CMAJ 1997;156:621
© 1997 Canadian Medical Association
Could Rick Hansen manoeuvre his wheelchair into your office? Barriers to movement and communication marginalize people with disabilities by imposing limits on their participation in society and impeding access to fundamental services such as health care. In this issue (page 647) Karen E. Jones and Itamar E. Tamari suggest ways that physicians can make their offices more accessible and welcoming for disabled patients. A few simple changes can make an enormous difference. We must bear in mind, as Malcolm Peat points out (page 657), that many obstacles faced by people with disabilities derive from the negative attitudes of the able-bodied.
An attitudinal shift is under way with respect to single-parent families. In 1991 over 10% of Canadian families were headed by single mothers. This trend reflects increasing rates of marital separation and divorce and the growing proportion of mothers who are not married. Ellen Lipman and colleagues (page 639) demonstrate that single mothers are poorer, experience affective disorders more frequently and have higher utilization rates for mental health services than mothers with partners. As William Avison argues (page 661), higher rates of mental health problems among single mothers reflect the greater exposure of these women to stressors, not a deficit in coping ability. Single-parent families are an increasingly important part of our social fabric; all the more reason for physicians to be aware of the added health burdens they face.
I started general practice in Cordova, Alaska, 24 hours after completing a rotating internship. A year later I applied for training in internal medicine and within a few months was a junior resident. Today's medical school graduate faces a much more complex challenge. Residency positions are extremely difficult to obtain for foreign students as well as Canadian physicians seeking retraining, and new graduates are encountering a system with far less flexibility than in the past. But are things as bad as they seem? In this issue (page 665) Dale Dauphinee and Dianne Thurber show that, because of new licensure requirements and a greater emphasis on specialist training, the number of residency positions for Canadian graduates actually increased between 1988 and 1995.
On the public health front, we have been experiencing a winter of excessive influenza infections. As we leave our flu season we remind readers that they and their patients should consider vaccination before travelling to countries experiencing their flu season (page 677). The pesky virus hides out in the tropics year round and in the temperate zones of the southern hemisphere from May to October. Southward-bound travellers at high risk for influenza complications -- as well as business travellers and vacationers unwilling to chance a bout of the flu -- should review their vaccination status before departure. -- JH
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