George Dunea, MD

BRITISH MEDICAL JOURNAL – VOLUME 325 – NOVEMBER 30, 2002

In the first year of my dictatorship I will ban sugar coated doughnuts, atonal music, phenylbutazone, and hospital public relations departments. With the ruthlessness of irrational dictators I will outlaw multivitamin pills, ties with horizontal stripes, malpractice lawyers, useless expensive drugs, and hot and cold water taps that turn in opposite directions.

Handsome women will not chew gum with their mouths open, petty bureaucrats will not notify their 500 employees of their two days’ absence from the office. Committees, especially on ethics and audits, will meet only on Saturdays, only for 30 minutes, no chairs provided. The police will destroy all answering machines announcing “I am away from my desk . . . but your call is very important to us.”

There will be other excesses. The priests of evidence based medicine will be proscribed, their proselytes reduced to meeting in catacombs. Banned will be charts with idiotic problem lists instead of diagnoses. In journals the number of authors will not exceed that of patients studied, and abbreviations will be forbidden, thus allowing articles to be read without reference to a glossary. Generic drug names will have no more than three syllables; “me too” drugs will be limited to four in any class; and drug company sponsored studies will be closely scrutinised for inherent biases in their protocols.

Banned will be computed tomography for stress headache, endoscopies for obvious gastritis, cardiac catheterisations for costochondritis. Doctors will make rounds in a quiet environment, nurses will accompany them, charts and x rays will be at the bedside, and comatose patients will not watch television during rounds. Some doctors will take calligraphy lessons or their noses will grow by an inch for every illegible word written.

Just as in Francophone Montreal, there will be a language police. Passengers will not “deplane”; patients will not be “clients,” doctors not “providers,” clinics not “health centres,” and prepaid plans not “health maintenance organisations”because they do nothing of the sort. The young will not be allowed to pontificate that the world is going to hell, nor the old reminisce about the good old days.

The dictatorship will last 70 years, then be overthrown by agents of the evidence based movement.