National Defence committee  No, it's not clear. The answer is both, or any of the above. The individual may notice it. His peers or his section commander or his platoon commander may notice something is not quite right. You'd generally send them to see the med tech or the PA at the forward operating base, and he may have an idea, he may not.

National Defence committee  The people who stay on an intimate basis with the troops at the pointy end are primarily med techs, physician assistants--more about physician assistants to come, I'm sure, in your study--and general duty medical officers. The mental health team is usually centralized at Kandahar airfield and sees people on a referral basis.

National Defence committee  Certainly. Many soldiers sent to the missions in Rwanda and Somalia came back with post-traumatic stress syndrome. The mission to recover the bodies of victims from the crashed Swissair Flight 111 also traumatized some rescue workers. It depends on the incident and on the individuals involved.

National Defence committee  I'll try it in English because I will lose my French. The current DSM-IV definition of post-traumatic stress disorder requires a stressor that was so important, that made such an impression on you, that you thought your life was in danger. You were convinced you were going to die or that somebody next to you felt peril for you, somebody very close to you, and you had a reaction to it.

National Defence committee  First of all, never say never in medicine. If you look in the psychiatric literature, I doubt you will find the term “OSI” anywhere. It's a term that was coined by the Canadian Forces to broaden the discussion of mental health issues beyond PTSD. It's any persistent mental health disorder that can be linked to your service with the CF.

National Defence committee  It is really hard to make that comparison. The numbers show a slight increase with the Afghan mission compared to the one in the Balkans. There are certainly people who suffered operational stress in the Balkans. Our numbers from that mission are not very precise. We did not do the same kind of post-deployment screening.

National Defence committee  The short answer to the second question, sir, is no. I'm not in the business of second-guessing provincial regulators as to who is and who's not appropriate to hold a medical licence to practise. I think there's a fine balance between public safety and having appropriately trained and qualified providers, and quantity of care is a quality all its own.

National Defence committee  It's always a tragedy when you hear of somebody who gets involved in an altercation with police with a tragic outcome or of someone who somehow seems to have gone off the rails somewhere. I think you have to be conscious that we don't cure everybody, particularly when it comes to mental health care.

National Defence committee  It's not uniform, and of course it's largely a case of individual providers. Remember, in most of the country, physicians are small business people, and they choose to bill us at their provincial medical association rates, not at the health insurance plan rates negotiated with the government.

National Defence committee  We make heavy use of our social workers along those lines. The vast majority of our marital counselling is done by uniformed social workers. It's open to families and members, one with or without the other; that's not an issue. I'm probably stepping on thin ice, but I'll say we exploit the ability of social workers to deal with families to the maximum.

National Defence committee  Yes, they are.

National Defence committee  It's an interesting question. I pay the health tax too. It varies widely across provinces, and of course it's not always the provinces themselves who provide the billing. It usually isn't. It's individual providers and the regional health authorities or the hospitals themselves.

National Defence committee  We had a serious problem with general duty medical officers—family physicians—which hit its low point about 2002, when we were short more than one-third of those. We now believe we'll be back up to full complement in a year to a year and a half. We've done extremely well with recruiting, with a very focused attempt.

National Defence committee  I have foreign-trained doctors, but only those who have gone through the established hoops to receive licences to practise in a province in Canada.

National Defence committee  There are no shortcuts through me. I can support them. There are a number of steps between the Medical Council of Canada, the federal medical regulatory authorities, and the provinces that run the schools that do the training. There are different kinds of thresholds. Generally, one of the big challenges these folks face is that they're required to do another period of residency that will be unpaid.