agent.
In Vancouver, the Quarantine Division and the Food and Dairy Division staffs" are available to
investigate food premises and take samples and histories. During office hours requests may be made
through the Health Dept. at Vancouver City Hall. At other times, including week-ends and holidays,
the service is covered by quarantine officers who take turns on call. The name and telephone number
of the man on duty can be obtained through the admitting office of the Vancouver General Hospital.
In the adjoining municipalities, the local Medical Health Officer or the sanitarian should be contacted.
In any case of suspected food poisoning it is most important to obtain samples of the suspected
material. The attending physician, being the first investigator on the scene, should make a point of
securing such material and keeping it refrigerated and protected until picked up for examination. This
may include vomitus and stool specimens. 1111
Another point that may be worth mentioning is that one should avoid definitely naming the suspected
material until proof has been obtained. There have been instances in which innocent establishments have
suffered considerably due to injudicious remarks. The observance of due caution may also mean the
avoidance of embarrassing legal action.
POLIO
Writing under date of Oct. 13 th, we are able to say that there is a gradual decline in the number
of cases of polio. 81 cases have been reported in the city and 60 in the rest of the Metropolitan Area,
making a total of 141 thus far.    In addition, 52 cases have been accepted into the city for treatment.
At times the bed shortage has been acute and we have appreciated the cooperation of the private
physicians in helping to meet  the situation.
If mild cases can be treated satisfactorily at home there is no need to hospitalize them. However, all
cases should be reported to the Quarantine Office so that we may have a true picture of the incidence
and in order that control measures may be enforced when indicated.
lHumtt pleasant Cljapel
I        FUNERAL    SERVICE
Kingsway at llth Ave. — Telephone EMerald 2161
Vancouver 10,  B.C.
flftt pleasant TUnbettaktnQ Co. Xtb.
Page 7 Cortope
ACETATE
(CORTISONE ACETATE Merck)
The many
iridications for
Cortone highlight
its therapeutic
importance in
everyday practice
Primary Site of Pathology and Indicatio
ns
1. EYE—Inflammatory eye disease. 2. NOSE—Intractable hay fever. 3. LARYNX—Laryngeal
edema (allergic). 4. BRONCHI—Intractable bronchial asthma. 5. LUNG—Sarcoidosis.
6. HEART—Acute rheumatic fever with carditis. 7. BONES AND JOINTS—Rheumatoid
arthritis; RJieumatoid spondylitis; Acute gouty arthritis; Still's Disease; Psoriatic arthritis.
8. SKIN AND CONNECTIVE TISSUE—Pemphigus; Exfoliative dermatitis; Atopic dermatitis;
Disseminated  lupus  erythematosus; Scleroderma  (early); Dermatomyositis; Poison  Ivy.
9. ADRENAL GLAND—Congenital adrenal hyperplasia; Addison's Disease; Adrenalectomy
for hypertension, Cushing's Syndrome, and neoplastic diseases. 10. BLOOD, BONE MARROW, AND SPLEEN—Allergic purpura; Acute leukemiat (lymphocytic or granulocytic);
Chronic lymphatic leukemia.t 11. LYMPH NODES—Lymphosarcomat; Hodgkin's Diseaset.
12. ARTERIES AND CONNECTIVE TISSUE—Periarteritis nodosa (early). 13. KIDNEY—
Nephrotic Syndrome, without uremia (to induce withdrawal diuresis). 14. VARIOUS TISSUES
—Sarcoidosis; Angioneurotic edema; Drug sensitization; Serum sickness; Waterhouse-Friderichsen Syndrome.
f Transient beneficial effects.
Cortone is the registered trademark of Merck & Co. Limited far
its brand of cortisone.
MERCK & CO. Limited
Manufacturing Chemists
MONTREAL • TORONTO • VANCOUVER • VAJLUYf 1110 We have been reading an article which appears in the little journal "Modern
Medicine", which finds its way into our offices monthly, and always contains something
worth reading.
This article is called "Problems in the conduct of consultations", and is written
by Dr. Sidney Leibowitz of Beth Israel Hospital, New York. It is a thoughtful article,
carefully written, and deserves, we think, to be carefully read by us all.
In the early days of medicine consultations were not very frequent—and were
generally rather ceremonious affairs, with a rather rigid protocol to be observed. Today,
we believe, they are much more frequent. Men call each other in much more freely
than they used to do—and in many ways this is a very good thing, both for the doctor
and the patient. One reason, of course, is the increasing complexity of medical practice,
and there is also the fact that so many men are specialists, and rarely consider the
patient from all his angles; so that they tend to have examinations of the other systems
than the one in which they specialize, checked over by other men who are more specially
fitted to investigate them. This pattern of practice has one disadvantage—in that it
adds to the cost to the patient, who frequently has to pay several bills, where he had
expected, or hoped, to pay only one—but this is perhaps compensated for by the
thoroughness of the examinations made.
But this is getting away from the subject a bit. The article in question deals more
with the technique and ethics of consultations. And this is a very good thing to do,
especially as regards the latter. For while the technique of consultation may change,
and become easier and more simple to follow, the ethics of consultation remains the
same in all ages. And we feel that there is a tendency nowadays in some cases to overlook this point.
The ethics of consultation between two physicians is a most important matter.
The physician who calls in a consultant, places his own reputation, and to some extent
bis fortune, in the hands of the consultant; and it is the bounden duty of the latter
to respect and justify this trust—and to see to it that he does and says nothing to
discredit the other man in any way or to embarrass him. The consultant's duty, of
course, is primarily to consider the patient's welfare, and this must be paramount in
his mind; but he also owes a duty, and it is a debt of honour, to the colleague who is
trusting him.
And this has certain implications. All too frequently have we heard complaints
from practitioners along the following lines; Dr. A. consults Dr. B. about a patient,
and sends the patient to see him. He receives no report, or perhaps only an oral or
telephone one. The patient does not return to him, and later on Dr. A. finds that Dr.
B. has gone ahead with the treatment of the case. Or he finds, and this is even worse,
that instead of sending the patient back to Dr. A., he has referred him to Dr. C, say for
surgery or whatnot, and this last name has taken over the case, and proceeds to carry
out whatever treatment is necessary. This is not uncommon, and many general practitioners have had it happen to them.
It is no justification for Dr. B. to say "Well, I knew that Dr. A. doesn't do surgery,
so I sent him to a man who does" or "This man needed specialist care". That is none of
the business of Dr. B. The Code of Ethics specifically states, "Responsibility for the
patient's care rests with the physician in attendance." (Of the Duties of Physicians
Regarding Consultations.) As it is, Dr. A. has had his patient stolen from him right
under his nose and what is worse, this cannot fail to discredit Dr. A. in the eyes of his
patient and the family concerned. It is rotten ethics on the part of Dr. B., and possibly
of Dr. C, as well, though he may have been quite innocent in the matter.
Page 11 We do not suggest for a moment that this applies to any but a very few consultants. On the contrary we know that by far the greater majority of them are mosl
scrupulous in observing the rules which govern consultations. They examine the patient
carefully, they give written reports^ they return the patient entrusted to them, thej
take pains to protect the referring physician in the matter, and unless asked to do soJ
they take no further part in the treatment. But there are some few who, either through
carelessness or thoughtlessness, or through a deliberate disregard of ethical considerations!
violate the rules, and in so doing, bring disrepute on us all, and discourage consultations!
Free and frequent consultation between physicians is to be encouraged by everyj
means, and can do nothing but good. But there are rules governing this intercourse off
minds—and this article in "Modern Medicine" does well in bringing them again to ourf
attention. The rules of ethics are simple; so simple that we often forget how utterlyi
necessary they are—and tend to forget that they are based on a very simple foundation—I
"Do to others as you would want them to do to you".
WORKMEN'S COMPENSATION BOARD
H VANCOUVER H     ■
September 10th, 1953 J
To the Members,
College of Physicians and Surgeons of British Columbia.
Dear Fellow Members:
Due to circumstances completely beyond my control I have been away from the
office for the past three months.
It is unfortunate that it was not possible to continue the series of letters to the
profession without interruption.
Similar problems are still arising with reference to incomplete reports. A number
of files have been seen during the past week and it was apparent that the Doctor's
office nurse or secretary had filled out the form or forms, and the Doctor had signed!
them without checking the information listed and had also neglected to fill in the
unanswered questions.
We at the Workmen's Compensation Board are most anxious to cooperate in every
possible way with the profession and their office staffs. If you will help us by seeing
that all possible information is provided, we will hope to avoid sending innumerable;
requests for further information. This assistance will in many cases facilitate the
earlier handling and acceptance of the workman's claims.
One of our most serious difficulties arises from requests for the re-opening of
claims. Many requests are made by doctors without enclosing any recent history or
examination which would help us to relate the present complaints with the claim
involved.
A personal letter would be very much appreciated if you have any complaints or
criticisms of the Medical Department of the Board, so that we may avoid many prob-j
lems which cause friction between the workman, the attending doctor, and ourselves^
Your cooperation in our mutual problems will, I am sure, be of great assistance to
everyone. ^|
Sincerely yours,
J. R. Naden, M.D.,
Chief Medical  Officer.
Page 12 I
*
Library Hours:
Monday to Friday - 9:00 a.m. - 9:00 p.m.
Saturday  \ 9:00 a.m. - 1:00 p.m.
Notice:
The Library Committee wish to inform Members that in future a charge will be
made to cover postage and insurance on all inter-library loans obtained from
foreign sources. Mailing costs on loans obtained from libraries in Canada will
continue to be borne by the Library.
New Accessions:
Essential Hypertension: An Epidemiologic Approach. Published by the Recess
Commission on Hypertension, Boston.
Diseases of the Chest by Sir Geoffrey Marshall, vols. 1 and 11, 1952.
Manual of Clinical Allergy by John Sheldon et al. 1953.
Shock and Circulatory Hemostasis. Transactions of the First Conference. October, 1951.   Edited by H. D. Green, 1952.
Preventive Medicine and Public Health by Wilson G. S. Smillie, 1952.
Manual for Sanitary Inspectors.   Canadian Public Health Association.
A Textbook of Surgical Pathology by Ackermann.   Mosby, 1953.
The Kinsey Report, v. 11, 1953.
Transactions of the Fifth American Congress on Obstetrics and Gynecology.
Edited by G. W. Kosmak, 1952.
Woman's Surgeon: by Seale Harris, 1950.   (The Life Story of J. Marion Sims.)
Monographs in Medicine.   Edited by William B. Bean.
BOOK  REVIEW
PRINCIPLES AND METHODS OF PHYSICAL DIAGNOSIS by Simon S. Leopold,
1952, pp. 430 illus.
The reviewer found this text-book so interesting that he read each chapter with
increasing approval.
One would specially like to commend the section on the examination of the
musculo-skeletal system, the chapter on "Sounds from the Thorax" by Warren, the
chapter on the examination of the lungs and heart, and the final chapter on the
history.
As small criticisms, one would suggest a better description of Mongolism and of
Erb's Palsy. The tendency of the author to show illustrations of very extreme examples
of diagnostic entities is well demonstrated in those shown of Cretinism on p. 37.
Illustrations of usual cases would have been better.
This book is recommended as an excellent text and guide for medical students.
A. H. H.
Page 13 Vancouver
President                         .
Medical
Association
.    .    ...             Dr. D. S. Munroe
Vice-President
Dr. J   R. Rlaclc
Honorary Treasurer
Or. G- F-, T,angley 9
Honorary Secretary
Dr. F. S. Hnhr*
F.Hifnr
Dr.   T.  H.  MacDermot
ANNUAL REPORT OF THE SUMMER SCHOOL
COMMITTEE—1953 §
The 31st Annual Summer School of the Vancouver Medical Association was held
from June 1st to June 5th, 1953, inclusive, at the Hotel Vancouver. There was a
total of 180 paid registrations, 13 of whom were visiting doctors from outside thej
metropolitan area, including New Westminster. As usual the internes and students:
of the medical school who could attend were admitted gratis. The lectures were well
attended. The Clinics, two at Shaughnessy, one at the Vancouver General and one
at St. Paul's were poorly attended.
The panel of speakers, both visiting and local, was excellent.   Dr. Martin Hoffman,!
Assistant Professor of Medicine, McGill University, made an outstanding contribution
in the field of Internal medicine.    We had tried for several years to secure Dr. Joel W.
Baker, Chief of Surgery of the Virginia Mason Hospital, Seattle, and this year were mosfcj
fortunate to have his practical and  fundamental discourses on problems related to
surgery.    Our local G.U.  confreres chose Dr. Carl Aberhart of Toronto, Assistant
Professor of Surgery, University of Toronto, as the speaker on Urological subjects.
Dr. R. Graham Huckell, Professor of Orthopaedic Surgery, University of Alberta and
Dr. Howard C. Stearns, Clinical Professor of Obstetrics and Gynaecology, University
of Oregon, both gave notable lectures in the subject matter allotted to them.    Wejj
especially wish to thank our local speakers—Dr. Sidney Friedman, Professor of Anatomy,
University of British Columbia, Dr. Robert B. Kerr, Professor of Medicine, University of
British Columbia, Dr. Peter Lehmann, Dr. W. L. Sloan, and Dr. H. E. Taylor for their
valuable contributions to a most interesting scientific programme.
The luncheon at the Hotel Georgia was attended by 64, not including the head
table guests. Dr. N. A. M. MacKenzie, President of the University of British Columbia,
was the guest speaker. The Golf Tournament held at Quilchena and the Dinner and
Dance at the Stanley Park Pavilion again proved popular and entertaining affairs, for
which we owe considerable thanks to Dr. H. Mcintosh, Dr. W. G. Evans and their
energetic Committees.
The financial statement shows the sale of 180 registration tickets at $10.00 each,
making a total of $1,800.00 and 64 luncheon tickets at $2.00 each, making $128.00,
thus giving a total receipt of $1,928.00. Our disbursements totalled $2,160.60. The
heaviest expenditures were $850.00 travelling expenses and $425.00 for hotel accommodations for the visiting speakers.    There was therefore a deficit of $232.60.
Next year the National Convention of the Canadian Medical Association will
be held in Vancouver in June when ordinarily our Summer School would be held.
The Executive of the Vancouver Medical Association has therefore decided that no
Summer School should be held next year. In view of this fact, it is recommended
that elections of new members to the Summer School Committee should be deferred^
until the Annual meeting in May, 1954.
Your Committee wishes to thank the staff of the Vancouver Medical Association
for their help and especially Mrs. Dewest, whose loyalty and executive ability contributed greatly to the administrative details of management.
Respectfully submitted,
S. L. WILLIAMS, M.D.,
,  Chairman, The Summer School Committee.
Page 14 CANADIAN   MEDICAL   ASSOCIATION
BRITISH   COLUMBIA   DIVISION
1807 West 10th Ave., Vancouver, B.C.      Dr. G. Gordon Ferguson, Exec. Secy
OFFICERS 1953-1954
President—Dr. R. G. Large . ' i Prince Rupert
President-Elect—Dr.  F.  A.  Turnbull   . Vancouver
Immediate Past  President—Dr. J.  A.  Ganshorn Vancouver
Chairman of General Assembly—Dr. G.  C. Johnston ■.;■"•"  -- Vancouver
Hon. Secretary-Treasurer—Dr. J. A. Sinclair..—-* 1 New Westminster
PRINCIPAL DELEGATES  TO  THE  BOARD  OF DIRECTORS
Victoria                                            New Westminster Vancouver
Dr. J.  F. Tysoe                             Dr. J.  F. Sparling Dr.  Ross Robertson
Dr. E. W.  Boak                            Dr.  D. G.  B. Mathias Dr   R   A   Gi|christ
Nanaimo Kootenay Dr. J.  Ross Davidson
Dr.  C. C.  Browne Dr.  S. C.  Robinson Dr-  R- A-  Palmer
Dr. A. W.  Bagnall
Prince Rupert and Cariboo        Yale Dr. P. O. Lehmann
Dr. J.  G.  MacArthur Dr.  A.  S.  Underhiil Dr.  Roger Wilson
Chairmen  of Standing  Committees
Constitution and By-laws Dr. Carson Graham,  North Vancouver
Finance   . Dr..J.   A.   Sinclair,   New  Westminster
Legislation - Dr. J. C. Thomas, Vancouver
Medical Economics | Dr.  P. O. Lehmann, Vancouver
Medical Education J! Dr. Charles G. Campbell, Vancouver
Nominations Dr.  R. G.  Large,  Prince Rupert
Kprogramme & Arrangements ^ Dr.  Myles  Plecash,  Penticton
Public Health Dr. J. Mather, Vancouver
Chairmen of Special Committees
Archives_____J: Dr.  J.  H.  MacDermot, Vancouver
Arthritis and Rheumatism Dr.  F. W.  B.  Hurlburt, Vancouver
Cancer ^ Dr.  Roger Wilson, Vancouver
Civil Defence I - Dr. John Sturdy, Vancouver
Ethics Dr.  Murray  Baird, Vancouver
Hospitals Dr. F. A. Turnbull, Vancouver
industrial  Medicine Dr.  W.  S.   Huckvale,  Trail
Maternal Welfare  Dr. A.M. Agnew, Vancouver
Membership : Dr. L.  Fratkin, Vancouver
Nutrition i Dr. J.  F.  McCreary, Vancouver
Pharmacy ■■ Dr. B. T. Shallard, Vancouver
Public Relations_J 11 i - , Dr. A. W. Bagnall, Vancouver
IMPRESSIONS OF THE ANNUAL MEETING
Another annual meeting has come and gone. This is being written shortly after,
though unfortunately it will not be published for another month. There were several
points I felt of interest, and here are a few miscellaneous thoughts.
I understand from the Secretary that the attendance was the best we have ever
had. This is an encouraging sign, showing more and more doctors are taking an active
interest in our Association. Various social events appeared to be of great success, and
I think everyone enjoyed them to the utmost.
The clinical papers were of excellent calibre, and prsented in a most understandable and interesting way by a top flight group of speakers. Most of us gained something
from the various presentations. It will be the aim of the Association to maintain this
level of excellence at future meetings.
The exhibitors, that is the various drug houses, put on a very nice show, and
in general seemed pleased by the interest taken by the various doctors who came
around to discuss things with them. We were thus able to keep up with the latest
in drug advances from the leading drug houses. The apple juice, tomato juice, coffee,
canned meats, also did a roaring trade as the doctors stopped for refreshments at these
various booths.
Page 15 The annual meeting of the Association was carried out very well with the in-;
stallation of our new officers.    We were privileged to hear an advanced Bulletin for-
the C.M.A. Convention which is to be held here next June.    Dr. G. F. Strong, presi-:
dent-elect, outlined these plans, and they are certainly showing that this meeting is
bound to be a success.
The meeting of the Assembly was to me the highlight of the entire Convention.
I am always struck by the manner in which Dr. F. Turnbull has been chairman of
this Assembly for the past two years, mamtaining complete control of the meeting,'
yet allowing and encouraging fullest possible discussion of any subject under consideration, even allowing time for those who have beefs to get them off their chest. Dr.
Turnbull has done a masterful job in presiding over the first four sessions of our
general Assembly and has set an excellent example of bow this should be done to all
future occupants of the chair. The discussions and decisions of that body, as well as
all committee reports, will be reported to you in detail. Our secretary, Dr. Gordon
Ferguson, is making these arrangements.
A new approach was attempted in our relation with the press for this meeting.
The problems of Public Relations has always been a thorny one for the medical profes-
For many years  the problem was  solved by ignoring it.     However  the bad
sion.
press we have been receiving over the past year or so seemed to force us into taking
some steps to correct this situation. These have previously taken the form of weekly
radio broadcasts, weekly columns in the paper, and more recently, our medical forums.
It is planned to hold forums monthly during the winter. With these for a start, it
was felt we could not neglect the press at our convention. We therefore made arrangements for them to interview the chairmen of the various committees, clinical speakers,
a scattering of doctors throughout the province, and in general attempted to cooperate in every way. The result has been a considerable amount of publicity in the
newspapers and over the radio, even to a brief notice on the CBC trans-Canada
programme of News Roundup. Of all the publicity, there was nothing which I myself
saw or heard, which I felt could react in anything but a favorable way for the doctors.
I certainly hope that the forward steps that have been taken by Dr. Gordon Johnston,
chairman of the Public Relations committee, will be continued in the future.
WARNING
Recently the synthetic narcotic alphaprodine (alpha-1,3 -dimethyl-4-
phenyl-4-propionoxy-piperidine), which is also known as prisilidene, has been
introduced to the medical profession in Canada. This drug made its appearance under trade name of Nisentil.
It is included in the Schedule to the Opium and Narcotic Drug Act and
conies under precisely the same regulations as other narcotic drugs. Moreover
from the information now available it would appear that the drug posessses
addiction properties of a nature necessitating great care being exercised by
physicians when prescribing it.
Yours very truly,
R. C. HAMMOND,
Asst. Chief,
Division of Narcotic Control
-  Department of National Health and Welfare.
Page 16 CANADIAN   MEDICALJASSOCIATION
BRITISH   COLUMBIA   DIVISION
■<?7&
&PED Y&l
PROCEEDINGS
OF
THE ANNUAL GENERAL MEETING
September 23,  1953
AND
THE GENERAL ASSEMBLY
September 22, 1953
Hotel Vancouver,  Vancouver, B.C.
Page 17 PROCEEDINGS
of the
1953   ANNUAL  MEETING
Canadian   Medical   Association — B.C.   Division
SEPTEMBER 23rd — 8:00 P.M.
SALON A — HOTEL VANCOUVER
1. CALL TO ORDER—Chairman, Dr. J. A. Ganshorn, President.
2. PROCEEDINGS OF LAST ANNUAL MEETING.
Motion—""That the proceedings  of the   1952  Annual Meeting be accepted as
printed in the Bulletin."
3. FINANCIAL STATEMENT AND APPOINTMENT OF AUDITOR—Dr. J. A.
Sinclair, Honorary Secretary-Treasurer.
We have examined the books and accounts of the Canadian Medical Association,
B.C. Division, for the year ended 31st August, 1953, and have obtained all the information and explanations we have required. We have prepared and append hereto the
following statements, namely:
1. Statement of Financial Position as at 31st August,  1953.
2. Statement of Operations for the year ended 31st August, 1953.
3. Statement of Receipts and Disbursements—Annual Meeting Fund for the same
period.
4. Statement of Founders Fund Receipts for the year.
In our opinion the accompanying statements are properly drawn up so as to exhibit
a true and correct view of the Association's affairs as at 31st August, 1953,"and of the
results of its operations for the year ended that date, according to the best of our
information, the explanations given to us and as shown by the books of the Association.
Reported by
Buttar & Chiene,
g|p Chartered Accountants.
Appendix No. 1
STATEMENT OF FINANCIAL POSITION
As at 31st August, 1953
CURRENT ASSETS
Cash:
On hand—Petty Cash $        15.00
In Current Bank Account:
General Funds | $11,901.90
Annual Meeting Funds     4,151.20
  16,053.10
In Savings Bank Account 1 I   10,039.61
$26,107.71
FOUNDERS FUND ASSETS
Cash in Savings Bank Account $ 3,485.74
Investment -in $12,500.00—4%—Provincial Hydro Electric
Power Commission Bonds—at cost   12,493.75
(Market Value,  $12,418.75)   15,979.49
Page 18 FLXED ASSETS—At Cost
Office Furniture and Fixtures $ 5,409.62
Less—Reserve for Depreciation        261.15
     3,148.47
TOTAL ASSETS $45,235.67
TOTAL ASSETS REPRESENTED BY:
Surplus Account:
Balance at 31st August,  1952 $21,701.60
Add—Net Income for year—per Appendix No. 2     7,554.58
Balance at 31st August,  1953 $29,256.18
Founders Fund:
Balance at 31st August,  1952 $13,350.28
Add—Receipts for year—per Appendix No. 4    2,629.21
Balance at 31st August,  1953 _fe_   15,979.49
 $45,23 5.67
This is the Statement of Financial Position referred to in our report of even date.
Buttar & Chiene,
Chartered Accountants.
Appendix No. 2
STATEMENT OF OPERATIONS
For the Year Ended 31st August, 1953
RECEIPTS
Membership Fees . $L • .$32,83 5.00
Interest on Savings Bank Account $ _J|§|       39.61
Canadian Medical Association:
Dues Collected. | $19,735.00
Less—Remitted  __.' ^^3pJjpf_l_  19,73 5.00
DISBURSEMENTS
Travelling Expenses:
Executive Secretary—
1953 C.M.A. Convention $ 272.50
District Meetings, etc gj .__>__  285.92
Portion Moving Expenses  250.00
Automobile Expenses  398.69
$ 1,207.11
Economics Committee ; 1—:__.-  358.25
President to 1953  C.M.A. Convention | i  227.40
Board of  Directors __ 322.80
District Tour -jlL -_if|2  190.47
$ 2,306.03
Vancouver Medical Association Bulletin _JJ|!  600.00
News Letter and Schedule of Fees Expense.—-  298.01
Audit and Legal Fees  3 50.00
Committees' Expenses—other than travelling:
Public Relations - - $ 2,581.14
Reference—net  -——        250.00
$32,874.61
Page 19 Salaried Doctors and Contract Practice        470.85
Economics  -i|§       85.00
     3,386.99
Election Expense         111.62
General Assembly  Expenses -2p     102.54
President's Chain of Office Expense  47.42
Administrative and General Expenses:
Salary—Executive-Secretary ^ $ 11,187.63
Salaries—Office  Staff     4,385.00
Postage, Telephone and Telegraph ,        809.92
Office Rent     1,421.65
Office Supplies and Expense     1,545.81
Unemployment Insurance  48.88
Medical Services Association |  34.23
Bank Charges and Exchange  50.26
  19,483.38
Depreciation  on  Furniture  and Fixtures _._£L    •   261.15
  26,947.14
INCOME FROM OPERATIONS | $ 5,927.47
Add—Excess of Receipts over Disbursements—
Annual Meeting Fund—Appendix No. 3     1,627.11
NET INCOME FOR YEAR 1 j|p $ 7,554.58
Appendix No. 3-
STATEMENT OF RECEIPTS AND  DISBURSEMENTS—
ANNUAL  MEETING  FUND
For the Year Ended 31st August, 1953
RECEIPTS
Year 1952:
Ticket Sales - $ 2,968.12
Programme Advertising  160.00
Exhibitors' Rentals—balance  100.00
$  3,228.12
Year 1953: |§
Exhibitors' Rentals—on account $ 4,300.00
Hobby Show Donations         100.00
     4,400.00
DISBURSEMENTS «
Year 1952:
Preliminary and Incidental $ 103.17
Printing and Stationery  661.31
Entertainment and Hotel Expenses  4,022.95
Speakers  243.3 5
President's  Dinner  83.18
Secretarial Honoraria and Expenses  378.95
Travel Expenses—Executive Secretary  88.57
Hobby Show Expense |  170.73
$ 7,628.12
Page 20
$  5,752.21 Year 1953:
Preliminary and Incidental _._.$ 8.70
Printing  and  Stationery j=        240.10
248.80
6,001.01
EXCESS OF RECEIPTS OVER DISBURSEMENTS—
Carried to Appendix No. 2 $ 1,627.11
Appendix No. 4
STATEMENT OF FOUNDERS FUND RECEIPTS
For the Year Ended 31st August, 1953
Payments from Founders $ 2,195.00
Interest on Savings Bank Account ^ |  . 10.13
Interest on Bonds _jS$fe_,  424.08
Total Receipts for Year—
Carried to Appendix No.  1 $ 2,629.21
The following motions were properly moved, seconded and carried:
"That the financial statement for the year ending August 31,  1953, be accepted."
"That the recommendation of the chartered accountants, Buttar & Chiene,
that the fiscal year be changed to coincide with the membership fee year,
i.e. January 1 -December 31, be accepted."
"That  Buttar  &  Chiene  be  appointed  the  auditors  of  the  Association  for
the coming year."
4.   REPORT OF THE CHAIRMAN OF THE GENERAL ASSEMBLY—Dr. F. A.
Turnbull.
The Annual Meeting of General Assembly of the C.M.A.—B.C. Division—convened
from 9:00 a.m. to 5:00 p.m. on September 22, 1953.
Activities of the morning were devoted entirely to the reception of reports. When
I relate that we received no less than 37 reports you will appreciate the great volume of
work, and the large number of your colleagues involved in the business and organizational pattern of this Association. Because nearly all of these reports will be published
later, and available for your leisurely study, it is unnecessary to review them in any
detail now.
The Honorary Treasurer reported on our financial status and has by the terms of
our Constitution reported again to the General Meeting. It was a gratifying report
particularly to those who could recall vividly our impoverished status of two years
ago. But our reserve fund has not grown sufficiently to make us complacent in the
face of the potential requirements for the not distant future.
The retiring president, Dr. John Ganshorn, reported in two important capacities
—as representative to the C.M.A. Executive, and also as Chairman of the Board of
Directors and of its Executive Committee.    These reports will be published.
Two other reports deserve special mention—Dr. Gordon Johnston's report of the
Committee on Public Relations, and Dr. Peter Lehmann's account of activities of the
Committee on Economics. The Committee on Public Relations has displayed remarkable energy and versatility. There is little doubt that their efforts have very effectively
reversed a sad state of relations with radio, press and public—and it was high time.
The Committee on Economics has done a lot of hard, slugging work this year. The
decisions about Extra Billing at the General Assembly Meeting last September provided
the Economics Committee with an almost impossible assignment at the start. It is
Just possible that in years to come, when we look back on this year, the improved
relation between the profession and Pre-paid Plans that has developed during all this
Page 21 turmoil about extra billing, may be looked upon as this Committee's major accomplish^
ment.    In passing, I must commend the sub-committee on Salaried Doctors, which!
under the chairmanship of Dr. Ross Davidson, has produced a monograph about the.
basis for payment of doctors' salaries which is of very great value.    It is a starting
point for a much wider study about the basic value of all medical practice.
At noon the report of our Nomination Committee was received and the voting
for officers took place. The afternoon of the General Assembly Meeting was devoted
entirely to a debate about two very difficult problems—both with implications that
extended well beyond the visible horizon.
1. The manner of payment for medical services when two or more doctors are
involved in the treatment of a surgical case.
2. The advisability of naming a certain very small group of doctors, who wilfully
break fundamental rules in respect to approved Pre-paid Plans, as "non-participating"
and therefore ineligible to receive payment from these Plans.
The debate was long and earnest.    Decisions were as follows:
1. By majority vote the Assembly approved action of the Executive of the Board
of Directors who had authorized S.A.M.S. to proceed, as a trial, with a new method
of payment for multiple services in surgical cases. In essence, this method provides that
the surgical fee shall not be divided, and that in addition to the surgical fee the family
doctor shall be paid not only for his preliminary work, and as assistant, but also for
a reasonable amount of post-operative attendance on a fee-for-service basis. The trial is
restricted to S.A.M.S. which the doctors control. What increase in cost will result we
do not know. The guesses vary widely. Representatives of the surgeons stated that
they were willing to consider an overall reduction of surgical fees if parity with present
costs cannot be maintained under the new system. The Assembly passed a further
motion requiring an accounting of the results of this trial method at the next Annual
Meeting of the General Assembly.
2. In respect to the naming of non-cooperative doctors. Some doubts were expressed about our legal status if such a proposal were enacted. Bearing in mind the
necessity of careful preliniinary investigation of this legal problem, the Assembly
approved in principle the recommendation of the Executive of the Board of Directors
that certain doctors be named as non-participating and ineligible for payment by
approved Pre-paid Plans.
That concluded deliberations of your General Assembly for the year ending
September 22,  1953.
5.   DISTINGUISHED VISITORS
The Chairman introduced two guests, Dr. C. W. Burns, President of the C.M.A.,
and Dr. T. C. Routley, General Secretary of the C.M.A.
Dr. Routley, in a short message to the members, said that in his opinion the B.C.
Division is being wisely led. He mentioned briefly government health insurance schemes
in various countries and that health insurance is coming to Canada. He emphasized
that winning a battle is one thing but it is more important to win it on a solid premise.
If we find we are wrong let us be broad enough to admit it. The public relations
forum, the approach to the people, all these things should go a long way to assure
legislation which will be sound both for the public and for the doctors. He thanked
the Association for the magnificent cooperation which he has always received from this
Division.
Dr. G. F. Strong, while not a visitor, as President-elect of the C.M.A., told the
members of some of the plans for the C.M.A. Convention to be held in Vancouver
in June, 1954. The scientific programme for the meeting is practically complete and
will be submitted to the Central Committee. He outlined the plans for coloured
television clinics.
Page 22 CONSTITUTION AND BY-LAWS—Dr. R. A. Stanley.
Dr. Stanley moved each of the following resolutions separately:
1. Resolved that By-law No. IV, Section 1, shall be amended to read: Organization—for the purpose of developing  the organization of  the profession in
this Province,  the province shall be divided into Districts  to be known as
District No. 2, 3, etc.   Seconded and carried.
2. Resolved that By-law No. IV, Section 3 (c) be amended to read: Principal
Delegates shall be elected to serve a term of two years and shall be eligible
for re-nomination. In Districts which elect more than one Principal Delegate
terms of office shall be so arranged that approximately one-half the delegates
retire each year. Vice-Delegates shall be elected to serve a term of one year.
Seconded and .carried.
3. Resolved that By-law No. IV, Section 4, be amended by deleting the words
"namely the Branches" in the fifth line and replacing the word "Branch"
with the words "Affiliated Society" wherever it appears.   Seconded and carried.
4. Resolved that By-law No. V, Section 1, be amended to read: The Officers—
There shalL be a President, a President-Elect, the Immediate Past President,
a Chairman of General Assembly, and an Honorary Secretary-Treasurer.
Seconded and carried.
5. Resolved that By-law No. V, Section 2, be amended by the addition of the
words "and the President-Elect and President of the Canadian Medical Association when resident in B.C."    Seconded and carried.
6. Resolved that By-law No. VII, Section 3, Subsection 5 (b) be amended by
deletion of the words "Vice-President".    Seconded and carried.
7. Resolved that By-law No. VII, Section 4, Subsection 5 (d) be amended by
changing the words "Branch" to "Affiliated Society".    Seconded and carried.
8. Resolved that By-law No. VII, Section 4, Subsection 3 (a) be amended by
deleting the words "and in agreement with the Council of the College of
Physicians and Surgeons of British Columbia".    Seconded and carried.
9. Resolved that By-law No. VII, Section 6, Subsection 1 be amended by changing the word "Branch" to "Affiliated Society" wherever it appears. Seconded
and carried.
10. Resolved that By-law No. XI, Section 3  be deleted.    Seconded and carried.
11. Resolved that in By-law No. XI, the Sections 4, 5, 6 and 7 be renumbered
3, 4, 5 and 6.    Seconded and carried.
12. Resolved that Section 2 (e) of the Constitution and By-laws "The objects
of the Association" be deleted.    Seconded and carried.
13. Resolved that By-law No. IV}| Section 4 be amended by adding the words
"If for any reason a Principal Delegate is unable to attend a meeting of the
Board of Directors he shall deputize a Vice-Delegate from his District to
attend in his place. Should for any reason a vacancy occur among the
Delegates, the Vice-Delegate from that District having received the highest
number of votes, shall fill the vacancy. Should a Principal Delegate be
elected an officer of the Association, the vacancy thus created in the Board
of Directors shall be filled by the Vice-Delegate from that District having
the highest number of votes."    Seconded and carried.
14. Resolved that By-law No. V be amended by adding: Section 6. Replacement
of Officers. Should a vacancy occur among the officers that vacancy may
be filled by appointment by the Board of Directors, pending the next election.
Seconded and carried.
Page 23 7.   REPORT OF THE PRESIDENT—Dr. J. A. Ganshorn.
This marks the end of two years since the reorganization of the B.C. Medical
Association and it is little more than one and a half years since the problems of
medical economics were placed on our shoulders.
I believe that our record has been good. We have certain definite accomplishments
to our credit. We have certainly been working and doing our level best to answer the
problems which crowd upon us. Perhaps we can be accused of doing too much—
one thing seems certain, that there is no end in sight to the problems.
There are several definite achievements which have been attained this past year
and I should like to speak about them for a moment.
The first and most outstanding is the progress we have made in Public Relations—
thanks to Dr. Gordon Johnston and his very energetic committee. Last year at this
time we made the decision to plunge into public relations—many of us wondered then
if maybe we weren't grasping a "tiger by the tail" and I couldn't say yet that we
know completely what we have grasped. We do know already though that the
"thing is not going to eat us alive," it is more friendly than a tiger; it has a tremendous
appetite. It is going to take much energy on our part to keep it fed. We started
with a weekly radio broadcast, this began with CJOR covering the island and the lower
mainland.^ It has spread to two other areas of the province. We were offered and
we accepted an unedited weekly column in two leading newspapers; then an offer came
to conduct public meetings with the Daily Province sponsoring the meetings and giving
complete newspaper coverage. We find the public are hungry for information on health
and illness. There is no question that in one way or another the public are going
to get this information and in an enlightened world it is correct that they should
have it. We know how this information has come in the past—popular writers in
magazines, self appointed writers on health. It is we, the organized profession, who
should be giving them this information and here in B.C. we are attempting to do that.
In this one year we have made wonderful headway. We have become the source
of supply for information on medical' matters. We are consulted by the press and
radio when advice is wanted. We are no longer silent, or trying always to evade
getting in the news. We are coming to realize too, that good public relations cannot
be bought. It isn't a lot of money we need to get our information out—it is doctors
we need who will do these jobs—prepare for public forums, write articles for the
papers, appear on the radio. It takes hard work and time to prepare these things—
and they are things only the doctors can do. The radio—newspapers—and no doubt
television will be and are glad and even anxious to carry our messages to the public—
Ae expense in money to ourselves is not large. The expense in effort—effort of the
doctors—is great.  Again I express our thanks to Dr. Johnston and this committee.
The second important contribution made this year comes from a committee whose
chairman was Ross Davidson. The title given was Committee on Contract Practice.
Dr. Davidson and his committee together with Mr. White, a chartered accountant,
have produced a document entitled "A Report on Medical Salaries". This report is a
valuable contribution to the doctors of the whole of Canada, indeed to the whole of
this continent. It is a report which indicates what a doctor is worth—one speaks
glibly of how costly it is to become a doctor; how long it takes to become a doctor;
and how much a young man who becomes a doctor, might have earned if he had
gone straight into a trade or business. These and many other factors have been accurately calculated and the proper salary for a doctor taking a salaried position has
been established on a sound actuarial basis. This has never been done before. The
B.C. Division has copyrighted the report.
Of what use is such a report? Well, this work has. been of valuable assistance in
getting the pay of doctors in the W.C.B. here in B.C. up where it belongs. It is true
we cannot see to it that every doctor on salary shall get at least the recommended
amount—but when the profession can say we know this doctor should be paid "such
Page 24 and such" and here is the proof   (real sound proof)   that he is entitled to it—then
that must bear some weight.
This work is only the beginning of a very large piece of work which needs
badly to be done. We should know on a sound basis "what a man in private practice
should earn". Knowing this we should go on to a still much greater task—almost a
Herculean task—the task of working out a rational fee schedule. A fee schedule which
is not just drawn out of a hat, so to speak.
To continue with the accomplishments of the year. A group life insurance plan
has gone into effect July 1, 1953, with 580 doctors participating. Our thanks is due
to Dr. Wally Brewster and his committee for this.
A pilot group pension plan has been authorized. This is only a pilot plan with
25 doctors participating. It has been authorized in this way to run a test to prove
whether such a means of providing an income tax free pension is accepted by the
Income Tax Department.    Dr. Nat Blair has worked on this.
The last which I shall mention—and one which only time alone will indicate to
be an accomplishment or a failure, is the implementation of the policy of "extra-billing"
in approved pre-paid plans. You are all quite aware what a "bitter pill" this has been
for certain specialist sections to swallow. The whole matter is to be reviewed after
a year's experience. I will make no further comment on this matter but I do want to
point out in this connection one "indirect accomplishment".
I doubt that any policy, certainly a policy of such importance as extra-billing, can
ever be decided upon, having been able to foresee all the implications. I doubt that
with even more forethought and preparation all the implications in this instance could
have been foreseen or their gravity noted. We, the people responsible for conducting
the business of the association, must act and we do act. I point out that we have
a set-up in our organization now, a democratic set-up which ensures more preparation,
and more foresight when we do act than ever before. What I want particularly to
point out as an "indirect accomplishment" is that we have demonstrated an excellent
way to solve difficulties. The aggrieved sections, some with many of their members
present, have sat with the economics committee and the executive around a conference
table for hours—to discuss and study the problems—and with profit.
I, as President, have visited many of the affiliated societies, together with Dr.
Ferguson, the Executive Secretary. We did not get to the Prince Rupert, Prince
George area nor into the Cariboo. These trips are of benefit to the whole profession
as well as to the local society, and I feel strongly that they should be continued.
The doctors everywhere are interested in the business of the association and this is
the one means of keeping them interested. I would advise that every district or
affiliated society plan to hold a meeting where the President and Executive Secretary
attend. Scientific speakers are also available through the Secretary's office. I enjoyed
my contact with these affiliated societies and profited by the association. I would
consider it a must—that the President—or one of the Executive representing him
together with Doctor Ferguson, get around to these districts once a year. The request
for such a tour should come from the district or affiliated societies.
And now if I may be permitted a few remarks, the kind that a retiring President
may feel that he should make.
I have been concerned in medical economies for the last six years. It all started
when I attended a conference of Canadian prepaid plans in Winnipeg in 1947. I
have been an officer of this association for five years. My greatest interest in economics
has been in prepaid medical care plans. I have been on the board of M.S.A. for two
years.
I should like to make some observations and give some advice in respect to these
approved prepaid plans.
Here in British Columbia we have something which is almost unique. We have
prepaid medical care plans and we have 100% of the practising doctors participating
Page 25 in these plans. A few doctors haven't signed cards—and a few doctors renege on
the contract occasionally, but all doctors have sent bills in and all doctors have received
payment from the plans. Do you know why we have such a high percentage of par-)
ticipating doctors? I think it is because in 1938 the Government of this province tried
to force on the medical profession a Government Health Scheme. The doctors united
98% strong against it and that health scheme never came into existence. That health
scheme never came into existence but another one did—the doctors' scheme—we
approved and even supported financially M.S.A. and the other approved plans which
you know. I want to make certain observations regarding these plans in the earlier
years and at present. The profession felt in those early years that it had found an
answer to the demand for health insurance. It was 100% behind the scheme and I
am told so much in sympathy with it there was very little trouble with doctors'
accounts. Specialists often billed as G.P.'s when the case was not referred. Now
perhaps that is not just quite a fair statement to make—how much did it matter
financially, to any doctor in the earlier years 1942-43-44. There were very few
patients covered by prepaid plans then. His payment from M.S.A. was small. Now
we have 1 in 5 of our patients in this province covered by prepaid plans. An appreciable part of a doctor's income must come from prepaid plans.
I want you to look at our profession now and compare it with 1939-40.    WellJ
over half the doctors practising in B.C. now weren't even here in those fateful years
when we stood firm  against the Government.    The number of doctors in B.C. has
doubled since 1945.    These newcomers at that time were either outside B.C. or as is
the case with most of them were not yet graduated.
The profession then was composed of 19% specialists; now in this province, 43%j
at least are specialists. The profession has changed. This is natural and parallels the
change in the profession everywhere. The prepaid plans have grown and in B.C.
have been popular with the subscriber. There has been concern in the last few years
about the cost of prepaid medical care as provided through the prepaid plans. One
of the observations which I want to make is that the scheme of health insurance which
we promote may be lost because of its increasing cost to subscribers. It must be
accepted that there is a limit to what people can or will pay for medical care—this
is so, as we know when the person pays directly to the doctor for each illness and it
is also true when the person prepays his costs into a plan. It is not necessary to decide
whether the premiums of our prepaid plans are now at the limit or not, the observations
which I want to make is that we must each of us show some concern for the ever
rising cost of medical care under prepaid plans. Do not misunderstand me—the
cost of good medical care is steadily increasing and for good reasons, but to consider
that because the bill is paid by a prepaid plan and not by the patient and therefore
the care can be rendered without regard to cost, is wrong. I should like to quote
what I think is a good case to illustrate my point—a Bus Driver—who has a wife
and a family of three, aged 7, 6 and 4, all covered by an approved plan. These three
children saw the doctor in his office one afternoon, no doubt the mother took them
down. Each was examined completely, and a W.C.B. and Differential was done on each
of them. A diagnosis of acute nasopharyngitis was made. They all saw the doctor
again five days later. Two weeks later they were all seen again in the doctor's office.
On the account form there was no indication of what treatment was given but the
diagnosis was acute naso-pharyngitis. The total bill was submitted for $46.50. Complete examination, $7.00; white blood count and Differential, $2.50; two subsequent
office visit, $6.00, making a total for each child of $15.00, or for the three, $46.50.
Three children with colds in their noses—for medical attention almost $50.00, not
including medications. What would be the picture if this family had not been covered
by one of our approved pre-paid plans? Would $46.50 have been spent on colds?
Would they have been getting poor medical care if less had been spent? Is it all the
doctor's fault? Do you think a mother looks forward to taking three children down
to the doctor with colds once a week for three weeks?   On this point let me quote
Page 26 from the summary of a report on the study of use services in the Windsor pre-paid
medical care plan done by the profession. "Subscribers in comprehensive plans apparently assign a less high recreational value to physicians' care than we have been led
to believe."
Now I have perhaps intimated that the 50% of doctors who are new in B.C.
since 1940 do not give enough thought to cost. I doubt very much if this is a correct
conclusion. They may not just understand what a stake we have in pre-paid plans
as well as those who have been in B.C. longer. I suspect that we all should say to
ourselves, "this is our alternative to Government Health Insurance; its cost must not
rise to a point to where it perishes; I must do my part to keep the cost reasonable, not
sacrificing anything as far as standards are concerned."
We are most of us in favor of pre-paid medical care plans—let us be sure that
it is not just lip service.
In closing my report I want to pay tribute to the men who have served so well
on the executive, on the Board of Directors and on the numerous committees, to the
members of the economics committee and the reference committee. These men have
spent much time and thought on our affairs. Thursday afternoons when it would
be much more pleasant on the golf course these men have sacrificed time, golf time
and time that might be spent with their families. We owe them a debt of gratitude
and on behalf of myself and the association I say a most heart-felt thank you.
8. INSTALLATION OF NEW OFFICERS
Dr. H. A. L. Mooney, a Past President, introduced each of the new officers for
the coming year:
Dr. J. A. Sinclair, Honorary Secretary-Treasurer.
Dr. Gordon Johnston, Chairman of General Assembly.
Dr. F. A. Turnbull, President Elect.
Dr. Mooney then introduced Dr. R. G. Large, the new President, and presented
him with a fine gavel as symbol of office to be passed to succeeding Presidents.
Dr. Large, in taking the Chair, expressed his deep appreciation at the honor conferred on him and for the generosity of the metropolitan doctors in electing an officer
from the interior.
9. NEW BUSINESS—None.
Dr. Strong arose and paid tribute to the menx and in particular Dr. Frank
Turnbull, who were the architects of the seherttigSQf reorganization of the Medical
Association in the past two years.
10.   ADJOURNMENT—Moved by Dr.  Boak,  seconded  by Dr.  Bryant,  "That  the
meeting adjourn."    Carried.
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Page 27 PROCEEDINGS
of the
GENERAL ASSEMBLY
Canadian   Medical   Association — B.C.   Division
22nd SEPTEMBER, 1953 — 9:00 A.M.
SALON A — HOTEL VANCOUVER
1. CALL TO ORDER
Meeting was called to order by the Chairman, Dr. F. A. Turnbull.
2. PROCEEDINGS OF THE GENERAL ASSEMBLY
The Proceedings of the General Assembly held in September, 1952, and May, 195*3,
were published in the October Bulletin and News Letter No. 3 respectively.
3. TREASURER'S REPORT—Dr. J. A. Sinclair.
The treasurer presented his report based on the auditor's statement and the explanatory letter which accompanied it. The letter had been mimeographed and was
before each member.
The full financial statement will be presented to the Annual Meeting for ratification.    It is published in the Proceedings of the Annual Meeting.
Motion—That the recommendation of the chartered accounants, Buttar & Chiene,
that the fiscal year be changed to coincide with the membership fee
year, i.e. January 1 - December 31, be accepted.    Carried.
Motion—That the Financial Report be accepted.    Carried.
A tentative budget was presented to the Assembly. By carefully apportioning the
funds there should be enough for all the regular functions of the Association and to
allow for travel to more districts. There would not however, appear to be enough for
the Division to meet its obligations as host to the CM.A. in June entirely out of
current funds.    It may be necessary to capitalize this over the years.
4. REPORT   OF   REPRESENTATIVE   TO   C.M.A.   EXECUTIVE — Dr.   J.   A.
Ganshorn.
1. C.M.A. meets in Vancouver, June 14 to 18, 1954, and the usual scientific
programme of the annual divisional meeting is cancelled or replaced by C.M.A. meeting. Dr. Routley retires as General Secretary at that time and Dr. Kelly steps into
his shoes. Dr. Routley has been named President-Elect of B.M.A. and will be President
when the B.M.A. meets jointly with the C.M.A. in Toronto in 1955.
2. Dr. Herman Robertson of Victoria was honored with the senior membership
from this division in June. He was unable to attend the meeting and his passing has
been noted since with regret.
3. The membership fee of the C.M.A. was raised from $10.00 to $20.00 one year
ago across Canada. There was some dropping off in membership. However the B.C.
Division has 997 members, an increase of 25 over the previous year. Income from
membership in C.M.A. in June was $71,000 over the previous year.
4. Authority has been granted and it is planned to print the C.M.A. Journal twice/
a month starting January, 1955.    The actual size of the new journal will be about
% the size of the present journal.
5. C.M.A. were again unsuccessful in gaining any ground with the income tax
department. Lawyers, professional engineers, chartered accountants and architects
combined their efforts through an eminent counsel who saw the Minister of Finance.
The C.M.A. is continuing its efforts together with the other professions.
Page 28 6. The C.M.A. is becoming more interested and active in public relations. They
have reversed their policy with regard to allowing the press to attend meetings of
council. Their experience the year before, when they allowed the press in, was not
the bitter experience we had—but I believe our experience influenced them to return
to the old system of conducting the business of the profession behind closed doors.
The Executive have authorized spending $10,000 on public relations this year. This
is twice the amount allocated last year. The C.M.A. is coming much closer to
a definite and organized plan for public relations.
No definite Radio or Press Program has been laid on but it is expected some will
be planned.
General Council did pass a motion to the effect that it was ethical for the doctor
to be named when speaking or writing on behalf of the association.
7. Health Grants: There has been no further action by C.M.A. since the Minister
of National Health and Welfare announced the new grants in the house in May. The
actual working out of these grants is a provincial matter.
General Council was disturbed that the C.M.A. Advisory Committee to the Minister
of National Health was utilized so late in the development of the health grants, and
instructed that the Minister be advised that the profession felt they could be of greater
assistance if they were consulted much earlier in the stages of planning for health
insurance that the Government is doing. We have a plan for comprehensive health
insurance which we are serious about and surely we are to be considered. The C.M.A.
could understand why at times the committee might be held to secrecy and instructed
the committee to honor such a pledge when it accepted the instructions.
With respect to the grant for Laboratory and X-ray diagnosis General Council
recommended that funds provided through this grant be used as follows:
(a) To increase diagnostic services in certain areas where such services are nonexistent or inadequate.
(b) To contribute on a fee-for-service basis to the X-ray diagnostic services for
indigent or public ward patients.
(c) To subsidize pre-payment medical plans for individuals with low income.
In other words—(1) Use the money to provide these diagnostic services in areas
where they do not exist or are deficient, and (2) use the money to subsidize the care
of indigents—do it on a fee-for-service basis and do it through our pre-paid plans.
8. There is considerable concern that medicine in Canada should speak with one
voice. This is considered of paramount importance in dealings with Federal Government. Meetings of representatives of C.M.A. and L'Association des medicins de
la langue Francaise de Canada have been held and now the Executive have appointed
a liaison committee to work with a similar committee of the French Association
to bring forth recommendations for joint action.
9. T.C.M.P.: C.M.A. continue to give their support to T.C.M.P., by granting
a further $2,000 to assist in getting the organization further started.
The statement of policy of C.M.A. on Health Insurance remains unchanged and
it is considered that T.C.M.P. and the further development of the provincial plans is
the answer of C.M.A. to the problem of health insurance.
10. The section of General Practice has indicated that it wishes to establish a
College of General Practice along the lines of the Royal College of Physicians and
Surgeons of Canada. The General Council approved this and the executive of C.M.A.
are setting up an' organizing committee to establish standards, by-laws and do what
is necessary to set up a college.
11. The Economics Committee of the C.M.A. has been charged with the problem of determining a rational basis for medical fees.    B.C. has already completed one
Page 29 stage of this study.    It has determined on a sound actuarial basis what a doctor on
salary should earn.
The study ftecessary to put the fee schedule on an actuarially sound basis will
require much more work and considerable expense. Much more than B.C. can afford—
and indeed there surely is no need that any one province should bear the cost.
12. A special commission has studied nursing with particular concern about
shortages of nurses. The C.M.A. is represented on this commission, but so far nothing
definite has come forward. The C.M.A. has now set up a separate committee to study
the shortage of nurses. The problem is acute and C.M.A. General Council was not
satisfied that the Commission had the correct approach to the problem.
13. Accreditation of hospitals in Canada:
The American College of Surgeons developed and carried out the plan for standardization and approval of hospitals in the U.S.A. and Canada and was well done.
It became a very responsible and expensive proposition. American College of Surgeons
decided to drop it and the full responsibility for inspection and accreditation of
hospitals was handed over to a joint commission in December, 1952.
The joint commission was composed of members of:
American College of Surgeons American Medical Association
American College of Physicians Canadian Medical Association
American Hospital Association
The Canadian Medical Association has promoted the idea of a separate and independent Canadian commission for Canadian Hospitals. However, such an independent
commission has been found financially unfeasible. The C.M.A. therefore is continuing
membership and financial support to the joint commission, with the Americans, and
has authorized sufficient monies in addition to place in the Canadian field an inspector,
representing C.M.A., who will inspect and accredit Canadian hospitals in conjunction
with the inspectors of the joint commission.
14. A revision of D.V.A. schedule of fees is being undertaken. Though it seemed
possible that the provincial schedules might be accepted, and your B.C. delegation
held firm to this to the last ditch, the motion to negotiate for this separate schedule
in each province was defeated.
15. The code of ethics and fee splitting was discussed. It was recognized the
C.M.A. and Royal College should have the same code of ethics and that there is need
for both the code to be stated more clearly and become more comprehensive in view
of the trend to having payments for services made by insurance schemes. No action
was taken.    Dr. Wallace Wilson will be chairman of this committee next year.
5.   NAMING REPRESENTATIVES
1. To the C.M;A. Executive for June, 1954.
Motion—That Dr. J. A. Ganshorn be nominated to be our representative to
C.M.A. Executive for June, 1954.
Motion—That nominations close.    Carried.
2. Nomination to M.S.A. Board of Directors.
Motion—That Dr. J. A. Ganshorn be our nomination to the M.S.A. Board of
Directors.
Motion—That nominations close.    Carried.
6.   GROUP LIFE ASSURANCE PLAN—Report
Enrollment
The Plan became effective 1st July, 1953, and as of 11th September the number
of doctors enrolled was as follows:
410 doctors paying premium through deductions  from M.S.A. accounts.
86 doctors paying premium through deductions from S.A.M.S. accounts.
Page 30 43 doctors paying premium by payroll deductions.
42 doctors paying premium by personal cheque.
581
Premium Payments
Where premium payments have been arranged through M.S.A. and S.A.M.S. and
payroll deductions the administrative arrangements are working well, but there is a
small number of doctors (42 in number) who have to pay by personal cheque. In
respect to this group it is desired to minimize the work of administration by evolving
some arrangement whereby premium payment would be automatic (thus absolving the
individual doctor from the responsibility of remembering to make premium payment
by the due date), and also to have uniformity in the period covered by each payment,
i.e. monthly, quarterly, semi-annually or annually.
Individual Certificates
Every effort is being made to get Individual Certificates of Insurance issued to
enrolled members as soon as possible. However, it must be appreciated that this Plan
I is unique and consequently the standard wordings normally employed on Proposal
Forms, Contracts and Individual Certificates do not apply.
While the principles and special provisions of the Plan have been agreed between
the Association and the Standard Life Assurance Company, these principles and provisions have to be expressed in the correct legal wordings to be incorporated in the
various documents. This work is now proceeding and as soon as it has been completed
Individual Certificates will be printed and issued without delay.
Newly Qualified Doctors
It must be pointed out that the success and continuance of the Group Life Insurance Plan depends upon the maintenance of a high percentage of participation by
eligible members. This is largely the responsibility of individual members already
enrolled. Newly qualified doctors should be urged in their own interest, as well as the
communal interest, to submit their applications .as soon as possible so that coverage may
become effective immediately they have fulfilled their eligibility requirements, and
without having to produce evidence of insurability. In this way, each member will
ensure not only the successful continuance of the Group Life Insurance Plan, but
also the steady growth of Association membership.
Marsh & McLennan Limited.
7.   GROUP SICKNESS & ACCIDENT INSURANCE PLAN—Report
Canadian Medical Association, B.C. Division, Accident & Sickness Group
Policy Period — August 2nd, 1952, to August 2nd, 1953.
We  are pleased to report  that  the Disability  Group  is  in  a  most  satisfactory
condition.    The most important factor is the maintenance of group membership, and
the total group enrollment is increasing adequately as compared with the membership
increase of your Association.
On August 2nd, 1952, membership in the Group totalled 355, and on August
2nd, 1953, the total was 420, and an active list is enclosed for your convenience. The
net gain of 65 arises from 83 new members less 18 lapses.
We were most pleased, commencing August 2nd, 1952, to be able to offer to the
Association, substantially superior coverage than formerly, such as—indemnity periods
increased to be five years for accident and two years for sickness—weekly indemnity
limit increased from $50.00 weekly to be $100.00 weekly—death and dismemberment
clause broadened.
May we thank you for your assistance and co-operation so readily given to us
at all times, by yourself and your staff and the membership.
Parsons, Brown Limited.
Page 31 8. PROGRESS REPORT—PENSIONS—Dr. N. J. Blair sent his regrets to the
Secretary that he would be away at the time of the meeting. Plans for the pilot
study are going ahead.
9. COMMITTEE REPORTS
EXECUTIVE COMMITTEE
Mr. Chairman:
I have the honor to present the report of the Executive Committee and the Board
of Directors.
During the year the Board of Directors met four times. The Executive met
monthly and in January and May met twice. It is the duty of the Board of Directors
to deal with the heavier problems concerning the profession and to formulate policy.
It is the job of the Executive Committee to:
(a) Deal with the lesser problems concerning the profession.
(b) Interpret and bring into effect policy as determined by General Assembly
and the Board of Directors.
(c) Act as a Grievance or Mediation Committee.
A report of the Executive Committee was presented to General Assembly when
it met in May, 1953. Members of the Association received the information in a News
Letter dated April, 1953. I will today refer "in summary" to matters reported previously, but in more detail to matters dealt with since the last report.
1. A group life insurance plan went into effect July 1, 1953, with 580 doctors
participating.
2. A group pension plan for doctors was studied; income tax free until benefits
are realized, and a decision was made to run a pilot plan with 25 doctors for one year
to determine definitely if monies paid into such a plan were in reality income tax free.
3. Authority was granted to establish M.S.A. coverage for employees of doctors.
It is a trustee type of contract to be set up by mjedical districts. M.S.A. indicates
that applications for coverage are being received in good numbers. Coverage will be
effective as soon as 75% of eligible subscribers have applied.
The Executive decided not to consider M.S.A. coverage for doctors and their
families. This decision was based on tradition and the fact that we were not yet
prepared to allow other professional groups coverage under M.S.A.
4. A Section of "Physicians in Public Services" was approved and has been
formed. B.C. is the first province to set up such a section and it is considered as a
most important step toward unity in the profession. It brings together again the
two branches of the profession who have almost become divorced; the doctors in
private practise and the doctors in public services. Each have contributions to make
in the solution of the major problems facing the profession today. There has been
a marked increase in membership in the C.M.A., B.C. Division, from doctors in public
services.
5. A sub-committee of the Committee on Economics has been set up to study
and make recommendations for an approved prepaid medical care plan to enroll individuals. This committee is also charged with the duty of considering with M.S.A.
a private bill which will permit M.S.A. to operate under a separate Act and not
under the Societies Act as it now does.    The committee has started on its work.
6. There have been two very difficult problems for your Executive and Board
to deal with this year, and indeed the answers are not yet clear. Both matters are on
the Agenda this General Assembly.
The first concerns the interpretation and implementation of our policy on extra
billing in the approved medical care plans. This has proved "bitter gall" to several of
the specialist sections in our Association. The report of the Economics Committee
deals fully with this problem. It should be noted here that the Association has met
and discussed with the sections involved, through its directors and Economics Com-
Page 32 mittee, have made every effort to learn as much as possible about these problems and
to correct injustices.
7. The second problem concerns the S.A.M.S. and teaching hospitals. When
S.A.M.S. was inaugurated in 1949 the Council of the College, through the Economics
Committee, entered into an agreement with Vancouver General Hospital to pay a
lump sum of $2,000 per month on behalf of S.A.M.S. patients who were treated in
Staff beds and in the out-patient department and some critical comments were heard
concerning the method of expenditure of the V.G.H. fund. The S.A.M.S. Sub-Committee recommended a study and appraisal of the problem.
After much study, the Economics Committee recommended to the Board of
Directors that the S.A.M.S. was not designed to support hospitals and its basic responsibility was to pay for medical services. The following basic policy was approved.
"The S.A.M.S. should pay for medical services on behalf of their beneficiaries, wherever
the service is rendered and to the person rendering the service."
The following was designed as a means of implementing this basic policy: "That
S.A.M.S. patients be regarded only as private patients and that payments be made on
a fee for service basis only to the individual doctor rendering the service after the
method now being used for W.C.B. patients."
When this was transmitted to the Medical Board of the V.G.H. with notice of
intent to terminate the agreement, the Board asked for a hearing. They pointed out
that our proposed methdd of payment would seriously embarrass the hospital in its
commitments to the Faculty of Medicine and at the same time the Heads of Departments of the Faculty assured the Association that it would seriously embarrass the
administration of the teaching departments.
The Association had no intent or desire to hinder the Faculty of Medicine and
it was agreed once more that the basic policy should be a guide and that the doctors
on teaching staff who did the work might instruct us concerning the manner of
settlement and to whom they wished the money paid, if not to themselves. After
a mail ballot they decided to accept the token payment and a voice in distribution
of the fund created.    It was to be their contribution to teaching.
An agreement has been reached with the Medical Board which is published in
News Letter No. 3.
8. Federal Health Grants. A committee has been named to liase closely with the
Provincial Department of Health and Welfare in respect to federal health grants.
Dr. R. A. Palmer, chairman, and a group who have functioned as a health planning
conference were named as this committee. Correspondence has been received from the
Department of Health indicating that projects are being considered but none have yet
been approved under the two new grants announced this year. The chairman has been
in contact with members of the Department.
9. W.C.B. and payment to doctors for X-rays. The Executive were influential
in having a W.C.B. ruling changed. This ruling concerned the direction of patients
for certain emergency X-rays and seemed inconsiderate of the patient and the doctor.
10. Re: Code of Ethics and Contract Practice. The Council of the College of
Physicians and Surgeons invited tht C.M.A.—B.C. Division—to participate jointly in
a committee to study the problems of contract practice from an ethical standpoint.
The Executive accepted and appointed three to the joint committee.
11. The Minister of Health was interviewed by representatives of the Executive.
He was made aware of our aim to eventually obtain payment for the care of S.A.M.S.
cases on the basis of 90% of the minimum schedule. The Minister seemed to indicate
sympathy for our aim but no increase in payment from the government was offered
and the matter was not pressed.
12. An agreement in principle has been reached with regard to assistance which
the profession will give the Minister to help control the rising cost of drugs supplied
Page 33 by Government to S.A.M.S. cases. A B.C. Formulary set up by our Pharmacy Committee has been accepted by the Minister and a joint committee, composed of two
members representing the Division and one representing the government, has been set
up. So far Government policy has not been enunciated. The Formulary has been
printed but not distributed. The government has been asked to supply each doctor
with one since it will be more essential that he have one in prescribing for S.A.M.S.
cases.
13. The Board of Directors set up a Reference Committee over one year ago.
The public was informed of the existence of such a committee following the Annual
Meeting of the B.C. Division last year. On request of a doctor, or a prepaid plan, this
committee will adjudicate a dispute about a medical account for services rendered
to a patient who is a member of one of the prepaid schemes. The committee finds
itself quite busy, sitting for one day once a month. The Plans have expressed appreciation of the work of this committee.
To supplement the Reference Committee, a Mediation Committee was also set
up. This Mediation Committee is in actuality the Executive of the Board of Directors,
acting in a special capacity. The Mediation Committee is prepared to act and has so
acted, in a wider field, i.e. disputes about accounts that do not involve members of
the Prepaid schemes, ethical problems that are perhaps outside the jurisdiction of
Council (outside in that formal charges are not laid). It also deals with appeals from
decisions of the Reference Committee.
The problems that are handled by these two committees often represent merely
a misunderstanding. At other times, the committee's interpretation cannot be so
charitable and decisions are painful for the committee as well as the doctor concerned.
It is all a part of "cleaning our own house" and one of the most important benefits
that arise from the activities of these two committees is the development and maintenance of better public relations. It has been the unpleasant duty of the Executive
to lay charges against one member of the profession which resulted in permanent
cancellation of his right to practise.
14. The experience of the Reference Committee and the Mediation Committee
indicates that all the problems were not solved when extra billing was allowed.
Some members cannot or will not wholeheartedly co-operate and a disproportionate
amount of the Association's time and effort is expended in attempting to solve the
problems created by the few. Certain patterns of practice and evidences of disregard
for the contract agreed to by the profession have come to light, which if allowed to
go on and to become more prevalent would do great harm to Prepaid Plans and great
harm to our public relations.
To handle this situation the Executive have passed the following two resolutions
which it recommends to the General Assembly as a policy to be followed in dealing
with non-cooperating doctors.
1. Declare that certain physicians be named by the Board of Directors as non-
participating doctors and this be recommended to the Boards of Approved
Prepaid Medical Care Plans.
2. Declare that the Association favours that no payment be made directly or
indirectly by approved Prepaid Plans when a subscriber is treated by a non-
participating doctor, except in emergency.
J.  A.  Ganshorn,  M.D.,
Chairman.
COMMITTEE ON MEDICAL ECONOMICS
I have the honour to present the report of the Coniniittee on Economics.
During the past year your committee of Medical Economics has met repeatedly
and has as before, pondered over many challenging problems.
We have been made aware of the ever changing components of the economic
problems facing the profession, and have become more conscious that many of these
Page 34
1 ^problems are immediately insoluble and can only be resolved by a slower process of
readjustment.
To be more specific,  since  the  September,   1952,  General Meeting in  Victoria,
the committee has  steadfastly faced problems arising out of extra billing,  and  has
rperhaps learned most from our errors of omission.   You will recall at that meeting two
resolutions were passed.
"That this Assembly approves the following policy in establishing terms of
service for approved pre-paid plans.
1. 'That any doctor, be he specialist or general practitioner, have the privilege
of extra billing, providing he gives the patient warning beforehand that he
may or will be extra billed.'
2. 'That subscribers be advised by the pre-paid plans that they may expect to
be extra billed if they go direct to a specialist—the specialist at an appropriate
timt to advise the patient that he will be extra billed.' "
These resolutions we recognized as expressions of principle only. However we
felt that they were in the best interests of pre-paid medical care, the public and the
profession. Unfortunately, we had invited the press to be present at our meeting,
ifeeling that we had nothing to hide, and our resolution had as a result considerable
publicity. To our dismay an immediate hostile criticism emanated from the public,
the pre-paid plans and several of our own sections. Our obvious error was in allowing
publicity to a principle before it was negotiated and explained.
Following the meeting we were in the compromising position of having to explain
to the several approved pre-paid medical plans the basis of our actions, and the principles of our resolutions.    We found the board members of all the schemes extremely
[hostile and distrustful of our motives, in fact they were actively antagonistic.
Eventually a basis of implementation of the resolutions was established with the
hoard of the M.S.A., and a new "term of service" agreement worked out with the
r|M.S.A. Meanwhile our relations with the other approved plans had deteriorated. It
was our impression that the basis of the new resolutions was already in effect with the
other approved plans. They confronted us with a demand for increase in discount
from 10% to 25%. This request was refused but served as a basis of establishing a
new understanding with the scheme.
Consequent to this deterioration of relations, the sub-committee to study pre-paid
medical care with Dr. Gordon Francis as chairman, met with all the members from
each plan, together with representatives from our own sub-committee. This group
meets every two months and has served to promote a very real improvement in relationship between the various Plans and our own organization^- A further development
has been a series of meetings of medical representatives of the Plans in an effort- to
coordinate and standardize assessment of accounts. Thus, there is a promising prospect
of not only better integration between the doctor and the Plans, but a standardization
within the Plans.
Further to the problems of pre-paid medical care plans, the Fraser Valley Medical
Dental Society has over the past year or two approached the association with regard
to receiving approval. There were many problems arising out of these discussions and
eventually the Executive decided not to approve the Society. You will all have received
communications in recent months from the Fraser Valley Medical Dental Society,
and I would remind you that at this time there has been no approval granted by the
Association, and consequently, they are not entitled to discount medical accounts.
The question of providing medical data to the Society is of course, one of individual
decision for each doctor concerned.
Subsequent   to   our   completing   implementation   of   our   principles,   the   M.S.A.
started in November to pay specialists' fees for referred cases only, and thereafter
asyour committee faced the impact of various criticisms arising from the section of
Paediatrics, Internal Medicine, Dermatology and Eye, Ear, Nose and Throat.    Each of
Page 35 these sections met with the committee and presented briefs—and the criticisms arising
therefrom were reviewed. These led to a series of resolutions passed in the forni
of recommendations to the spring meeting of the general Assembly—which were a:
follows:
1. "That in non-operative problems when treatment is continued by the specialist
after consultation by that specialist, payment should include consultation fe<
plus payment for continuing treatment at specialist rates."
2. First  visit in non-referred,  non-operative  cases.     "In  respect  to  the   $3.0G
and $7.00 fees for first visits (items 0100 and 0101 of the schedule of fees)
that the pre-paid plan payment be determined on the basis of the work don^
as recorded on the account card and not solely on the diagnosis."
3. Reference Committee. "That doctors' accounts submitted to Prepaid Medical
Plans when disputed may only be assessed by the Reference Committee of the
C.M.A.—B.C. Division." Adequate publicity will be given before this motion
is put into effect.
4. "That the policy of payment of specialists at general practitioner rates foij
non-referred cases be continued until January 1, 1954, to determine whethen
it is effective in limiting excessive utilization of specialist services by members-
of the prepaid schemes. If at the end of this trial period this policy cannot;
be shown to be effective in controlling the rising costs of subscriber care that
consideration be given to its abolishment."
5. "That non-referred cases seen by a specialist where services rendered are customarily only done by such specialist should be paid at the specialist scale of
fees."
These resolutions have been presented to and discussed with the pre-paid plans,
with the request that they will be implemented by September 15,  1953.
During the past few months a Committee has been formed to evolve a methodi
of providing Pre-paid Medical Care for individuals. This has long been a deficiency!
in the Province of British Columbia and has been brought prominently into focus
by the formation of T.C.M.P. The Committee of necessity must at the outset be
entirely medical and may later recommend lay personnel or appointees to a board of
directors. The M.S.A. board has offered help in the form of advice, and the use of
equipment—but is unable to take the responsibility for this new venture.
In comparison to the difficulties and frustrations with pre-paid medical care, the
sub-committee on salaried physicians has provided a most gratifying forward step. The
chairman, Dr. Ross Davidson, together with his committee and Mr. D. G. White,
C.A., have worked for many hours to produce what we believe is a unique document
which determines a basis of remuneration. for salaried physicians. This document
has been copyrighted by the Association. It is planned as the first stage of a more
comprehensive study to determine a factual basis of medical income. It is hoped that
stage two of this study will be undertaken in the near future.
The problems of the S.A.M.S. have throughout the year come under the supervision
of the sub-committee of which Dr. Ross Robertson is Chairman. A difficult problem
was that the token payment was not an equitable distribution of the S.A.M.S. funds,
and that these patients should be treated as private patients in all hospitals. This
interpretation was shared by the medical economics committee, and the executive of
the B.C. Medical. However the Vancouver General Hospital Medical Board met with
the executive to bring forward the argument that these patients constituted a considerable part of the teaching beds, and they were anxious to maintain these patients
as teaching material. Eventually, the executive agreed to a referendum vote of the
individual members of the staff of the medical faculty, and the results of their votes
were that the token payment to teaching hospitals be continued. Your Committee
in accepting this considers that the solution is hot on a satisfactory permanent basis.
The Association has suspended its arguments temporarily in deference to the formative
Page 36 period of the Medical School. The Medical School would have suffered in a conflict
between our Association and Hospital in the changing economics of staff patients.
In other words all staff bed occupants are no longer indigent since S.A.M.S. covers
[the pensioner group.
The tariff sub-committee has been active throughout the. year, Dr. J. Tysoe and
his conimittee have met representatives from each section. For the most part pressure
has been put on the committee for increases in medical fees. This has been most
apparent in the sections of radiology and dermatology. Your sub-committe recognized
that costs of medical practice had no doubt risen but that the same relative costs had
affected all forms of private practice, and that the significant increases requested were
not justifiable at this time.
The sections have requested adjustments in certain items, and for; the most part
these have been approved but no broad scale increases have been made. The Tariff
Committee report is now before the Board of Directors.
The problem of distribution of fees for surgical procedures carried out by a
surgeon and general practitioner has again been under discussion. The surgical section
is anxious to avoid the utilization of division of surgical fee as a solution to the problem of remuneration for the family physician who originally does the work-up of the
case, assists at the operation and carries out certain post-operative care.
The S.A.M.S. considered this problem of the payment of a pre- and post-operative
fee to the general practitioner, for care in those cases where the surgery was performed
by a surgeon specialist. They recommended a procedure of assessment of accounts
which would give some information on the problem. The Board of Directors authorized
this procedure and you have been so advised.
"That we recommend to the Tariff Committee through the Committee on
Economics that in surgical cases where the family doctor is the first man to see
the case and calls in a surgeon consideration should be given to paying the family
doctor not only for his preliminary work and as assistant's fee, where applicable
(as outlined in the present minimum schedule of fees), but also for a reasonable
amount of post-operative attendance on a fee for service basis, this to be quite
separate from surgical fee."
During the year there have been three meetings of a committee to study health
planning. This committee has met with Dr. Russell Palmer as chairman, and have
discussed various prospects, standards and proposals with regard to further measures
toward socialization of medicine. Naturally this committee has had little factual
material or data to discuss other than the Provincial Government Health Survey reports,
and this only since April, 1953. However the meetings have been beneficial and are a
means of informal expressions of opinions. This Committee has been given the responsibility of advising the Board of Directors on the Health Grants and to meet with
the Department of Health when necessary.
Your chairman has attended two meetings of the Medical Economics Committee
of the C.M.A. during the year. These were very successful in presenting a comprehensive picture of the problem of the various sections of the country. It is apparent
that the problems vary and the attitudes toward those problems varies as does the
degree of progress in the field of medical economics. In this regard the three most
westerly provinces seem to be the most advanced in their thinking and most comparable to each other. The problems of medical care for R.C.M.P. & Sick Mariners
were discussed.
P. O. Lehmann, M.D.,
Chairman.
SUB-COMMITTEE ON PREPAID PLANS
Following the resolution on Extra billing passed at the last Annual Meeting of the
Canadian Medical Association, B.C. Division, and the attempted clarification of this
resolution  by  statements   in  the press  by  the  Association  and   the  M.S.A.,  it  was
Page 37 requested by the Approved Plans other than M.S.A., that a joint meeting be held
between their representatives, and this Sub-committee. At this meeting, the representatives of the Approved Plans pointed out that their plans had received no notification or instructions relative to the implementation of the new resolutions, beyond
the information they received in the daily press. They wished to be assured that if
future major changes in policy were considered, they would at least be advised of
such before the date of activation. We could not but agree with them completely.
In addition to this, the representatives of the Plans stated that their economic position
was not enviable, and made the plea for a return to the 25% discount of medical
accounts. This was regarded by the Association as a retrograde step, and the Plans
were informed that they .must economize in some other direction.
However, arising out of this meeting was the feeling that perhaps we were not
offering as much help as we could to these smaller Prepaid Plans to which we had
already given approval. Accordingly, in the weeks that followed, arrangements were
made for joint meetings between the Sub-committee and representatives of the Prepaid Plans every other month, while during the months between, a member of the
Sub-committee, with our Executive Secretary, attended a meeting of the Approved
Plans. In this way a much closer relationship, and a more amicable one, was established
between the Association and the Approved Plans.
One point that became evident from the discussions at these meetings was that
there appeared to be a lack of uniformity among the Medical Directors of the Plans
in assessing medical accounts. To overcome this disparity a resolution was passed
forward from the Sub-committee that a Conference of the various medical directors
be held at intervals so that each might become more familiar with the other's problems.
This has been implemented and there has been formed a Sub-committee of
Medical Advisors to Prepaid Plans, under the \Chairmanship of Doctor G. L. Watson.
This new Sub-committee will function to the advantage not only of medical directors
and Prepaid Plans, but also of our Association, as reports and recommendations will
be forthcoming from this Sub-committee from time to time.
I think it would not be remiss to again remind the members of the Assembly
of these plans that are approved by the Association.    They are:
M.S.A. B.C. Telephone
CU. & C. Cunningham Drug Stores
Vancouver Teachers B.C. Government Employees
B.C. Teachers
These plans, and these plans only, are Approved.
G. H. Francis, M.D.
REPORT OF SOCIAL ASSISTANCE MEDICAL SERVICE
The following is a table summarizing the receipts and disbursements of this
service for the fourth year of operation. This is the first full year of operation at
$18.50 per capita. It will be noted that the percentage paid to doctors on assessed
accounts averaged 60 in this year of operation. The difference between accounts as
rendered and accounts as assessed was a reduction of 12.3%. Further points of interest
are as follows:
Recipients—There has been an increase in-the total number of recipients in this
period of 3,391, from 62,857 to 66,248.
Hospital Out-Patient Laboratory and X-Ray Services—The cost of this service
to the Scheme was 32c per capita for the full year of operation.
St. Paul's Hospital Out-Patient and Staff Cases—Accounts have been rendered
by the attending staff of St. Paul's Hospital for these services and have averaged
approximately $1,800.00 per quarter as assessed. These have been paid at the usual
percentage for the quarter.
Page 38 Administration Costs—The administration costs have been maintained at 3.8%
of the total receipts for the year. This has been made possible by the diligence and
industry of a very loyal staff.
Fourth Year of Operation — April 1, 1952, to March 31, 1953
Number
Amount Rec'd
Total Accounts
Total Accounts
Total Medical
Cost of
Covered
m^ •    ^
As   Billed
As Assessed
Expense
Admin.   3.8%
64,703
i    m
$1,190,243.30
1
$2,141,040.57
$1,877,020.55
$1,151,788.99
$45,879.18
Yours sincerely,
Social Assistance Medical Service
H. Scott, M.D.,
Medical Director.
PUBLIC HEALTH
Your committee continued to act in an advisory capacity on matters related to
the field of public health. The only matter of importance for consideration was that
of the Report on Narcotic Addiction prepared by the Community Chest and Council
of Greater Vancouver, so as to advise the Board of Directors of the B.C. Medical
Association as to what action should be taken. A study committee, which included
representatives from all interested groups in the profession was formed and recommendations were drawn up.
G. F. Kincade, M.D.
Re Committee on Public Health:
Dr. Wallace Wilson extended to the Committee on Public Health the very great
appreciation of the Community Chest and Council for the great interest they took
in studying the narcotics situation.
COMMITTEE ON CONSTITUTION AND BY-LAWS
Mr. Chairman, and Members:
Several amendments to the Constitution have been suggested for this year. Each
is self-explanatory. They have been approved by the Executive Committee, April 25,
1953, the Board of Directors, May 22,  1953, and passed by the General Assembly,
I wish to thank the members of the Committee for their cooperation.
May 23,  1953. ||j
R. A. Stanley, M.D.
COMMITTEE ON MEDICAL EDUCATION
Mr. President:
The members of the Committee on Medical Education for the year 1952-'53
were Dr. J. Balfour, Secretary, Doctors H. J. Weaver, D. M. Whitelaw, D. E. Starr,
C. G. Campbell.
Since your Executive wished to re-establish the policy of having various speakers
prepared to attend Medical Society Meetings throughout the Province, your Committee
on Medical Education assembled a roster of fifteen speakers. These men were chosen
from all the branches of Medicine so that almost any subject can be covered when
requested by a particular Medical Society.
Speakers were sent to meetings in Vernon, Nelson, Cranbrook and Parksville during
the past year. It is the intention of your Committee to rotate various members of the
profession through this roster and to keep the individuals alerted to a call from a
Medical Society for a speaker.
T. R. Sarjeant, M.D.
Page 39 COMMITTEE ON PROGRAMME AND ARRANGEMENTS
The above committee was made up of the following members: Drs. J. A. Ganshorn;
H. A. Chisholm (Secretary); G. R. F. Elliot (Entertainment); J. F. McCreary, J. E.
Musgrove, J. H. Black (Scientific Programme); R. P. McCaffrey (Hotel); G. F.
Kincade (Finance); J. C. Thomas (Exhibits); W. M. G. Wilson (Registrar); A. C. G.
Frost (Hobby Show); George Langley (Golf); J. L. McMillan (Printing and Publicity) ; G. G. Ferguson (ex-officio).
Your Cornmittee held its first meeting in November, 1952, and have met monthly
since then finalizing the programme which is now in the hands of all members. It is
the sincere hope of your committee that the meeting will prove as successful as those
of the past.
We are fortunate this year in obtaining an outstanding group of scientific speakers
whose contributions should prove of particular interest to our members. In this
regard I would like to thank Dr. Burns, President of the Canadian Medical Association,
and his executive members for their continued interest and help in arranging the group
of visiting speakers from The Canadian Medical Association and to our own Sub-
Committee on Programme for obtaining such well known and capable guest speakers.
The commercial exhibitors are in excess of any previous meeting. In as much
as the financial success of the annual meeting depends largely on the co-operation of
these exhibitors I would urge our members to visit all the many interesting displays
that will be offered.
The Ladies' Programme has been entirely looked after by a separate committee
under the Chairmanship of Mrs. J. A. Ganshorn. This committee has prepared and
forwarded to all members' wives an outline of the many entertaining features that I
am sure will be enjoyed by all who attend.
The Social functions of this year's meeting have been in the capable hands of
Dr. G. R. F. Elliot, who has given unstintingly of his time and efforts integrating
the many details on which the success of the meeting depends.
I wish to take this opportunity of thanking each member of this committee for
their whole-hearted co-operation. Through their energetic work and expenditure of
time they have prepared a programme, which I am sure you will agree compares favorably with the high standards set by this Association in the past, and have made the
work of the chairman a sinecure.
H. E. Taylor, M.D.
COMMITTEE ON PUBLIC RELATIONS
Mr. President and Gentlemen:
Following the Annual Meeting in September, 1952, your Public Relations Committee contracted with Station CJOR for twenty-six weekly radio broadcasts at
approximately $74.00 per program. These programs were carried out on schedule
and covered a wide variety of topics, most of which were planned to interest and
serve the public regarding matters of health. Others were designed to clarify the
purpose of extra billing, the organization of medical practice, the education of medical
students, and our policy on National Health Insurance, etc. Later in the year, our
tape recordings were picked up by the local stations in Penticton and Prince Rupert
and rebroadcast, free of charge, as a public service. It is not possible to accurately
assess the value of these programs, because there is no means of determining the size
or character of the listening audience. It is noteworthy, however, that a large number
of doctors heard favorable comments from many of their friends and patients, showing
that the number listening was probably considerable.
The programmes were recorded as interviews and a different doctor was interviewed each night.    In all cases, the identity of the doctor was known.
At the time of the Annual Meeting, a free, weekly, unedited column was offered
the Association by the Colonist in Victoria.    This offer was accepted and this paper
Page 40 has been pubhshing our column since then until the end of last June.    This particular
work has been under the control of Dr. Gordon Grant.
In December of 1952, the Vancouver Daily Province offered us a similar column
and again we accepted and publications began in February, 1953. Dr. Arthur Bagnall
was in charge of this column.
Finally, in May of 1953, the Vancouver Daily Province suggested that we produce
a Medical Forum which they would sponsor. As you know, this suggestion was acted
upon and two trial forums were held toward the end of June, 1953, at the Georgia
Auditorium. Although there was some rather serious criticism of such a step from a
number of medical men prior to these productions, due to the wide publicity given
to the members of the panel, these doubts were largely dispelled by the success of
the venturt and it would seem that another epoch had been successfully entered.
Although there were many smaller matters which demanded our attention, these
were the main achievements of the committee during the past year.
The transition period of no public relations to publicity of such magnitude in
such a short time acutely strained the facilities and imagination of our committee.
Meetings had to be held weekly for the first half of the term and then every second
week for the latter half of the year. It will be apparent that we were novices in
publicity and had to learn to deal with each phase as it appeared and at the same
time stay within the bounds of the policies laid down by the Association. We were
greatly handicapped in that we, because of our inexperience, were unable to anticipate
the effects of our actions on either the public or the profession. In all this we were
greatly helped by the ex-officio members, namely, the President and the Executive
Secretary of the B.C. Medical Association, and the Chairman of our Economics Committee. Mr. Dorwin Baird of CJOR attended all our meetings and his staunch support
and help were invaluable. Most of all, the Board of Directors gave us unlimited
support of all kinds. Finally, we rapidly enlarged our committee as new phases of
the work came into being, and were delighted at the amount of talent and enthusiasm
that is available in the profession.
Now that the first year has ended, it may be worthwhile to reflect on the results
so far achieved. In the first place, prior to September, 1952, there was a great deal
said and written on matters of health by politicians, laymen and various groups engaged
in the business of healing, but "outside the pale" of our profession. Some remarks were
made by individuals belonging to our profession, but their comments were often contradictory and in many cases did not have the approval of the profession behind them.
All this occurred while the doctors of the province looked on helplessly, because they
were completely unorganized and rendered impotent by their self-imposed, peculiar,
medieval ideas of ethics. Today we have completely eliminated our competitors and
have taken our place unchallenged as authorities on matters of health.
Secondly, a year ago we felt like snarling and snapping in helpless rage at our
critics. But today, our public influence is such that we can afford to ignore the disgruntled crackpot who lashes out at us. We feel we are regaining public confidence;
not because we have won or attempted to win any economic arguments, but because
we have simply regained contact with the people arid given them frank and honest
service as a profession.
Thirdly, only a few short months ago, people were suspicious of our motives and
doubted our sincerity. As a profession we were probably hated by a considerable
portion of the population. Now, we think this attitude is rapidly changing and we
think it is because we have gone out to meet our public as a profession, on the radio,
in the press and most important, on the stage in a public forum. We had lost the
common touch and now we have regained it.
Fourthly, in 1952, we had no idea of our political power or the appeal to the
public of the work we are engaged in. Now that we have thrown off our inherited
reticence and come down from our lonely aerie, we find that we are warmly received.
Page 41 Fifthly, only a year ago we felt bitter toward the press and thought that they
were uncooperative. Since our reincarnation, however, we find that they are most
agreeable to deal with and are helping us enormously.
In short, we have found that we cannot adequately serve the public and have
its trust and respect if we remain cold and aloof. If we are willing to throw off our
ridiculous shackles, however, and take our place in the community as ordinary mortals,
there is probably no limit to the influence we may be able to exert.
Your committee, therefore, after serious consideration, would like to recommend i
that: (1) The radio programme continue because it is the only medium we can
afford and completely control at all times, and because with it we get considerable
help in our relations with the public and other media of communication at no extra
cost. It is the only part of our publicity that we actually pay for. We would also
like to suggest that the next committee give some consideration to a more appropriate
hour for the programme and that the feature programmes might be dramatized to
some extent.
(2) We think the columns in the press should be continued because they reach
a large audience. They improve our press relations and they are appreciated by the
public  and cost  us nothing except considerable effort in writing  them.
(3) The Medical Forums are a most valuable asset and should be carried on
about once a month for most of the year and it is extremely important that they
should be well organized and rehearsed and couched in simple language. This personal,
down-to-earth contact with the people is most important.
(4) Simultaneous broadcasts over the radio from the Medical Forums are available
without charge, but this should probably be avoided for the moment because of the
complications that might arise between our sponsors, the Vancouver Daily Province,
and our radio station, CJOR. Furthermore, television will soon be available and its
possibility should be considered before we place ourselves under too much obligation
to any radio company.
(5) Finally, it should be emphasized that in order to have publicity we must be
free to publish the names and photographs of doctors, because media of communication are not interested in anonymous or impersonal news.
This is respectfully submitted and I move its adoption.
Gordon C. Johnston, M.D.
Dr. Boak voiced  the appreciation of all members for the work of  the Public
Relations Committee and its Chairman.
COMMITTEE ON ARTHRITIS AND RHEUMATISM
Mr. Chairman and members of the General Assembly:
This committee continues to be active, meeting several times a year. It continues
to act in a dual capacity, serving as a medical advisory committee to the Canadian
Arthritis and Rheumatism Society, thus acting as a liaison between this committee and
the Canadian Medical Association, B.C. Division.
One of its prime concerns has been to further clinical and laboratory investigation
into the causes and treatment of the rheumatic diseases. In this respect a long term
clinical investigation to determine the best use of cortisone in rheumatoid arthritis
and rheumatic fever has been completed as a research project, and final reports are in
the process of being compiled. These will be published in the near future. Funds for
this work were supplied by the Canadian Arthritis and Rheumatism Society, and a
sub-committee under the chairmanship of Professor Robert Kerr engaged actively in
the direction of the project.
Investigation into the measurement of various steroids in blood and urine in
health and disease is continuing at the University of British Columbia under Professor
Marvin Darroch. This difficult piece of work has now reached the stage of perfection
of technical methods, so that normal and probably abnormal steroid patterns should
be able to be worked out in the next year.
Page 42 Owing to numerous requests from regional medical societies, a travelling consultant service in rheumatic diseases will be inaugurated in the next few months.
This service is designed primarily for those in low income groups, and is to be provided
only to those districts which request it, as is in line with our policy of augmenting
facilities available to the physician in the treatment of rheumatic diseases.
The committee would again like to emphasize the need for special beds, particularly in the larger hospitals, for the instruction of under-graduate and post-graduate
students. It is felt that adequate instruction in the rheumatic diseases at the medical
school level will result in much of the improvement in the knowledge of these diseases.
This committee in its dealings with the Canadian Arthritis and Rheumatism Society
has always advised that its policy should be one of augmenting the facilities available,
to the family physician, and also to encourage research into the basic causes of the
rheumatic diseases.
F. W. B. Hurlburt, M.D.
COMMITTEE ON CANCER
With regard to the Annual Report of the Committee on Cancer Canadian Medical'
Association, B.C. Division, no meetings have been held to date.    Quite recently the
Executive Committee of the B.C. Cancer Foundation has made the following request:
"That the Committee on Cancer of the British Columbia Medical Association be asked to make enquiry of representative hospitals in British Columbia and
private physicians through the British Columbia Medical Association as to whether
co-operation from hospitals and private doctors can be assured in obtaining cancer
records to implement a cancer records programme for British Columbia as outlined
by Dr. A. J. Phillips in his report of March 21, 1953; further, that the Medical
Committee of the Foundation in conjunction with the Committee on Cancer be
asked to submit a report to the Executive Committee."
Owing to important members of the Committee being on holiday this month, we
will not be able to meet until early in September to consider this question. It m(ay
be that by September 22, 1953, we shall have made enough progress in this matter to
submit a supplementary report.
Roger Wilson, M.D.
Committee on Cancer—Dr. Roger Wilson.
Motion—That the Cancer Institute proceed with the plan for keeping records
of cancer patients in the province.    Carried.
COMMITTEE ON CIVIL DEFENCE
The Committee on Civil Defence has functioned in an advisory capacity to the
Vancouver Regional Civil Defence Organization. It has expressed to the Provincial
Director of Civil Defence the willingness of the Members of this Association to participate actively in any medical matters pertaining to Civil Defence. The Committee
has not been utilized to date by the Provincial Civil Defence Organization, and has
no official status in this body. It has, however, established active liaison with the Civil
Defence Planning Group in Ottawa, which has kept your Committee well informed
of Civil Defence measures as they are planned, and as they fructify in various parts
of Canada.
In January of this year your Chairman, with representatives of the Regional and
Provincial Civil Defence Organizations, attended the Western Provinces' Civil Defence
Conference in Edmonton.
In Victoria and Vancouver the local medical societies have cooperated in exemplary
fashion with the Regional Civil Defence Groups, and commendable advances have
been made in these two cities in the matter of medical preparedness. The medical
aspects of Civil Defence in Victoria are under the able guidance of Dr. T. H. Patterson,
and the chain of casualty evacuation has been established for some time. In the
past year Dr. Stewart Murray has solidified most of the basic medical arrangements
Page 43 for the Lower Mainland area, and has established prospective sites for first-aid stations, (
medical assembly points, and emergency hospitals. Within the next few weeks hei
plans to have instituted first-aid and home-nursing classes for Civil Defence purposes.
He has further arranged for mandatory instruction in these matters for student nurses
in all approved schools of nursing. Categorization of medical manpower is at present
being undertaken, and with the assistance of the Vancouver Medical Association Committee on Civil Defence, it is expected that this necessary task will soon be completed.
In the remaining target areas the attitude of the local physicians to Civil Defence:
has been one of cooperation with the local Civil Defence Organizations.    Their activities have, however, paralleled the desultory progress made in Civil Defence affairs
by most of the Regional Civil Defence Organizations.
With  the exception of Victoria, no attempt  has  been  made  to staff  proposed)
installations in the line of casualty evacuation.    Members of this Association will bej
called upon to participate actively as the need arises, and only when plans attain an
adequate level of maturity.    The formulation of these plans is not the responsibility j
of the Provincial Medical Association.    The measure of their success, however, will be
the response of its Members when specific tasks in Civil Defence are designated.
J. H. Sturdy, M.D.
COMMITTEE ON MEMBERSHIP
Mr. Chairman and Members:
Membership during the past year has increased by approximately 135, now making j
the total membership 1,120, consisting of 1,073 paid-up ordinary members, 35 unpaid
ordinary members, 7 honorary members and 5 post-graduate members.
It is felt that this is a very satisfactory response and means that 80% of thej
potential   members   belong   to   the  Association.     When   we   consider   that   this   is   a
voluntary organization, this is certainly a good response.
At the same time the number of Founders has increased considerably so that]
we now have 258 members who have paid their Founders' fees. This is not too i
satisfactory as yet as it is felt that we should have at least 500 Founders.
997 of our members belong to the Canadian Medical Association as compared to
953 members for the year 1952.    This is a good increase and means that we are welli
represented at the national level.
E. C. McCoy, M.D.
COMMITTEE ON PHARMACY
Mr.  President:
The Committee on Pharmacy of the Canadian Medical Association, B.C. Division,
has met on several occasions during the past year. Representation was made in the
early part of the year to the Provincial Government strongly recommending that
Cortisone and ACTH be made available for certain conditions in which these drugs
have proven themselves to be of great symptomatic and even lifesaving value. So
far the Government has not taken any action on this recommendation.
At the request of the Government, a Committee was formed to assist in the
reduction of the cost of drugs to Old Age Pensioners and other Social Assistance cases.
The machinery has been set up to perform this difficult task and is ready to go ahead
whenever the Government wishes to proceed.
After considerable delay the Formulary was published in July of this year and is
ready for distribution throughout the province to doctors and pharmacists.
D. M. Whitelaw, M.D.
COMMITTEE ON HOSPITAL SERVICES
I beg to report that there has been no activity during the past year for the
Clommittee on Hospitals.
J. C. Moscovich, M.D.
Page 44 COMMITTEE ON MATERNAL WELFARE
A committee has been formed to study the detailed clinical records in all cases
of maternal mortality, in an attempt to assess the preventability or non-preventability
of death.
At present this study is confined to the majority of hospitals in the Vancouver area
but it is hoped that gradually all hospitals in the province will make their records
available for study.
All discussion deals with clinical records only and the names of patients and doctors
do not enter into it.
It is intended to eventually study all cases of maternal mortality in the province
and to make available to the men in practise the history, discussion and final assessment
of these cases. This will be done through medical meetings and by publication in the
Bulletin as an educational measure in the continued programme of maternal welfare.
ALEC M. AGNEW, M.D.
10. REPORTS FROM SECTIONS
The representatives of the following sections reported on behalf of their sections:
Anaesthesia Obstetrics & Gynaecology
Dermatology Neurology & Psychiatry
Eye, Ear, Nose & Throat Internal Medicine
General Practice Paediatrics
General Surgery
11. REPORT OF NOMINATING COMMITTEE
Mr. Chairman and Members:
The Nominating Committee met this morning and presents the following nominations for 1953-54.
President Elect i Dr. Frank A. Turnbull
Chairman General Assembly JIl Dr. Gordon C. Johnston
Honorary Secretary-Treasurer Dr. John A. Sinclair
Members of the Finance Committee.-SSiS! Dr. Eric Boak
Bj_f3_?
Dr. Gordon Matthews
Dr. W. A. McElmoyle
PLACE  OF  NEXT  MEETING
That the invitation of the Penticton Medical Society to hold the 1954 meeting
at Penticton be accepted.
The Chairman called for further nominations for each office separately. There
being no further nominations, the report of the Nominating Committee was adopted
in its entirety, and the officers named declared elected.
THE AFTERNOON DEBATE:
PAYMENT BY S.A.M.S. WHEN TWO OR MORE DOCTORS ARE INVOLVED
IN THE TREATMENT OF A SURGICAL CASE
The Board of Directors approved the recommendation of the S.A.M.S. Subcommittee "That we recommend to the Tariff Committee through the Committee
on Economics that in surgical cases where the family doctor is the first man to see
the case and calls in a surgeon, consideration should be given to paying the family
doctor not only for his preliminary work and an assistant's fee, where applicable (as
outlined in the present minimum schedule of fees), but also for a reasonable amount
of post-operative attendance on a fee for service basis, this to be quite separate from the
surgical fee."
Motion—Moved by Dr. Lehmann, seconded by Dr. Ganshorn:
That this Assembly approve the action of the Executive in authorizing
S.A.M.S. to pay two or more doctors on one case, with particular reference to surgical procedures.
Page 45 The President—"This is a very old problem to the profession and has been acutely
focused at this time. Your Executive in making this move recognized that the sections
involved were very serious about the problem presented, that of fee splitting and the
division of fees. In making the recommendation that this be implemented in S.A.M.S.,
the Executive had not made up their mind on the policy. The recommendation came
from the S.A.M.S. Committee who strongly recommended it and the chairman pointed
out that the committee who recommended this were representative of the profession.
Such a basis of payment where two doctors were involved would probably mean only
a very small increase in the cost, maybe 2 %. We endorsed- it with S.A.M.S. as an
experiment because we can get the reaction of the profession to this change without
hurting the public or any other party.
For the S.A.M.S.—Certain considerations were in our minds when we proposed
this resolution. The first was that there has been a great increase in prepaid medical
care over the past few years and that is influencing the pattern of practice. The conception that there is so much money for a particular job. The practice has arisen
where the surgeon gets all the fee and the others look to the surgeon for remuneration.
The medical directors of S.A.M.S. have been very lenient in assessing these accounts
and have been inclined to pay a second physician not only for preoperative care but
for some of the post-operative. We feel that people are looking for doctors whom
they can trust. The patient's family also looks to this man to advise them about the
patient's condition. We feel that that is the proper function of the medical doctor.
We do not necessarily agree that there is ar fixed amount for any surgical procedure.
It is often a culmination of a long period of work on someone's part and the beginning
of a long course of treatment that that patient may require. If two or more medical
men are involved with the case, the cost may be a little higher than if there were only
one. It is reasonable that the patient does get better service when he has two people
involved. That might present administrative problems to some of the prepaid medical
plans and we are perhaps patterning our behaviour too much according to what is
administratively feasible for the prepaid plans and not for the good care of the patient.
It is not good for the medical profession to be contending for a fixed amount for a
job. From the patient's point of view and the point of view of the profession, we
thought we might solve the problem by paying both doctors for what they actually did.
I think that this experiment can very well be carried out in S.A.M.S. The total amount
will not vary very much, only the distribution will vary.
Chairman S.A.M.S. Sub-committee:
First I would like to go over some points about the operation of S.A.M.S. that
have an indirect bearing on this issue. One of the big sources of dissatisfaction is that
a lot of physicians feel that their fee is cut whereas the surgical fee cannot be cut.
In the past year we have made a real effort to remove that dissatisfaction. In some
cases the committee needs to assess accounts. The assessment of accounts increases
the overall payment by 10%. .
The old schedule of fees allowed one-third of the surgical fees for the general
practitioner for the work that he does with a patient for surgery. Very often the
general practitioners' accounts have not been allowed by the prepaid schemes;W-What
S.A.M.S. would like to do, with your approval, is to see if we can work out a scheme
whereby the general practitioner is paid for the work he does. The surgeons have assured
me that if this increases the cost of surgery to the scheme that they will reduce their
fee for the surgery to absorb the increase.
Section of Surgery—The Surgical Section are in favor of this plan. We believe
from what information we can get from prepaid schemes that the additional cost
would be about 2% across the board. If that sum is too much to be absorbed our
section would be willing to reduce the surgical fee to absorb it. We feel that surgical
fees should not be divided.    It is bad for the patient and bad for the surgeon.
Page 46 The Surgical Section in favor of this policy, believe it is going to eradicate fee
splitting and will remunerate each man for the work he has done. We feel that the
division of the fee is fee splitting. The remuneration for the work each man has done.
In no other vocation is any other method of payment considered. The Surgical Section
is quite ready to consider the reduction of surgical fees across the board. '
In such a scheme it is quite likely that the overall cost to the scheme may be less.
It is said that such a scheme will bypass the general practitioner. We feel that it is
up to the general practitioner to make hjis services so helpful that the patient will
rely on him and will expect him to be there. Patients do not walk in off the street
to a surgeon. Patients expect to pay more for a surgical specialist. The ethical surgeon
is responsible for everything that happens after operation. This S.A.M.S. plan will
support good surgical care.
Section of General Practice—Thjs is certainly a big problem and has taken a lot
of thinking by many committees over a long time. General practitioners are concerned
about fee splitting and concealed fee splitting. We are not quite sure if this answer
that the Surgical Section have come up with is the right answer. We are not sure that
the patient can afford to pay more. The patient is paying just about all he can afford
to pay. The General Practitioner Section felt that they had four principles that they
should stand by.
1. We are certainly against all concealed fee splitting.
2. We believe a man should be paid for the work he does.
3. The general practitioners feel that the total fee when two people are involved
should not be appreciably greater than if only one doctor did the job.
4. We believe that separate bills should be rendered by the two doctors involved
in the case.
If the profession as a whole through this Assembly thinks this is a fair proposition, we will follow along. Probably the right way to handle this would be to look
into it a little further before we put it into effect. We would like to see a committee
composed of general practitioners and surgeons sit on this and come up. with an answer.
A group of men in the New Westminster area made up of everyone and not
only general practitioners, were unanimously of the opinion that the action of the
Executive had been precipitous and that a little more thought should be allowed.
They felt that when the scheme meant costing one group more that it was undemocratic to force it on all. The group suggested that the way to settle the problem
best was to have a number of general practitioners and specialists meet together with
some neutral party.
An Internist—Someone has to provide the pre-operative services, go out to the
home and make the diagnosis, arrangements for hospital. Our surgical colleagues have
not recognized the contribution that the general practitioner has made. There is no
scientific basis for the surgical fee schedule. If we had a fair valuation, then there
would be no need for these various techniques. The fee schedule should represent a
fair evaluation for the work done.
The motion was voted on and carried.
Motion—That the motion just passed is understood by this Assembly to be an
experiment and that therefore the terms of the resolution be limited to
an experiment and reported at the next Assembly.    Carried.
TO NAME NON-PARTICIPATING DOCTORS IN RESPECT
TO APPROVED PREPAID PLANS
Motion—That this Assembly agree that it is necessary for the Board of Directors
to name certain physicians as non-participating doctors, and that the
rPage 47 action of our Board be a recommendation to the Boards of Approved
Prepaid Medical Care Plans.
And declare that the Association favours that no payment be made
directly or indirectly by approved Prepaid Plans when a subscriber
is treated by a non-participating doctor, except in emergency.
In explanation of the above motion, the President said that a few doctors wilfully
disregard the fact that we have agreed to accept 90% of the schedule of fees from the
approved prepaid plans. The other problem is extra billing and doing it with the
obvious inference that they do not honour the agreement the profession has with the
prepaid plans.
There is also the doctor who has an abnormal pattern of practice. The pattern
of practice of a man may be costly to the patient and M.S.A. The services are friuch
more than what an ordinary doctor would use—experimental medicine.
Chairman of Economic Committee:
I would not want to see the motion put into action. If we have this power it
should be sufficient. Our recommendation to the Plans might well be that certain
doctors be named as non-participating but the decision to do so would still rest with
the Plans.
A Member:
Are we going to allow a few to jeopardize the rest of the profession? We have
to show the public that we are alert to stop any of these patterns of practice to
develop.    I think the time of action is here.
Motion carried.
Meeting adjourned at 5:00 p.m.
FOR  SALE
Well established practice in Surrey municipality, with offices at both
Crescent Beach and White Rock. Doctor's home at Crescent Beach
has four bedrooms, office and waiting room and is valued at $15,000.
Also included would be considerable amount of medical equipment,
supplies and books. Please write Mrs. William Sager, Crescent Beach,
B.C., or telephone Newton 128-L3.
MEDICAL OFFICES FOR LEASE
Broadway at Trafalgar
Smart, new building on south-east corner with efficient office layouts—double  or  single suites.   Owner  will  furnish   reception  and
consulting rooms.
Now ready for occupancy
BOULTBEE, SWEET & CO. LTD.
555 Howe Street
PAcific 7221
Page 48 PUBLIC HEALTH AND MENTAL HEALTH NEWS
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health, Province of British Columbia
A. M. GEE, M.D.,
Director, Mental Health Services, Province of British Columbia
GAMMA  GLOBULIN
Immune serum globulin (better known as gamma globulin) was made available
for possible prevention of poliomyelitis in selected contacts in this province on September 17, 1953. The Gamma Globulin Advisory Committee of the Department of
National Health and Welfare authorized the release of a limited supply of gamma
globulin to the Health Branch, B.C. Department of Health and Welfare. Responsibility
for the issuance of gamma globulin has been delegated to the local medical health
officer, and a supply is now on hand in the offices of the Metropolitan Health Committee of Greater Vancouver, Victoria-Esquimalt Board of Health and the local health
units throughout the province.
Immune serum globulin is an antibody concentrate prepared by the fractionation
of human plasma. Although useful in a number of other medical conditions, the
gamma globulin issued by the Health Branch, B.C. Department of Health and Welfare, is to be used exclusively for the prophylaxis of paralytic poliomyelitis, with no
charge to the patient.
Indications for use: gamma globulin should be given only to household contacts
(between the ages of six months and sixteen years or those who are pregnant} of known
paralytic cases. Such prophylactic injections should be given within three days following diagnosis of the original paralytic case.
Contra-indications for use: gamma globulin is of no value after clinical symptoms
of the disease have appeared. Insufficient supplies are available at the present time to
permit of widespread community prophylaxis or to attempt immunization of household contacts to non-paralytic and suspect cases.
Dosage:   the recommended dosages are as follows:
For children up to 35 lbs. in weight-  5 cc.
For children 3 5 to 60 lbs. in weight 10 cc.
Children weighing over 60 lbs. may require 15 cc
Administration: injections of gamma globulin, in divided dosage if necessary,
should be given intramuscularly through a wide-bore needle (No. 18 or 20). A
separate syringe and needle should be used for each subject in order to rninimize the
hazard of the transmission of homologous serum jaundice through contamination of the
syringe with blood.
Reactions: the intramuscular injection of gamma globulin is not accompanied by
any significant reactions. The danger of local or systemic reactions must, however,
be considered if repeated injections are contemplated.
Records and Policy: (1) the issue of gamma globulin for administration to specified contacts will only be authorized where Poliomyelitis Notification Form A is on
file in the responsible Health Unit for the paralytic index case, and (2) in order to
permit evaluation of the protective effect of gamma globulin against paralytic poliomyelitis, one copy of the Poliomyelitis Research Project form must be completed in
respect of each and every contact of the index case whether they receive gamma
globulin or not. The completion of this form will be the responsibility of the Health
Unit Director, working in cooperation with the attending physician, and on completion will be forwarded to the Health Branch Office^ 2670 Laurel Street, Vancouver
9, B.C.
Page 49 BIOPSY   SERVICE   SPECIMENS
More careful packing of specimens addressed to pathological  laboratories is requested in order to reduce to a minimum parcels received in damaged condition.
It   is   essential   that   these   containers   have   firm,   tight-fitting   stoppers   and   be?
adequately surrounded with cushioning material, which should be absorbent, in order
to soak up any liquid which may escape.    The outside container should be of some
rigid material strong enough to withstand pressure in the mails.
When a parcel of this nature is damaged, any other items contained in the samej
parcel, as well as other parcels, may be damaged by the escaping liquid, in addition,
of course, to the fact that the specimen itself may be damaged, thereby preventing a
satisfactory examination being completed.
This question has been raised by the District Post Office Inspector, who is concerned j
at the increasing number of such parcels received in damaged condition.    Your co- (
operation in drawing this matter to the attention of your staff would be very much
appreciated.
MEDICAL STUDENTS EMPLOYED IN HEALTH UNITS
Three third-year medical students from the University of British Columbia were
employed during the summer months in the Central Vancouver Island, North Fraser
Valley and Boundary Health Units. The students chosen were Mr. H. M. Webster,
assigned to the Nanaimo area, Mr. J. H. Woods, assigned to the Mission area, and
Mr. A. M. Knudsen, assigned to the Langley-Surrey-Delta area..
The students were given specific responsibilities, some of which were examination
of children entering school for the first time this fall, assisting at well-baby clinics,
including conferences and immunizations, sanitary inspections, including swimming
pools, and the conduct of special surveys which had been previously planned but postponed due to lack of staff. One of the surveys completed was a tuberculin survey
of the staff of a local hospital followed by the administration of B.C.G. where indicated.
Early reports indicate that this plan has had distinct advantages both for thei
students and the health units. The students have received valuable experience in public
health practices by participating in the actual functions of the health unit. As a
result, they have gained an understanding of public health and an appreciation of the
important part that the practising physician must play in these programs. In addition,
they now have a knowledge of public and private health and welfare agencies and of
the effect of illness on the family of the patient, both of which will undoubtedly be of
value to them in the future.
On the other hand, the three health units, which are in areas of increasing population requiring increased services, received direct aid in their day to day responsibilities,
as well as in attempting special projects in the health unit area.
This year is the first time such a plan for medical students has been in operation
in British Columbia. Final assessment of the plan is not yet possible but there is
every indication that it has been most worthwhile.
Arrangements for the training programme were made between the University of
British Columbia, the Provincial Health Branch, and the local health units. Funds
were made available from the Federal health grant.
OFFICE  SPACE
New up-to-date office space available in good area.
For further particulars phone FAirmont 3717
Page 50

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