Sunday, 14 January 2018

How to fail your exams and sue your University!

       I still have nightmares occasionally when I dream I am setting out for my final medical exams in Trinity College, Dublin. I already had a job lined up in a food canning factory in England so I could support my wife and daughter while studying for the exam re-writes. Then I wake up in a cold sweat for a few moments before I am flooded with the relief of realizing it is just a nightmare. For the record I did pass my qualifying exam on the first writing but I did gain some insight into how a falling candidate would feel, particularly if in the exiguous financial condition I was in. The option of blaming the University program was unimaginable.
Today, almost every student who gets into medical school graduates. In my day it was quite different. As far as I can recall about twenty percent of candidates dropped out and another percentage had to repeat part or all of a year. Nobody sued the medical school, nobody thought of suing the medical school or university.
    Even as undergraduate medical students, we realized that there was great variation between teachers, some were highly entertaining despite the fact they they were not great teachers, others were extremely erudite but so dull that half the class fell asleep and there was everything in between. Most of us realized early on whether our various programs had weaknesses and as responsible doctors to be, many of us learned how to compensate for the deficiencies of the program. Physicians need to be resourceful and even in the era before everyone had a computer in their pocket and access to all the knowledge in the world, we usually knew what we had to do to make up for the deficiencies. I went to a good school but I recognized there were area where I needed some extra help and sought some private tuition.
    The case in the news at the moment is of an Ontario physician suing Western University for $11,000000 because he contends that the medical school didn't give him the education he needed to become certified as a specialist in medical microbiology. This was a five year residency program which the doctor claimed deteriorated rapidly while he was enrolled in it. He failed his specialty exam three times , in 2012, 2013 and 2014. Then instituted legal proceedings and Western is seeking to appeal a judge's ruling that allows the law suit to proceed.
  In this age in which almost everyone considers themselves a victim of one sort or another, it doesn't seem to occur to the doctor that even if most he has to say is accurate, that HE is responsible for his education. This is not a naive young student, but a man who has gone through the rigorous educational system to get an MD degree. There were numerous remedial steps he could have taken including taking some of his studies at another institution (not an unusual solution in numerically small programs), arranging to work under the supervision of a recognized expert in the area, independently planned study perhaps in coordination with a colleague in a similar specialty. The doctor/victim seems to feel that he is just a victim who never had control over his plight.
    If the Doctor succeeds in his efforts the face of medical education and indeed, of University education may be forever changed. All any failure has to do is sue the University and he/she may never have to work again! Throw in a suggestion of racism, gender discrimination or ageism and maybe we can all be victims.

Thursday, 11 January 2018

Canadian Health Care Embarassment and administridiot hubris.


  It's a major embarrassment that Canada,a country that once enjoyed international recognition for its health care system was ranked last of eleven developed countries by the Commonwealth Fund. If you still think our service is acceptable read the report for yourself. You will be horrified. Our politicians have done an incredible job of' fooling most of the people most of the time'. Still, they are smart enough to vote themselves a special health care package.
Most criminal of their activities is their acceptance, even encouragement, of the dangerously long waiting lists. The average wait for treatment by a specialist from the date the patient was referred by the Family Doc has hit twenty (20) weeks. In 1993 it was about 9 weeks. The wait-times continue to increase. In some specialties the wait is much longer unless you have a life threatening emergency.
    I can think of no reason why people put up with this appalling situation other that they have been fooled into believing that we still have the excellent exemplary standards we once had. We are now an example of another kind.
    Countries like Australia, Britain, Germany, France and Switzerland have systems far superior to our own.
    One of the main reasons for our dismal failure in improving or even maintaining our system is the Canada Health Act, a brain child of Canadian Politicians , that is so rigid that it leaves no possibility of improvement. The Canada Health Act prevents the private sector from playing a significant role in health care delivery except when the government is totally unable to provide the service. They jealously guard their monopoly despite being well aware that all of the above countries use all the help they can get from the private sector, sometime involving co-payments or deductibles. The Canada Health Act prohibits this although it is successful and provision is made so that the poor receive the same benefits as others. People in  the above mentioned countries willingly buy supplemental insurance or make modest co-payments thereby injecting much needed funds into the health care system to everyone's benefit.

   Unfortunately the hubris of Canadian politicians of all ilk make them regard any help as a loss of face, although they have already sustained that by reducing one of the finest health care systems in the developed world into one of the poorest, but as long as they do not perceive it as costing them votes, who cares?
   Remember Ronald Reagan's quotation of the nine most terrifying words in the language: "I'm from the government and I'm here to help."  
   How right he was! 

Be sure to read next weeks Medicalmanes to learn about suing your University for not passing your exams!! 


Sunday, 24 December 2017

Drug Pushers - of a different kind!

Drug pushers of a different kind!  (But not all that different.)

   The amazing irresponsibility of our government and its administridiots is not difficult to explain.  They are well aware that the consequences of legalized recreational marijuana are just beginning to be scientifically examined and that they look significant.   On the other hand, they are drooling at the huge pot of money they are sitting on.  Particularly in Ontario, where the Liberal government has turned what used to be the economic engine of Canada into a 'have-not' province, is the enthusiasm great.  Not only may they realize a significant financial treasure, but they may be able to keep the Mal-contents a little happier and win their  vote.  (In fact, an accountant I respect assures me there is a good chance that the governmental drug pushers of Ontario may be the first drug pushers in history to lose money!) 
   A Canada Health survey,the Canadian Cannabis Survey, 2017, reveals some interesting facts.  The survey included 9215 respondents recruited from randomly selected telephone numbers (landline and mobile).   Of particular interest and relevance was the attitudes of responses to driving among the marijuana users.  Only half of the respondents who had used marijuana in  the past year felt that marijuana use affects driving.  Twenty-four per cent said 'it depends' and nineteen per cent said it doesn't affect driving at all.  Of those who had used marijuana in the last twelve months, thirty-nine percent said they had driven within two hours of its consumption.  Forty per cent said they had done so in the previous thirty days and fifteen per cent said they had driven after using cannabis in association with alcohol.  Concerns about how to detect and deal with this are high, particularly as blood tests are necessary to make the diagnosis and the levels defining intoxication are arbitrary.  The Public Safety Minister says," The message is simple - don't drive high!"  I'm sure the pot users are listening!   Fortunately pot breathalyzers are in development and being assessed for reliability, as well as ignition control devices that will disable cars if the driver does not pass the test. (Cannabix Technologies Inc)  This will enable police to be able to test at the roadside and employers to check in hazardous workplaces.
   So, what's the hurry?  The urgency is that both the provincial and federal Liberals want the votes.  If another few die on the highway - too bad.
  Those pushing for the legalization of medical marijuana in 2018 should carefully study the document "the Legalization of Marijuana in Colorado: The Impact"  published in October 2017 by the Rocky Mountain High Intensity Drug Trafficking Area (www.rmhidta.org).  They might learn something.

 
 

Sunday, 17 December 2017

Transgender -another gender bender!

   CBC was recently scheduled to go on the air with a BBC documentary program entitled "Transgender Kids: Who Knows Best?".   Unbelievably, the Cowardly Broadcasting Corporation cancelled the program mere hours before it was to be broadcast.  This apparently was because a group of Snowflake Loonies thought the public were too  stupid to see a program and judge for themselves whether they considered a program produced by the  BBC (no neophytes when it comes to presenting investigatory documentaries!) was "transphobic" and "harmful".  That the CBC, funded by taxpayers dollars should take it upon themselves to  change their programming to accommodate what they describe as "transgender activists" is unacceptable and insulting to the Canadian public.  One of the aspects of the program that these unqualified morons take exception to is the argument that some children diagnosed as  transgender may simply be suffering from treatable mental health  issues.   Read this outrageous statement by Joshua Ferguson, a 'trans filmmaker':
"it disseminates inaccurate information about trans youth and gender dysphoria and will feed transphobia."  (Sounds like another phobia we've all been accused of by the LWLs!)
   Although an investigation by the BBC had deemed the film to be impartial the feckless wimps of the CBC removed it from its schedule after receiving some complaints from 'social media'.  I remember when CBC was there precisely to air such issues and debate both sides of the discussion.  Now, its objective is  to suppress  free speech around this grossly politicized topic.  
   Dr. Kenneth Zucker, used to  head up Toronto's Gender Identity Clinic.  He was a critic of the 'gender affirmative approach',in which parents and health advisors fully support a child's wish  to change gender identity. He also asserted that 80% of children exhibiting gender dysphoria become comfortable with their bodies after they grow up.  For his efforts, Dr. Zucker's clinic was disbanded and he was fired.
Another Gender-Bender! 

 By the way, one of the reasons for CBC's dumping the film may have been that the BBC's film was filmed largely in Canada.  Maybe CBC couldn't cope with that.  The fact that the CBC takes it upon itself to be the arbiter of what the Canadian public is sufficiently mature to evaluate is alarming.  Even more alarming is  that they are encouraging the politicization of an issue which interferes with a parents ability to raise their children in  the way they think best and will have a vital impact upon our children.  The 'Activists' even go further with allegations that parents are negligent if they reject the 'gender affirmative' approach.
   As a transgender from Ottawa said, "There's nothing wrong with being a boy.  It's just that I don't enjoy being a boy!
   Gimme a break!!

If you have any views on this important topic - share them!

Sunday, 10 December 2017

Winter Vacations !



Wanta Winter Vacation Eh??

We’re thinking about our winter vacation again.  We had an interesting and enjoyable vacation last year but it doesn't always work out quite as one expects.  Only a few years ago we had a somewhat different story.   We like to drive   No worries about what you can take and what you have to leave at home.  I remember taking my entire painting kit on a vacation which was to establish me as a great artist.  (I never actually opened it but still, I might have.)  The removal of the necessity to deny to one’s spouse the space to take along those items that cannot possibly fit in to a single suitcase, most of which seem vital, notwithstanding the fact that they may never be actually worn, almost guarantees a successful holiday.  I should add that taking along my own electronic toys totally allays the boredom of shopping as I scan the areas around ladies apparel vendors my better half is exploring for free wi-fi internet connections.  I am no longer the miserable curmudgeon that I once was when I had to wait too long. 
So we started rounding up the paraphernalia that the luxury of traveling by car allows.  I placed my extra-large Eddie Bauer hold - all in the middle of the basement floor, about two months ahead of departure time and threw everything I could possibly need into it long in advance so that I couldn’t forget anything.   The credit cards were packed and the traveler’s cheques were purchased. I was feeling confident that I had taken care of everything.  Now I could relax and just wait until it was time to load up the car.
        It was the Saturday prior to our departure, all our bills were prepaid, the appropriate credit cards were sitting on my desk with my Health Care Card, auto insurance and every other document I could possibly need.  Time, I thought, to pack all these vital papers in the special Samsonite organizer I had bought in the days before I was fully organized.  It even had a special compartment for holding our passports.  As I packed our various documents into it, on that cold Saturday at the end of January, I contemplated the delightful, warm, sunny February we would find in Naples, Florida.  For some reason I flipped our passports out of the wallet to take a quick look at them.   Ohmigod!  Horror of horrors.  The expiry date was the middle of February and we weren’t getting back until the beginning of March.
“Irene, get ready, we have to go and have passport photos taken.  Our passports expire on Valentines Day.  I don’t know if we’ll be able to go as planned, but if we get our photos taken today and I go down to the passport office on Monday morning, maybe we can get an express passport renewal in time to leave on Wednesday as planned, though I’m not too hopeful.  At least I hope that we won’t have to delay our departure by too long.”
She didn’t even call me an idiot or give me a hard time. 
         “Okay,” she said, “I’ll get ready as fast as I can.”
The Clerk at Black’s Photography emphasized that we must not smile or show our teeth.
“If even a tiny amount of white shows the picture is not acceptable.”
I assured her we would have no difficulty whatsoever in not smiling.
I went on line as soon as I got home.  The government web site covered it all.  I learned more than I ever needed or wanted to know about passports, including the fact that it takes about four weeks to get one.  I also learned from the US site that a passport should be at least six months from expiry to gain entry into the US.  The only glimmer of hope from my research was the discovery that there is a new expedited pathway for passport renewal for Canadians, and for an additional fee there is also an express route.   
I was at the passport office before they opened on Monday morning and after appropriate begging and groveling was promised a renewed passport for Irene and me for a mere additional thirty dollars apiece. The clerk was really nice because when she informed me that a piece of white tooth showing make the passport photo unacceptable and I looked as though I  was going to break down, she pulled out a black marker and eliminated the white spot, while informing me this was our secret as she could get into serious trouble for altering an official document!   There are still some kind people around!
I had scheduled a major pre-safari servicing of my trusty Honda Accord.  You know, a “check the steering, check the breaks, check everything, replace everything, damn the expense, our lives may depend on it, type of overhaul.  Especially check the brakes, I cautioned them, because the brake light seems o come on occasionally.   When I picked it up they reassured me that this car was indestructible. 
We departed on Wednesday after picking up our brand new passports only a few hours behind schedule.  We had a delightfully uneventful drive to Naples, avoiding even the mildest vicissitudes of weather and as we cruised into Naples and our rented condo, I remarked to Irene, “Hey, a Honda Dealership just a few blocks from where we’re staying, at least we know where to go if we ever have car problems.”  I laughed at that ridiculous prospect.
We found our condo to be delightful and after picking up some grocery essentials settled in to organize ourselves.  The next morning was rather cool and overcast so we took a trip out to the Outlet Mall, one of those magnificent plazas, that shoppers get so excited about, where manufacturers get rid of all the garbage that they can’t sell anywhere else.  I had a few things I wanted to buy – like another few long sleeved shirts, that I had a feeling that I was going to need.  After that I settled into my car, as it became increasingly overcast, to read a good book that I’d found in the condo the night before.   I also set up my computer and iPod in case my stay became prolonged.   It didn’t and we started home just before the rain came pelting down. 
“You know,” I said to Irene, “the brakes seem a little soft and spongy.  I’m really glad I had them checked out thoroughly and new brake shoes put on the back.  I guess this whole Toyota brake disaster (remember?) is making me a little anxious.”
“It might just be from the all the rain and moisture,” she said, as the rain poured down and I turned up the wind-screen wipers to top speed in an effort to see which way the freeway was going.  We made our exit and arrived home a few minutes later.
“I hope these brakes are okay” said I.
When I got up next morning I knew that I must have been letting my imagination run away with itself, with the Toyota disaster and all.  Just for the hell of it I would test the car around the condo complex.  I got in the car, started it up and to my horror the brakes pedal hit the floor before the car braked.  It did stop, however, and I decided after some consideration that it would probably be safe to drive to the Honda dealership, which I know was only a couple of miles away.   So Irene and I got into the car and drove to Honda. 
 I drove into the service lane and was greeted by a young man whom I told I had no brakes.     
         “You’ve got no brakes,” he told me sternly, after checking out the car.
 I felt appropriately guilty.
“I’ll have to get Tony, the service manager to take a look at this.”
It sounded pretty serious to me, and I hoped Tony was a nice guy.  He was.
“Hi, I’m Tony Capobianco,” he said, “I hear you’re having a problem with the brakes?”
“Yes, don’t seem to have any!” I said.
“That ain’t good,” said Tony, who was a grey haired grandfatherly fellow like myself.  “I gotta take a while to assess the extent of the damage.  We’ll drive you home; I’ll call you later and let you know the damage,”
He did call me a couple of hours later.  It seems that the right rear brake caliper developed a leak and required replacing.  That, of course, automatically meant that the system needed to be flushed out.  It would only cost about $500. That was the good news.  The bad news was that they didn’t have a brake calipers in stock and it would take a couple of days to get one.
“Have you got a loner?  I’m a prisoner here without a car.”
“Sorry, we haven’t,” Tony said sympathetically, but we do have an arrangement with Hertz, They’ll let you have a car for a flat $30 a day while your car is being repaired.
           To cut a long story short I phone Hertz, they have nothing available because they have pulled all the Toyotas off their fleet until the brake debacle is resolved.  They laugh at me for suggesting thirty dollars a day.   I phone Tony back.
“What? I’ll phone you back in a few minutes,”
He does phone back in a few minutes.  “Call the local office and ask for Dan, tell him that Tony told you to call.” 
I did.  Dan was duly impressed.  “Sure, we’ll pick you up in a few minutes.  Thirty bucks a day, sure.  What sort of car would you like?”   
Tony obviously does have clout!
          When I called to pick up my own car, Tony said, “this is a lot of money, I’m going to give you ten per cent off.”  I hadn’t even asked!
          “Thanks, Tony,”   He didn’t have to give me the ten percent, whether or not it was previously added on.  I sort of liked Tony.
          So much for the beginning of our vacation.  The cold Florida weather was sure to warm up soon.  Things could only get better - and they did.
          By the way, when I got home  Honda issued me a cheque, without a whimper, for the brakes repairs, once I showed them the work order with the request to pay particular attention to checking the brakes!
           It's these little Gordian knots that make a vacation so fascinating in retrospect!


                                                                            

Sunday, 3 December 2017

Mickey and Archie Bunker.

    Nowadays, when I get news of a erstwhile friend whom I haven't seen for for a long while it tends to fall  into the obit classification.  If I don't read it in the  obituary column, the main focus of my thumbing through the Canadian Medical Association Journal or the Canadian Family Physician (mainly to make sure that I'm not there) it's from a mutual acquaintance I chance to run into.  While we are swapping yarns in the grocery store, or more likely, the liquor store about who had the most coronary artery grafts or the most successful stents, some name comes up of one of our colleagues who has recently gone to the Great Clinic in the Sky.  The other day, I heard about an old friend, we'll just call  him Mickey.
    I first got to know Mickey when we were in school in  Ireland.  He was a few years ahead of me, a short, stocky kid , from a not very affluent family, in fact by present standards, from a poor family.   He was a bright kid with a great Irish sense of humour and was friendly with a cousin of  mine who was three years older than I.  Somehow, almost miraculously, he managed to get to medical school, not an easy task for a poor boy in those days.  How that came about is a story in itself, not the one I am recounting today.  Occasionally, I bumped into him in medical school, he was several years ahead of me. The last thing I heard about him while I was still in Med School was that he had emigrated to Canada.
    Years later, I ended  up in Saskatchewan myself.  As the years went by and I was on a number of  national medical  committees that met in various cities, I would get messages from colleagues like, "Hey, you just missed Mickey, he's from Dublin too and he mentioned he knew you."   Mickey, it turned out, lived in London, Ontario and was on the faculty at the University of Western Ontario.  We always seemed to just miss each other at National meetings of one sort and another.
    Long story short, after years in  Regina and Saskatoon, our family moved to London, On.  Not long after settling in, I attended a refresher course in the city.  As I ambled around during the lunch hour break, I noticed a woman following me around.  She seemed to be looking at me in a strange way.  In those days it seemed quite appropriate to say,
   "Hey, you seem to be following me around.  Do we know each other?"
    She said, "Actually, I was trying to read your name badge."
    She glanced down at it.  "Stan Smith?"
    "Yes."
    "From Dublin?"
    "Yes."
    "My  husband asked me to look out for you! He's from Dublin, too."
    So we exchanged phone numbers and a few days later we had a call from Mickey to invite us over for  dinner.  It transpired that Mickey had that great Irish story telling talent  as well as a cultivated palate when it came to Irish and Scotch whiskeys.  The two blended delightfully and made listening to his stories entertaining.
    After dinner, we were discussing the sad decline of television entertainment and I happened to mention one of my all time favorites, 'All in the Family', starring Carroll O'Connor as Archie Bunker.
   "You know, Carroll O'Connor's brother studied medicine in Dublin and was in the same class as I was,"  he said, "we had many a pint in Davy Byrnes (A famous Irish Pub) at 21 Duke St."  There such literary icons as James Joyce had been frequent visitors and the fictional Leopold Bloom of Ulysses fame often  dropped in for a 'jar'. I knew it well and as a student used to go there once in a while when I could afford to and look out for some of the Irish literary crowd who used to  hang around there, so I could take a few gulps of culture while I sipped my beer.
    Mickey continued, "Carroll came to Ireland  with his wife to join his brother and study English  and drama.  He worked in the famous Gate Theatre after having been 'discovered' in a National University Drama production.  Then  he went back to New York and bit parts until he was really discovered.   Before he left he gave me his family's home phone number and he made me promise that if I was ever in  New York I would look him up and I did.   That's how several years later when I was in New York I phoned the number and got his mother.  Carroll, she explained to me, was in Los Angeles for a part in a series. Where was I staying, she wanted to know and when  I told her, she said, 'you get out of that cheap hotel and get  into a taxi and come right over here and stay for as long as you like.'  So I did and that's how I got to know Carroll's mother better than I knew him!"
   Looks like all the folks I knew who'd kissed the Blarney Stone are shuffling off!
   R.I.P. Mickey.
   





Sunday, 26 November 2017

Health Care System is bleeding a lot faster than my Nose!! .

Wasting resources for a bleeding nose.
   A number of  years ago I had a series of nose bleeds.  I tend to take such events more seriously than I  might otherwise do, because I am on anti-coagulants (blood thinners).  It's not that the nose bleeds were severe, but with waiting times, between seeing my doctor and then being referred to an ENT specialist a fair amount of time passed between the initial incident and the specialist diagnosing and removing a small benign lesion to cure the problem.  Should I have any further episodes in the future I  was to come back.  Had I not been a physician and able to monitor my own anti-coagulant levels and adjust my own medications I anticipate that there would have been at least another three visits to my family doctor and perhaps even a couple of visits to the teeming overcrowded emergency room, to spend a few hours waiting to be seen and have the appropriate tests, etc.  Instead of one visit to the family doc and a timely referral to a specialist, our bleeding health care system generates multiple physician and lab visits, which  is not only expensive, but bad medicine.
   So, when I had a couple of very minor nose bleeds recently, I wasted no time.  Since our health care system requires  a new referral and the wait times are so lengthy I decided I  had to strike pre-emptively despite the fact that when I  had my blood test it was satisfactory.  While in an efficiently functioning health care system I would have been quite satisfied to wait and monitor my progress, knowing if I has a  serious nose bleed I could be seen by the specialist - in the emergency room, if necessary,  I know that in our system I would be seen by a medical resident and receive emergency treatment, usually after a lengthy wait and then had a consultation request for ENT which could well have taken months.   Instead, I made an appointment to see my friendly family physician and because the system wastes her time as well as mine, I had her review the three year old letter from ENT saying that they would like to see me again if there was any further epistaxis (nose-bleeds).  She obliged and now I have an appointment being set up, in case I need it.  In the meantime I have had no further nose-bleeds, but my doctor told me to go to emergency if I  do!!  It's a shame we have to work the health care system that way.
   The health care system is bleeding a lot faster than my nose!!