Sunday, 19 March 2017

Health care priorities in Canada.

Former Guantanamo prisoner has 19-hour surgery in Canada 

Washington Post. Associated Press.

This was a recent headline in the Washington Post.
   In a country where citizens are suffering  (and sometimes dying) on obscenely lengthy waiting lists  Khadr, who sustained a shoulder injury in the process of a confessed involvement in the murdering of a U.S. Army Medic was allowed to usurp services in a declining, second rate, health care system that hard working Canadians have worked for and paid for all their lives. The nineteen hour surgery cost many thousands and deprived people with life threatening conditions. It is an embarrassment that this man was allowed to retain Canadian citizenship and to come back to Canada and an outrage that Canadians are forced to pay for non life threatening and non emergency surgery resulting from his crimes.  We desperately need some sane guidelines as to where our grossly inadequate health care resources should be spent. 
   His lawyer said, "it would be great for him to get in to Medicine of some sort! 
Personally, I think Law would be a more suitable sort of profession for him!

   Because most of my acquaintances are well aware that I spent a lifetime in medical practice, (no matter how hard I try to conceal the fact ), they frequently bring their health care system problems to me and many of them are truly unconscionable.   I am horrified at the indifference of the administridiots and others to their suffering and their preoccupation with political correctness.  This is at the expense of social justice to Canadians who have contributed all their lives to make the system work and to have appropriate care when  they are ill or disabled.  It is very nice to be generous and charitable to everyone, but the old trope about charity beginning at home contains more than a grain of truth.     Unfortunately, until an individual or a member of their immediate family is affected, most people don't give it a thought.  Someone awaiting an MRI for a potentially serious condition should not have to wait while Khadr and his ilk are getting Cadillac health care.  I have worked in the Corrections Canada system and the same rules apply there.
   Decent hardworking law-abiding citizens do deserve preference in the handing out of health care resources than convicted criminals.  Sounds like common sense to me.  Political correctness be damned!

   Time for Canucks to wake up!! 

It's hard to  believe the world is so full of snowflakes that no one will have a comment to make on this.


Monday, 13 March 2017

Sexual Abuse and Bill 87.

"Ontario has introduced legislation that would, if passed, further protect patients in Ontario and keep them healthy, including strengthening and reinforcing Ontario's zero tolerance policy on sexual abuse of patients by any regulated health professional. 
The Protecting Patients Act, 2016 includes legislative amendments that would, if passed:

  • Expand the list of acts of sexual abuse that will result in the mandatory revocation of a regulated health professional's license
  • Remove the ability of a regulated health professional to continue to practice on patients of a specific gender after an allegation or finding of sexual abuse
  • Increase access to patient therapy and counseling as soon as a complaint of sexual abuse by a regulated health professional is filed
  • Ensure that all relevant information about regulated health professionals' current and past conduct is available to the public in an easy-to-access and transparent way." 

       Sexual abuse, within or outside medical practice is outside the pale and never to be tolerated.  Within the profession the safeguards against it and the measures that have been set up to detect and deal with it have been rigorously enforced and due process has been followed.  The Royal College of Physicians and Surgeons has been charged with the responsibility of monitoring medical malpractice of any kind and of investigating and dealing with any breaches of proper professional behaviour.   For the most part the system has worked well, though as with most regulatory bodies there are occasional failures.  There are also false allegations made on occasion that can irrefutably damage a health care professional who is entirely innocent.  Nevertheless, both patients and physicians have had access to due process and been treated fairly and for the most part the punishment has fitted the crime.  That any accused be given a fair hearing and not massacred by the media, has been the bedrock of a  civilized society, but that seems to be under attack in many ways in contemporary society.  The government of Ontario now intends to change this structure in a fashion that would give them complete control of how individual cases would be disposed of  and of defining what comprises an infringement and how it should be dealt with.  It is allocating to itself the defining of the committee structure and penalty for alleged infringement of any rules they legislate.   It is undermining a system implemented by the College of Physicians and Surgeons composed of both physicians and non physicians, that has worked well in Canada in the fifty-five years I have practiced here and plans to replace it with a department of health dictatorship.  Because the risk is so high for any physician frivolously, maliciously or mistakenly accused of such an offense, I would advise no physician to do an intimate examination of a patient without a family member present and if still in practice I would so inform my patients.
       How many pelvic, rectal, prostate or breast exams will remain unperformed if this bill passes is hard to assess.  Ultimately, it is the patient who loses out.
       Meanwhile, the administridiots continue to destroy health care in Canada.
    Comment if you have any view on whether Bill 87 will help or harm health care.

Thursday, 9 March 2017

Patient advocacy.

  Yesterday, while looking  for a book in Indigo, I ran into a lady I  know and learned that she had recently lost her husband, who was a diabetic and not very old.  After expressing my condolences, I listened with horror to the story of her husband's management.  Not his medical management as such, he was going to die in a short time whatever the treatment, but the total lack of compassion with which he was treated, the tardiness of access when he needed it, the inability to contact the family doctor and the inadequacy of the response when by all accounts an urgent response was called for.   (She had to call 911 when a return telephone call would probably have avoided a trip to the hospital and an overnight stay.)  She stayed with him around the clock because she was fearful of what might happen to  him if he didn't have an advocate when he was no longer capable of looking out for himself.  Having practiced medicine for more than half a century, I hear stories of this sort with alarming frequency.  The technical service that patients receive is usually of a high standard, but the level  of indifference to the discomfort and sometimes distress of the patient is such that I would recommend that no one with more than minor illness should be without an advocate such as a family member or close friend.
   Nowadays, one reads increasingly  of groups that label themselves advocacy groups, often suggesting that what we need is the establishment of further government funded groups allegedly looking out for the patients welfare.  In an era when there are more highly paid, highly pensioned people, without any health care training, employed in the health care field, consuming an increasing portion of the health care budget, I am often surprised to hear of the huge gap in health  care advocacy,  particularly in relation to the elderly.  I can only write it off as indifference.  This should be a major part of the training of every health care administrator and for many years I laboured under the misapprehension that it was.  There are already many advocacy groups supported by various pharmacy and medical appliance interests.  There are also privately paid patient advocates . But the  sort of advocate that every patient needs most of all, is  a loving family member or friend who is going  to accompany them whenever serious situations arise or are anticipated.  No stranger provides that sort of input.
     As layer upon layer of health care administrator evolve, holding endless meeting at which the ultimate objective often seems to be the hearing of one's own voice and an attempt to assert a degree of authority unmatched by talent, I recall with horror the amount of time I was forced to waste as a department chair at such meetings.  I knew, of course I was only there to give an aura of legitimacy to the proceedings ("of course we had medical input!"), nevertheless, I was sometimes afraid to go to the washroom for fear of the decision that might be made in my absence.    I frequently noticed at these meetings that the emphasis was almost entirely on the non clinical aspects of medical care.  This was because the committee as a whole, understood little of the clinical attitudes, knowledge and skills necessary for a first class medical system.  There are issues important in health care management  that physicians and nurses need to be aware of and point them in the the appropriate direction to be resolved.   These are responsibilities for administrators and social workers to deal with so that physicians and nurses can spend their time doing what they are trained to do instead of wrestling with administration.  I am referring to attempting to resolve issues such as social determinants of health, poverty, ignorance, cognitive impairment, financial management and the business of administering hospitals and other physical plants..  I am also talking about dealing with obscene waiting lists for which there is no excuse.  Absurd Medico- legal situations that have earned themselves the title of 'health care lotteries' should be dealt with in a very different way, instead of resulting in huge expenses in performing investigations that are necessary only because physicians have to protect themselves.  Keeping up to date in medical skills is a full time job and maintaining physician patient relationships that benefits both the patient and the physician takes time, eye contact and meaningful communication.  Unfortunately, the computerized medical record seems to have taken the wrong track and become more a tool for administration and administrative control than a tool for patient care.  It is time our Colleges got back on track and instead of mindlessly adopting the 'politically correct', start looking out for patients and physicians.    
  And it is time for the armies of healthcare administrators to roll up their sleeves and start dealing directly and efficiently with the non clinical problems of patients, instead of trying to turn physicians into medical technicians whom they can manipulate as they please.

Sunday, 5 March 2017

A sick woman with a sick agenda.

 The Liberal Government of the Province of Ontario
believe that the sexual  education of the children of this  province should be determined by them regardless of the opinion of parents.  Fortunately, the Canadian Family Alliance (CFA) had the guts to initiate a program to stop the radical sex education of children.  For more information about this outrageous sex ed program promoted and pushed through by the amoral disturbed premier of this province you should go to to gain some insight into the devious attempt to influence how children think about sex and sexual  issues.  There is obviously an progressive attempt to engineer children into sharing Ms Wynne's views.
   Children as young as six are having 'genitalia' instruction and by eight are being taught 'Gender Identity Theory'. Whether you are a boy or a girl is unrelated to your physical anatomy.  Being a boy or a girl is just an "imagined social construct", you can choose what you want to be.  After that masturbation education and by age of twelve, anal intercourse, oral sex and sexual pleasure are dealt with.  At the advanced age of  thirteen, children are encouraged to make a personal sexual plan.
   By the way, the man under whose direction this curriculum was written, the former Deputy Education Minister Benjamin Levin is behind bars for - yes, you guessed correctly - CHILD PORNOGRAPHY AND PEDOPHILIA -RELATED CRIMES.
   Ms Wynne and her satraps have already destroyed the economy of this once economic engine of Canada,
are we now going to sit by while she destroys our youth?

Tuesday, 21 February 2017

MY Hi-Tech Holiday

🎅😂😂😂😂😂😂😂😂Holidays aren't what they used to be.. When I was a boy growing up in Dublin, on rare occasions our family got to 'go on holiday'. That meant we would go to a seaside resort named Bray that we frequently visited on day trips. Bray was precisely thirteen miles from Dublin and we usually went there by steam locomotive. There were twelve station stops between Dublin and Bray, as the puffing, streaming, whistling engine started and stopped and as far as we were concerned we could have been traversing the planet. My excitement at going there for about one week far exceeded the blase reaction of many of the kids I know nowadays who have circumnavigated the world. Strangely enough, I think we also learned more about life and human interaction roaming around Bray, than our modern counterparts learn from roaming around the world with their well trained organizers showing them only what they want them to see and brainwashing them as they see fit, when they have time to look up from the smart phone.  I say that because we were part of what was going on in Bray in a way today's kidditourists could never be. But that's another story for another day. What I want to dwell on today is the changed nature of what we used to call a holiday. (No-one ever called it a vacation in those days.). The erstwhile concept of a holiday was to get away from it all for a well earned break from all stresses and bustle of everyday life. To leave work, phone calls and all the pretty irritations behind. No one expected to hear from you apart from perhaps a postcard and assumed was that all was well, unless they heard otherwise. One 📧📧📧📧📧📧📧📧📧ad ones escape for a couple of weeks and came back refteshed and ready to take over running the world for another year. Alas, things have greatly changed. The connected world and all of its labour saving devices demands that everyone be connected one hundred percent percent of the time. Thus has the modern labour saving world generated a whole series of new labour categories in order to perpetuate itself. Usually, we drive down to South Carolina but since we were going quite a bit  decided to fly. Although I consider myself moderately efficient in dealing with everyday technology, I certainly am not a sophisticated user once I get beyond the limited hardware and software I am accustomed to use. Not having embarked on an international flight for some time, it was very evident things had greatly changed. First off, as I am  the least sophisticated travelers among that you preprint your boarding pass. That seemed simple enough and when it didn't happen after several tries, I finally realized it was twenty five hours before my flight and the service is only available within twenty four hours of take off. I came back to my computer an hour later and completed the mission without any further problem. The London, Ontario to Toronto flight went smoothly enough though on arrival, the distance to departure gate, schlepping everything but the checked case seemed endless and the convenience of a wheeling cart was prohibited by the fact that you can't take them on the moving side walks. . Eventually we do get to the security clearance lineup and after my beautiful bride made it clear to the security officer that she had no intention of taking her shoes off as directed because she was over eighty and on her last trip she was informed that exonerated her, we got through. Her day was made by the security guy yelling to his colleague, "Hey. This lady is over eighty. Sure doesn't look it." . Meanwhile, I had submissively removed my shoes and was putting them back on. Next we shuffled our way to passport control where a series of complicated monitors challanged us to insert our passports, right way up and to answer a multiple choice battery of questions. Unfortunately, I hit one of the wrong buttons,, which resulted in a security officer racing over and starting the whole process from scratch. The whole process resulted in the machine spitting out a slip of paper with my passport number and a copy of my passport photo. My wife went through the process a little more easily. We shuffled on with the crowd a few feet more and hand over the printouts and our passports to the custom and emigration officer, who kept the printout. I still haven't figured out why I can get in my car and drive across the border by just flashing my passport and having a brief word with the customs and immigration officer usually without even getting out of my car. The three and a quarter hour flight was pleasant enough apart from the fact that even the customary pack of peanuts or crackers are no longer dispensed with the soft drink. Let me take just a minute to remind you what it used to be like. When I used to fly frequently between Regina and Toronto, usually coach class, as economy was called in those days. The was no limitation on the number of pieces of luggage one could check, or if there was neither I nor anyone I knew ever reached it. As soon as the plane was in the air, the stewardess wheeled the beverage cart down the aisle dispensing complimentary liquor or soft drinks and a packet of almonds or cashews to the travelers. By the time that was consumed, the stewardess would traverse the cabin with the meal menu. There was always a choice: steak, chicken or fish. Mind you, if you were too far back the steak was usually gone ! In addition, there was complimentary Red or white wine to accompany your choice. Anyway;, after an uneventful flight and arrival in Fort Myers, we picked up our car, ("pick up any car in your category, sir, and just drive out!"). It was an easy drive to Naples and we got in at about 10th.30pm, with only a little difficulty in finding our actual condo. After schlepping our luggage up to our third floor condo, (it took us several days to find that there is an elevator), we were really pleased with the digs. Then we decided to have a nice cup of tea and something to eat. No water from any of the faucets. We we hungry and thirsty and getting just a tiny bit irritable. So we piled back into the car and began our food odessey. now apart from a few downtown nightspot, Naples tools up the sidewalks at about nine-thirty. Everywhere locally was closing up and we were just preparing to give up, when we spotted Pelican Larry's. We parked and breezed in. It was a noisy, lively place and I guess we were about thirty five years older than the oldest there. We bellied up to the bar and sat next to a young fellow who seemed to be enjoying his supper and a bottle of beer. He greeted us cordially. "So how is your hamburger?" I inquired. "Very good," said he, with a Southern accent. We ordered our hamburger and a pint of beer, that I sorely needed by that time. We chatted with our neighbor and the barman. He was from Kentucky and moved to Naples to escape from the cold. We regaled him with stories of Canadian winters and he was suitably impressed by our stories of thirty below cold snaps. Our hamburgers were good and I was feeling adequately refreshed after my hamburger and beer. We decided to take a bathroom break since we had no running water. By now it was about one thirty am and as we bid farewell to our new friend he told me how cool we were and how the guys and gals at the bar were surprised because they didn't often see folks of our age, but we fit right in and he hoped we would come again. As soon as we got back to the condo we tried the water again with the same results. "We will have to phone a plumber first thing in the morning," I said as we settled down to sleep, still grumbling about not being able to flush the toilet etc. We bought some water in the pub so at least we weren't going to die of dehydration. I feel into a deep sleep and woke up after about an hour having been stroke by a bolt of common sense. "what," I asked myself, "was the last thing I did before taking off on this vacation?" If you guessed turn off the water at the mains, you were right. So I prowled around until I found main water feed and three was the tap waiting to be turned back to the on position. The reassuring sound of the rush of water and the filing of the toilet tanks were comforting enough to let me go back to sleep. We awoke to all the conveniences of the modern home and I rushed off an email to the condo owner who I had texted the previous night to assure him that all was well.📧 After breakfast I decided to call the family to let them know we had settled in nicely. I picked up my cell phone. No connection to any provider. Fortunately the condo has a wifi router so I managed to contact David who put me through all the paces to no avail. No land line in the condo. My provider, previously called WIND has been bought out by Shaw communications. Before I had time to contact them they sent an email saying they would be hooked up with AT&T the next day. Irene's old cheapo phone was unsuitable so they Fedexed is a loaner which arrived two days later. The three Samsung Smart TVs turned out to be another hi-tech challenge. Fortunately Century Links maintains a 24/7contractual arrangement, so if they can't talk you through the problems they'll send a technician out. Fortunately, after about an hour talk through we got everything functioning satisfactorily, although I'm still learning. The washing  machine has over 30 settings! Soon we will be starting the home trip. I hope it's simpler!

Thursday, 26 January 2017

Euthanasia, Put 'em down and save money!

   Canadians now have the right to demand euthanasia.  Theoretically, at least, we should all be delighted.  Canada continues to struggle to support what is at best, a second rate health care system.  Mainly, the bureaucrats in charge tell us, because we can't afford anything better.  They never mention the large sums drained out of the system to support the health care elites, who contribute little to  health care, but who have to protect their image by earning at least as much as their counterparts in  the business world.  That is understandable, because they consider medicine to be a business and nothing more.  As long as they can sell their product and retain their job, they consider themselves successful.  But health care is not like any other job but unfortunately most of the  folks don't realize that until they find  themselves in  a situation in which they require urgent health care.  The minor  cases slip by, usually with minor inconvenience.  The critical  care issues are dealt with effectively because the skilled physicians and nurses and others are available to deal with acute life threatening issues.  The optics of not being able to do  that would be too demoralizing to a developed country like Canada, which once had a health care system that the world envied.  There is an increasing awareness both at home and abroad that the Canadian system is crumbling, enough for some of  the administridiots and their political masters to realize that they do need to do something to protect their image and career.  More money has to be freed up to improve the image of the health care system and in Ontario, due to the incredible mismanagement of the province there is no government money available and the hubris of the elites requires at least some appearance of action.  So, what could  be better than to recover and redirect the very considerable resources being 'wasted' on the incurably ill and dying. Surely it would be much more effective to just put them out of their misery and suffering by terminating them?  The only acceptable alternative would be to provide some skilled, professional palliative terminal care, because that can very often make make the difference between comfortable dying and unacceptable suffering.  But, to do that requires skilled caregivers and considerable resources, so why not just provide a painless termination.  End of life care in Canada is not good and would  require investment of resources and money to improve it.  Estimated as saving between $34,000,000 and $138,000,000, encouraging the old folks to 'euthanase' could be a big money saver for the health care system and those savings could be directed at a more activist voting group.  I'll leave where it might be directed to your imagination.  Unfortunately, I have a pretty good  idea where it might go.
   A very high proportion of Canadians die in hospital.  Inappropriate heroic attempts or resusitative measures in the elderly or even the terminally ill are the norm in this litiginous society, only to keep the patient alive for a repeat performance or perhaps several repeat performances before finally expiring.
  In another gentler, more caring era, elderly family opted to die at home.  The family doctor was truly a family doctor and made house calls as often as necessary and the district nurse visited as often as necessary to help with any medical necessities. 

Friday, 20 January 2017

Concierge Medicine, can it improve health care?

   The whole health care system is so sick and inefficient that it is difficult to imagine how it can be repaired without first drastically reducing the multiple layers of parasitic bureaucrats and health care administridiots who enjoy generous salaries and benefits, without making any contribution to health care. They will only attempt to reproduce their own kind and to increase and perpetuate their power.
   There will be no single universal solution to this massive and complex problem.  It will take a multifaceted approach to make any significant inroads in averting the disaster that we are racing toward.  Concierge Medicine may be one small to medium sized step in the right direction.
    What on earth is that you may ask?   Its other name is retainer medicine. It is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer.  In exchange for  the retainer, doctors provide enhanced care and that includes a commitment to limit patient load, so that each patient will have adequate allocated time and ludicrous concepts like 'only one complaint per visit' will not be possible.  Guaranteed availability is an important aspect of concierge medicine and although details vary from group to group, most strive for same day or at least next day appointment and consistency of coverage on a twenty four hour basis, three hundred and sixty five days a year.   If you, the customer are buying it, you are entitled to know exactly what you are paying for.  The government takes your money and expects you to be grateful for what you get.  The unmitigated gall and brazen effrontery of your government is that they dictate what you can (or rather can't) buy with your own money.  They certainly don't tell you that you cannot buy high priced organic foods because you think it is better for your health, because all can't afford it or that you can't buy a better health food supplement than many can't afford and if they did, the LWLs  (Left Wing Loonies) would be screaming.
    Have you ever tried to get hold of your doctor for something that a short telephone call or even an email might resolve?   In my last years in practice I couldn't even get my own nurse on the line, my call was automatically flipped over to her answering machine.  I used to joke that the telephone had become an instrument for the avoidance of conversation with a live person.  That's not the way it used to be.  Most nights I used to bring home a stack of phone calls to make after dinner.  Physicians don't do that anymore.  Most Concierge physician groups are offering to do that and have someone available  around the clock for phone or  email consultation.  Can you imagine how many emergency room visits that saves and because emergency room visits are disproportionately expensive, how much money that it would save the public health care system?  Can you imagine the convenience of being able to pick up the phone to discuss whether you need to be seen right then or whether you could just drop by the office in the morning and know you could be seen without waiting three hours?  But government and bureaucrats don't want you, the public to know how easily many of the three hour waits in crowded unhealthy emergency rooms and subsequent two week waits to see your doctor could be avoided.  They just want you to think you are getting excellent health care and be grateful, when we rank eleventh out of twelve in developed countries. 
    So do we have any concierge clinics available in Canada.  You bet we have, but they keep a very low profile, because once they come to the notice of the College of Physicians they are accused of contravening the Canada Health Act and are put under notice that unless they stop they will be put under suspension.  The government, the Colleges (licensing bodies) the OMA hope to keep the dismal state of the health care system under cover for as long as possible and most of the folks don't care about it until they themselves or their families are impacted by it. 
   The bottom line is that the government of Canada, the Health care bureaucrats and all of the sycophantic organizations that help support them want things to stay exactly as they are.
    As one character in  Mel  Brooks hilarious movie 'Blazing Saddles' said, "gentlemen, we have to protect our phony-baloney jobs".  
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