Friday, 9 December 2016

Medical morale and Health Care Decline. Bill 41.



   Bill 41 is a piece of recently passed Provincial legislation that will have a devastating effect on your already failing  health care system.  Awareness of its existence is almost unknown outside the health care professions.  Couched in the usual and deliberately unintelligible legal mumbo-jumbo, I am still studying it to try to determine how far reaching its effects will be.  For those of you interested, I will be dealing with the bill and its implications in a separate blog.  In the meantime let me over simplify it by saying it will result in a completely new layer of civil service administridiots who will dictate what health care will be available and how it should be provided.  Bear in mind that most of these folks have little or no health care experience.   It is my understanding that your files and documentation will be available to them.  Their salaries and benefits including pension will be an additional drain on the already strapped health care budget.
   The letter I have shared below expresses the concerns of the College of Family Physicians on this topic.
   The name the bureaucrats have given this new bill is "Patients First Act!"










Pulse on Family Medicine

primary care policy update
The Paradox of Putting Patients First
Without Engaging Family Physicians

The OCFP is disheartened that the framework for Patients First implementation is now law through the passage of Bill 41, Patients First Act, 2016 when there is a deep and growing impasse between the Ontario government and physicians, including family physicians.
 
This impasse has destabilized the profession and devalues the significant role that family physicians play in keeping Ontarians healthy. The adverse environment is not supporting the meaningful engagement of family physicians that we know is the key ingredient for any sustainable and effective primary care transformation efforts.
 
Our research of other jurisdictions that transformed primary care confirmed that without meaningful family physician engagement, efforts were not successful, stalled and failed. The OCFP has been monitoring the planning of primary care to support Patients First, much of which has been done without the benefit of full engagement with frontline providers. A top down approach does not reflect frontline experiences, needs or realities of practice.
 
Family physicians are aware of the challenges that they and their patients face every day. They are also aware of opportunities to improve both primary and secondary care. Many family physicians are leaders in clinical improvements, primary care networks, medical education and mentoring, hospital coordination of services, and provincial and regional committees, all aimed at changing the delivery of health care to meet the needs of their patients and communities.
 
In Ontario, family physicians have often provided their expertise without support for their time because of their genuine willingness to improve the system for their patients, and with a genuine belief that their input mattered. The frustration that exists currently among Ontario's family physicians will make engagement more difficult, and any real change challenging to implement. Further, many new family medicine graduates and residents are facing barriers to entering into or establishing the kinds of comprehensive team-based practices in which they have become familiar through their training. This will have consequences for the future of family medicine.
 
The bill's passage now enables moving from planning to implementation of Patients First. The government now needs to address the issues that are challenging for family physicians in practice such as wait times for specialists, inconsistent information to improve coordination between primary care and the hospital sector, patient accountability, and equitable access to inter-professional health-care provider resources.
 
The OCFP hopes the Ontario government will place a high value on the services of family physicians and not continue to expand the services of other providers without a vision for primary care, the Patient's Medical Home, that supports the critical role of the family physician working with an inter-disciplinary team to provide comprehensive, coordinated and continuous care for patients.
 
The Board of Directors of the OCFP is discouraged by the ongoing tensions between the government and the medical profession, and will continue to advocate for the Ministry of Health and Long-Term Care to reach a negotiated agreement with the OMA, ratified by the membership.
 
Building a strong primary care foundation requires frontline family physicians to be engaged in planning that is clear enough to reduce variability, but innovative enough to develop local solutions that can be implemented effectively because they reflect the realities of local practices, community context and the population needs being served.
 
The OCFP will continue to support members to address clinical priorities through continuing professional development and mentoring networks. And we will continue to promote the Patient's Medical Home as the vision for primary care - a patient-centred model where comprehensive, continuous and coordinated care is provided by an inter-professional team led by a family physician.
 
We continue to listen to your comments and feedback in all the ways that we are able. We know that family physicians want faster access to specialists, better tools for providing care, better access to mental health resources, and support for managing patients with chronic pain and addictions. We will advocate for e-consults and meaningful digital tools to support access to care, improved resources for palliative care and medical assistance in dying, better integration and coordination between primary and secondary care, and additional inter-professional resources to help you to support your patients.
 
We hope that the messages expressed are helpful to you should you wish to make your views known either to the OCFP or within your primary care networks, and that they represent the important priorities of family physicians. Please let us know about other issues you want the OCFP to address at ocfppulse@cfpc.ca .
 
Links:

Monday, 5 December 2016

Free Speech and Intimidation of Nurses.

   In Saskatchewan recently, a nurse, who posted on her Facebook page her concerns regarding the treatment her grandfather had received in a long term facility, has been found guilty of professional misconduct.  The nurse had written about the 'subpar' treatment her grandfather had received.  She had written the post as a caring family member, not in her professional capacity as a nurse and was not in any way involved with the treatment team who provided the care.  The Saskatchewan Registered Nurses Association, ruled that she had violated the act by harming the reputation of nursing staff at the facility and had undermined the public's confidence in the staff. They also stated that she had not used the appropriate channels to bring forward her complaints and did not conduct herself professionally when using social media.  In  other words, they were saying that because she is a nurse she did not have the  right to voice her concerns in a public forum because it might make the public aware of some inadequacy of treatment and undermine confidence in  the staff or the facility.  This may be precisely what is needed.  It is called transparency, which everyone is in favour of, except when it applies to them.   The Association ignominiously expressed the opinion that unfavourable comments by one of their members in good standing should not be divulged to the public, no matter how accurate it may be..  What arrogance!  What unmitigated gall!  To want to punish a nurse for speaking out her mind regarding the treatment her grandfather received is unbelievable in an era when we pay such lip service to freedom of speech. 
   Her punishment has not yet been revealed. 
   She gave some specific advise re improvement of care which the facility might be well advised to take.   Perhaps her message will persuade families of long term facility patients to  monitor the treatment of their loved ones more closely, which would be a good thing for all concerned.
   Freedom of speech means others are free to express their opinion, even when  they don't agree with you!  This is a gross contravention of civil rights that I hope the nurse will  pursue . 
  Saskatchewan Registered Nurses Association have to realize that opinions such as these should not and cannot be suppressed.  A culture of intimidation of nurses for voicing their opinions and concerns is no longer acceptable, unless it breaches the nurse/patient relationship or involves malice.
 








Wednesday, 30 November 2016

DSM and Profile of a sociopath.


Profile of a Sociopath.

 Today more than ever we need to brush up on antisocial personality disorder, as so many of our world leaders exhibit them to a greater or lesser degree.

 This website (www.mcafee.cc/Bin/sb.html) summarizes some of the common features of descriptions of the behavior of sociopaths.


  • Glibness and Superficial Charm
  • Manipulative and Conning
    They never recognize the rights of others and see their self-serving behaviors as permissible. They appear to be charming, yet are covertly hostile and domineering, seeing their victim as merely an instrument to be used. They may dominate and humiliate their victims.
  • Grandiose Sense of Self
    Feels entitled to certain things as "their right."
  • Pathological Lying
    Have no problem lying coolly and easily and it is almost impossible for them to be truthful on a consistent basis. Can create, and get caught up in, a complex belief about their own powers and abilities. Extremely convincing and even able to pass lie detector tests.
  • Lack of Remorse, Shame or Guilt
    A deep seated rage, which is split off and repressed, is at their core. Does not see others around them as people, but only as targets and opportunities. Instead of friends, they have victims and accomplices who end up as victims. The end always justifies the means and they let nothing stand in their way.
  • Shallow Emotions
    When they show what seems to be warmth, joy, love and compassion it is more feigned than experienced and serves an ulterior motive. Outraged by insignificant matters, yet remaining unmoved and cold by what would upset a normal person. Since they are not genuine, neither are their promises.
  • Incapacity for Love
  • Need for Stimulation
    Living on the edge. Verbal outbursts and physical punishments are normal. Promiscuity and gambling are common.
  • Callousness/Lack of Empathy
    Unable to empathize with the pain of their victims, having only contempt for others' feelings of distress and readily taking advantage of them.
  • Poor Behavioral Controls/Impulsive Nature
    Rage and abuse, alternating with small expressions of love and approval produce an addictive cycle for abuser and abused, as well as creating hopelessness in the victim. Believe they are all-powerful, all-knowing, entitled to every wish, no sense of personal boundaries, no concern for their impact on others.
  • Early Behavior Problems/Juvenile Delinquency
    Usually has a history of behavioral and academic difficulties, yet "gets by" by conning others. Problems in making and keeping friends; aberrant behaviors such as cruelty to people or animals, stealing, etc.
  • Irresponsibility/Unreliability
    Not concerned about wrecking others' lives and dreams. Oblivious or indifferent to the devastation they cause. Does not accept blame themselves, but blames others, even for acts they obviously committed.
  • Promiscuous Sexual Behavior/Infidelity
    Promiscuity, child sexual abuse, rape and sexual acting out of all sorts.
  • Lack of Realistic Life Plan/Parasitic Lifestyle
    Tends to move around a lot or makes all encompassing promises for the future, poor work ethic but exploits others effectively.
  • Criminal or Entrepreneurial Versatility
    Changes their image as needed to avoid prosecution. Changes life story readily.


Other Related Qualities:

  1. Contemptuous of those who seek to understand them
  2. Does not perceive that anything is wrong with them
  3. Authoritarian
  4. Secretive
  5. Paranoid
  6. Only rarely in difficulty with the law, but seeks out situations where their tyrannical behavior will be tolerated, condoned, or admired
  7. Conventional appearance
  8. Goal of enslavement of their victim(s)
  9. Exercises despotic control over every aspect of the victim's life
  10. Has an emotional need to justify their crimes and therefore needs their victim's affirmation (respect, gratitude and love)
  11. Ultimate goal is the creation of a willing victim
  12. Incapable of real human attachment to another
  13. Unable to feel remorse or guilt
  14. Extreme narcissism and grandiose
  15. May state readily that their goal is to rule the world

(The above traits are based on the psychopathy checklists of H. Cleckley and R. Hare.)



NOTE: In the 1830's this disorder was called "moral insanity." By 1900 it was changed to "psychopathic personality." More recently it has been termed "antisocial personality disorder" in the DSM-III and DSM-IV. Some critics have complained that, in the attempt to rely only on 'objective' criteria, the DSM has broadened the concept to include too many individuals. The APD category includes people who commit illegal, immoral or self-serving acts for a variety of reasons and are not necessarily psychopaths.



For more information.
DSM 1V and DSM V 
DSM 5 Criteria- becomes increasingly  amorphous and were reviewed in 2012, but here is the essence as plagiarized by me.  ( I  am all in favour of plagiarization as long as it is freely confessed.  How else are we to progress?)

-
 Criteria for  the Personality Disorder antisocial Personality Disorder:

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three
(or more) of the following: having hurt, mistreated, or stolen from another.
1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4  Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5.Reckless disregard for safety of self or others.
6.Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7.Lack of remorse..   

Obviously there are various degrees of affliction with  this disorder, nevertheless the salient points are recognizable in many past and present  leaders.  If you can't name half a dozen you need to  read more history and news.  My comments column sits empty!
   





Sunday, 27 November 2016

Transgender and Plastic Bottles.


Sydney, age 7, was born female but identifies as a boy. He was photographed Nov. 3, 2016, at his home in Calgary.







National Post Headline.

‘I feel like a boy, mom:’ Doctors seeing an increase in preschoolers convinced they are in the wrong body.





Monday, 21 November 2016

Hemorrhaging heathcare & the Free Market.

   You're living in Regina, Saskatchewan and after waiting for several weeks to see your family doctor, you just recently saw the specialist he sent you to, after several more weeks of waiting.  The specialist determined that you need an MRI and the hospital told you it might take several months before they could 'fit you in'.  By now you are getting acutely anxious, even a little desperate.  Then your friend informs you that she heard that you can have it done privately. You make some inquiries and find out she is right.  The Saskatchewan government recently announced that two MRI clinics have been licensed to do MRIs privately, for a fee.  You phone and find that instead of waiting months, that you can have it done within a week.


   Wow!    In the land of Tommy Douglas, which gave birth to Canadian medicare, they realize that to give the folks the option of buying the care they need when the government can't afford is a no brainer.  I practiced in NDP Saskatchewan for almost thirty years and thought I'd never see the day.   Amazingly, the Saskatchewan Medical Association is opposed to what they label a two tiered system. Now the whole country is recognizing that if the folks can't buy it here in their own province or in Canada at all, they'll buy it somewhere else, thus making it even more exclusive.  That is, the whole country except our chosen political servants, who have appointed themselves our political masters.  In every province in Canada there are private facilities, obviously more available in the densely populated parts of the country.
   Waiting time for medically necessary treatment in Canada is not improving.  A specialist survey reported a median waiting time of 18.3 weeks to treatment, from the date of referral by the GP.  This is almost double the time it took in 1993. For less urgent problems or procedures, it is not unusual for the  delay to be a year or greater.  Many of these waits subject patients to pain and suffering and sometimes outcome risks.
   So, you may ask, how much is an MRI going to cost me?   Here are the rates from one private MRI Clinic.




Rates
All scans include radiologist’s report and a CD Rom copy of the images.
Brain
Routine Brain $895
Brain for MS $895
Brain for Seizure $895
Facial Bones (no brain included) $895
Temporomandibular Joints (no brain included) $895
Brain & Facial Bones $1,120
Brain & Orbits $1,120
Brain & Sinuses $1,120
Brain & Pituitary $1,120
Brain & Circle of Willis MRA $1,120
Brain & Internal Auditory Canals $1,120
Brain & Trigeminal Nerves $1,120
Brain for Tumor (contrast included) $1,195
Brain Trauma with Susceptibility Weighted Imaging (SWI) (for mild traumatic brain injury) $1,245
Brain Stroke (includes SWI) $1,245
Carotid MRA (contrast included) $1,470
MS Brain & Cervical Spine Combination $1,500
Brain & MRA Circle of Willis, Contrast Enhanced Carotid $2,270
Brain & Spinal Cord for MS Combination (cervical & thoracic) $2,395

Body
Chest (mediastinum, chest wall) $895
Soft Tissue Neck $895
Sternum, SC Joints $895 each
Brachial Plexus $895
Specific Muscle $895
MRCP $895
Pelvis $895
Abdomen $1,095
MRA (renal or aorta) $1,200
Dynamic Liver(contrast included) $1,395
Abdomen/Pelvis Combination $1,545


Whole Body Health Screening Program (see video)
(2000+ detailed images including specific screening for brain, aortic & abdominal aneurysms, compression fractures of the spine, gyneacological cancers, liver lesions and pancreatic, kidney, biliary disease/malignancy)
$2,450

Extremities
All Extremities (ie. knee, wrist, ankle, etc.) $895 each
Foot/Ankle Combination $1,590

All rates subject to change without notice.

Feel free to comment.

Thursday, 17 November 2016

Hemorrhaging medical care and the two tiered system.

 The hemorrhaging medical care system and private clinics.

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity."

   Despite the fact that the hubris of the government of Canada results in attempts to violate the rights of citizens to buy health care, government either refuses or cannot afford to give, private clinics continue to quietly surface.  They do so with a minimum of publicity, just enough to be visible to those who seek it and hopefully not enough to bring them to the attention of the "health commissars".  If they can keep their heads below the radar for the present, perhaps they will thrive as the public gets used to better, more timely care.  The fact that many people are prepared to pay from their own pockets, in addition to the considerable taxes they pay, surely makes it clear that the system is unsatisfactory and this is the only way they can get better care.  When I started looking to see what already exists, I was surprised.  As  I  started searching it became  apparent that private medical care is already more developed  than I had imagined.   I had only been looking a short time when I hit upon: findprivateclinics.ca.  Their web site attempts to list all of the private health care facilities available.  If you are prepared to pay, that MRI that was going to take a year can be obtained this month, or maybe even this week.  Need to see an orthopedic surgeon Instead of waiting a year you can do it this month, or possibly this week.  You can even get your hip or knee replaced in short order, if you are prepared to pay for it.  Most of these services are available in Canada but for some it may be necessary to travel to the U.S.   In some cases the U.S. has come to us.  The Cleveland Clinic, a global non-profit academic medical centre opened a 26,000 sq foot medical facility in Toronto in 2006.   Located in a prestigious building in Bay Street, the Cleveland Clinic Canada, is a part of a clinic that enjoys an international reputation.  Have a look at their web site :http://my.clevelandclinic.org/canada.  

      findprivateclinics.ca is an easy to use comprehensive web site that lists most of the private facilities in Canada.  Obviously, they tend to be clustered in the most populous parts of the country, but they are found everywhere. Because private health care keeps a low profile for obvious reasons, some are a little slow to come to light.  The facilities are listed by province and the opening menu lists by specialty icons, starting at A for Allergy and ending with W for weight loss.  Just click on the subject of your interest and voila, the clinics are listed, most of which have a detailed web site of their own.  Even if you are not contemplating using private health care facilities, this is worth taking a look at.  The site gets about eight thousand monthly visits.  The only thing I could not easily access was cost.   So, the much maligned two tiered  system is already here.  The government doesn't want to admit it because it emphasizes their failure The doctors and other health professionals like to keep a low profile, for fear of waking up government.  The folks who need it and can afford it want to see it thrive and prosper.

Do you think we need a two tiered health care system? 

   

Saturday, 12 November 2016

The Medical Dictatorship violating my rights.

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity."

   The government is violating my rights. Publicly funded health care is a wonderful and necessary thing.  No civilized country should be without such a safety net.  However, that should not preclude me from spending my own hard earned money on aspects of my or my family's health, particularly with regard to services the government cannot afford or chooses not to cover.  The header above this article makes clear that the government finds it satisfactory for us to rank tenth out of eleven health care systems (though by now, we may be eleventh).   The only reason imaginable for their reluctance to allow willing providers to provide service to patients on a voluntary insurance or cash basis is that it is a de facto admission of the failure of the public system to  provide adequate care. It is not as though those who would like to avail of such a system are seeking to avoid the large tax burden of the public system.  Quite to the contrary, they are offering to subsidize the system by buying their own care through cash or private insurance.  They are shortening waiting lists for the public system and saving it money.  When they buy services or investigations such as MRI they are making space in the public system.  Folks with money do this already, they shop, they frequently go across the border and leave their money in  other country's exchequer.  Our government addresses these problems by systematically introducing layer after layer of bureaucrats, each layer draining funds for salaries, benefits and pensions.  None of these administridiots contribute anything to the delivery of health care or the care of patients.  It would be interesting to know what proportion of the health care budget goes to maintaining this hierarchy. There is an urgent need for services the government cannot provide in a timely fashion.  There is no consolation in constraining the availability of service to the lowest common denominator to satisfy government ideologues. Patients die while on waiting lists.                                         Fifty two thousand five hundred and thirteen Canadians traveled abroad for medical care in 2014.  The large number coming from Ontario is not entirely explained by the larger population of the province.  Private health care clinics are springing up all over the country, while keeping as low a profile as possible to avoid the consequences of  contravening the Canada Health Act.  In Quebec in 2005 the Court ruled that a one year wait for a hip replacement violated the provincial human rights law.  Dr.Brian Day, an orthopedic surgeon has a Charter challenge going on in BC, that is finally before a judge after an eight year wait.

  I believe the private clinic concept is going to thrive despite attempts to  prevent it doing so.  In the meantime, those who can afford it will just continue to go abroad when they can't get satisfaction at home.  Next, we will explore some of the services that are available in Canada - right now!