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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Saturday, 14 January 2017

Swimming your way to Health and Happiness!




Swimming your way to health and happiness!

   I started swimming seriously after my quintuple bypass in 2004.  Various physicians and others suggested joining a cardiac exercise program at the hospital  and I did go once, but all those old puffing elderly folks who looked as though they were working so hard were so depressing that I decided not to go again.  If I was going to exercise on any sort of regular basis it was going to have be fun, not work.   I had always liked swimming and I was a fairly good swimmer in my time.  My first foray was almost the last.  I had decided to go to the university pool but when I got on campus I drove around for fifteen minutes and still hadn't found a place to park at any cost.  Students, I decided, must be much richer now than when I was a student.  I could always find a spot in those days, to park my bike.  I then decided if this was the way it was going to be, university was not for me!   I swung impatiently out of the gilded gates of academe and headed for the Aquatic Centre, an impressive Olympic dimensioned pool that had been built for some major event.  I had often driven by that interesting building but never actually had a look inside.   I drove straight there and was overjoyed to see a large parking lot with lots of space.  I parked my car, registered for a nominal fee and twelve years later I'm still going on a regular basis.  My objective was to swim three times a week and as the song goes "with a little help from my friends", I have been for the most part, successful.  Now everyone knows that even the best intentioned people tend to fall off the exercise wagon when left to themselves.  So I knew that I would have to devise a means to overcome the inevitable boredom of lane swimming for an hour three times a week.  Don't get me wrong, I enjoy the swimming itself. It is excellent exercise, in that one can fine tune the activities to one's individual  capabilities.  Unlike those activities that pound and stress one's knees, hips and lumbar spine, one can get as much exercise as one wants or can tolerate, without the side effects of those other activities. Still, it can get a little repetitious and even boring, although one certainly has an opportunity to reflect on everything from the meaning of life to the content of the next blog.
   I had only been attending for a short while, when I noticed that in a separate deep water diving pool set apart from the swimming lanes, there was music and activity directed by an enthusiastic and athletic young woman, demonstrating a series of exercises.  I had been lane swimming and was getting a bit bored, so I got out of the main pool and joined the twenty five or so women and two men in the exercise class.  This was quite good fun, following the graduated exercise instructions, watching the graceful young woman on the pool apron demonstrating the ballet- like moves and encouraging us old folks to build up a  head of steam.  They were not all old folks in the pool but the mean age would have been closer to my age than to the youngest participant's.   The other advantage to this particular activity is that in  the course of the exercising, one is in close enough proximity to people to talk to  them.   
   After a while I started to get to know a few interesting people.  Otto, an elderly widower, well in his eighties, would finish off his exercises by climbing a sheer 'climbing wall', probably twenty feet high.  It had foot and hand grips and was obviously there for the kids to climb and then push themselves away and drop into the pool.  Otto would precariously climb this and then drop into  the pool.  The whole thing looked so dangerous that the life guard told him not to do it.  He politely listened to the advice, nodding his  head sagely in agreement and then didn't do  it again until  the next day and the next and the next.  Eventually they closed it down when he was in  the vicinity.   He was disappointed but continued swimming.  'The swimming" he said, "is good for my body, but even more important for my mind."  I've thought about that a bit and I agree with him.
  One of my closest friend now is an ex cop, who is even more talkative than me.  We started having a coffee at the Tim Horton's just across from the pool, where we continue regale each other with stories from our respective professions.  We call our dialogues, 'The Doc and the Cop' stories. That was the beginning of a beautiful friendship.   
   Early on, I ran into a lady who had been the chief radiology technician in a hospital in  Ontario.  We found a lot to talk about while in the exercise group.  It turned out that her son is a local  Ear, Nose and Throat  specialist to whom I referred patients when I was in practice.  It is a small world.  I ran into this lady in a store some while ago.  Initially she didn't recognize me, but when she did, her rather loud exclamation was, "Oh, I didn't recognize you with your clothes on!!"  A few nearby shoppers pretended not to hear!
   These are but a few of the folks I have met at the pool.  I arrange to  meet with  the cop on a regular basis, so on those mornings I might  have stayed in bed or lazed around the house because it looked dreary, I can't, because I have an appointment and I always keep  my appointments, and on time!
You will get an occasional follow up of life in the pool! 

Sunday, 8 January 2017

A lesson in child education - Part 2.

   It is just about a year since wrote about the two little girls I am systematically brainwashing in the most creative way possible.  The  coup de grace was when so called educators decided that cursive writing required too much precision and effort  and therefore should be dropped from the school curriculum. In the kakocracy in which we dwell, music and art and so- called culture has become aggressive, atonal, careless and chaotic, one has to search hard for some redeeming activities that can  re-introduce some appreciation for precision, order and beauty to our declining civilization.  When Omar Khayyam wrote, "The moving finger writes and then moves on ", he was not just stating a mechanical fact.  He was explaining that the brain is directly wired to the fingers and that the thoughts flow on to the paper or parchment or papyrus.  Any monkey can pound on a keyboard, but it takes a human to write, although ofttimes they may not make any more sense than the monkey does.   However, that's not the point of today's little story.  The point is that cursive writing is an exercise that develops manual dexterity, precision and artistic skills at the same time as it is developing the brain.  I freely confess that none of these ideas are evidence based, but I am free to opine and always right!
    My grand-nieces and their parents, who live in another  city, a long days drive away, usually visit us at this time of the year for the past three or four years.  I believe it was when I was showing my pen collection to their parents, the girls, about eight or nine at the time showed considerable  interest.  When they came to visit the following year, the first thing they wanted to do was to go down  to  the 'Pen Dungeon' to see all the pens I have in captivity.  (Most of them are quite tame, though a few of them show signs of restlessness and rebellion and look quite threatening.  I try make sure that there are 'safe spaces' in my pen boxes and that no one pulls off a screw cap or screws a pull cap).  So, I decided the time had come to continue the 'braining washing', which is another word for education.
   See my blog  "A Lesson In Child  Education" for the early session.
   As soon as they got here after a long drive, they wanted to go 'down to dungeon' .  They confided in me, a little apprehensively, that they didn't have time  to practice as much as they would have liked to and they hoped they would pass the test.   This is the certificate they got last year. 

     They are anxious to get the certificate of  'Advanced Achievement'  this year or perhaps even an 'Award of Merit'.
      They had certainly improved significantly.  The seriousness of the situation was somewhat impeded by two factors:
      1.  I have a slot machine in the work area adjoining the dungeon that they had already discovered during a previous visit.  The machine pays out, but is not adjusted to require insertion of a coin to work.  So the girls got a negative lesson, in that they now think you can gamble with only winnings and no losses.  I tried to explain this to them, but they refused to take it seriously until there were no coins left in the machine to pay out when they got a winning combination.  They now know what it is like to 'break the bank' but have no idea what it means to go bankrupt.  I don't think it registered when I tried to explain that one!  However, they have very intelligent parents and I am sure they will be successful where I have failed.
      2.    'Uncle'  Rick McDonald, of my Pen Club, kindly gave me some invisible ink pens, visible only in ultra violet light.  They were absolutely fascinated and after writing on various paper samples, soon discovered they could write on the arms and hands etc all invisibly.  Then, when my son David, always their favourite (they never hesitate to drop the 'old man' when Dave is around!) arrived, they set about decorating him.  I don't know how quickly it washed off, but I regret that I never got a chance to photograph him under ultra violet light.
       Thanks, 'Uncle' Rick, you contributed palpably to the fun.
       All in all, it was a fun few days and the important thing is that the girls are still enthusiastic about fountain pens and cursive writing.  And I am sure my niece Tanya, will be eternally grateful that I taught her daughters never to leave an ink bottle uncapped!

    Don't be afraid - feel free to make a comment!

Monday, 2 January 2017

Health and Mind. Fortune and Misfortune

   Despite years of studying disease, both endogenous and exogenous and with absolutely no 'Evidence Based'  Research, to support my hypothesis, a life time of medical practice has convinced me that what many people have concluded intuitively is correct.  Health and longevity are more related to how you play your hand, than the hand you have been dealt.  Attitude is a key factor in the quality of life, as well as health and longevity.  I recently listened to the biography of the celebrated author, journalist and international commentator Dr. Charles Krauthammer, who transected his cervical spine and became quadriplegic in a diving accident.  He was a medical student at the time and he commented that he knew what happened as soon as soon as he hit the water.  Not being able to  move, he thought he was going to die right there in the water, but he was pulled out and and taken to the hospital.  He knew, he said, that he was never going to  walk again or fully use his upper limbs.  Nevertheless, he decided, there and then, that he was not going to let this interfere with his life, other than in his words, in how he dealt with the force of gravity.   Ponder that for a moment.  In a situation where most people would be totally devastated,  Krauthammer, an active and athletic medical student is already planning how he is not going to let this catastrophic event decimate his life.  Ridiculous!  But he succeeded and became one of the worlds most successful, award winning journalists.
   More than half a century of medical practice has convinced me that attitude makes a huge difference.  Time and time again, I have seen people "beat the odds", almost always those with a positive view.  I have repeatedly seen folks who seem to have nothing but misfortune and bad luck refuse to let it get them down.  I have wondered how some have dealt with  misfortune I could barely imagine and still have that vital elan that is a part of their being.   Others, lacking that esprit, are often devastated by relatively minor misfortunes and set-backs, sometimes to the extent that they never recover.  Somehow, the misfortunes are translated into physical changes which are permanent.  How can that be?
    Hans Selye, the Hungarian-Canadian endocrinologist did indeed demonstrate that stress can cause physical changes including high blood pressure, immunological changes and actual changes in the brain.  The puzzling thing about this is that not all people are equally effected.  Recent research suggests that what matters is not just the level or type of stress, but how it is thought about.  It is well established that some stress is good.  In other words, the same stress can have a different effect to the extent that what is harmful to one being is beneficial to another.  Perceiving stress as a challenge rather than a threat produces psychological and physiological  responses that are very different.  "One man's stress is another man's spinach!"  
   We need to know why people like Krauthammer can deal with such catastrophe and still lead a full and meaningful life, while others disintegrate under much lesser misfortunes.  Some would say it is all in the genes, I think they are wrong.  
   It is all in the mind!  Now all we have to do is learn how to treat it.
                                                     

                                     Happy New Year! 
  

Sunday, 25 December 2016

The Death of Medical Confidentiallity.

 Bill 41 and the end of  Medical confidentiality. 

  The ultimate death spasms of medical confidentiality which has taken place in Ontario, will come as a surprise to many citizens when eventually it affects them.  Most folks have never even heard of Bill 41  which was recently passed and which  is going to drain the health care system and the tax payers pockets.  It will result in the creation of a whole new layer of administridiots with their cohorts of assistants, secretaries and clerks with generous salaries, benefits and pensions but as far as I can make out will add no new resources to actual  health care.  no new doctors or nurses, no reduction of waiting times for procedures and no extended health care.  It has been given the euphemistic name of the "Patient's First Act", although that is exactly what it is not.  Truly, it is the "Bureaucrats First Act" although it is the patients who will be paying for it.  The Act is there for everyone to read, though unless you happen to have a law degree, which  I don't, it is difficult to fully comprehend.  But I do get enough to tell you some of the effects it will have on  you and me.
   1.  Medical confidentiality, which has been dying for years is now soundly dead.  This act gives the government access to your medical records.  Now, the confidentiality of medical records has been  under attack for years.  Those who can gain access to your medical record may gain access to information that you desperately want to keep private.  I can recall being forced to give information in court that I didn't want to divulge as it was not in  the best interests of my patient.  I was informed that if I refused to I  would  be found guilty  of 'contempt of Court' and could go to jail.  I was also  informed by the court that I didn't have to worry about being sued by the patient because I  would be protected by the 'Canada Evidence Act', which I had never heard of until then.  So even  then they had you where they wanted you.
   With the introduction of  Medicare patients willingly surrendered a major component of their privacy, because all billing submitted  to the government had to have a diagnosis attached.   Some physicians, who really respected the patient's desire for privacy would sometimes disguise an unpalatable diagnosis to prevent the patient from embarrassment, but the administration soon caught on to that  and cautioned physicians regarding the consequences of so doing.  Occasionally patients requested to pay in  cash, to prevent a  billing slip with  the diagnosis going to  the billing agency.
   Bill 41 allows the government or their agents to access your medical record on very slim guidelines that offer you little protection.  Government knows that information is power and wants to know all about you.
    This is what George Orwell had to  say:"There was of course no way of knowing whether you were being watched at any given moment. How often, or on what system, the Thought Police plugged in on any individual wire was guesswork. It was even conceivable that they watched everybody all the time. But at any rate they could plug in your wire whenever they wanted to. You had to live—did live, from habit that became instinct—in the assumption that every sound you made was overheard, and, except in darkness, every movement scrutinized."  Now the folks do much of the work for them on facebook and  twitter!
   2. Bill 41 gives the Ministry of Health total dictatorial power over the the main Health Care providers without requiring other than token input so as to appear as though they are involving the key players like physicians and nurses in their decision making.   Most of those administrators, with no medical knowledge whatsoever, some with a minimal amount, are making medical decisions that will eventually affect every person  in the province.  To be successful in  their endeavours they have to minimize physicians and nurses and to reduce them to obedient  technician status.  And make no mistake, they are well on  the way to doing that.
   3.  Medical resources, scarce enough already are going to become even more strained to support the new bureaucratic layer.  There will be no benefits to patients in  terms of improved health care.

  Remember Ronald Reagan's caution:  The nine most terrifying words in the English language are, "I'm from the government and I'm here to help!"
      
  

Tuesday, 20 December 2016

Child abuse - blame the Doctor!

   One of the latest headlines in my favourite newspaper:  "Doctors zeal to protect children was his undoing".  The story was of a Montreal pediatrician, Dr. Alain Sevard, whose diligence in attempting to protect children from violence resulted in such reaction and criticism, because he was not always right, that he felt his only recourse was suicide.  The story is of a caring pediatrician, with a reputation for  being an expert in child abuse, frequently consulted by emergency departments in cases of suspected child abuse, who became a victim of his own caring because he was not always right.   Consulted in many cases of brutal child abuse, Dr. Sevard always hoped he was making the best decision, but when in doubt suspected the worst and turned over the case to the child welfare services and for this he was demeaned and punished.  That was because on occasion  he was wrong and indignant parents and family were more concerned with their own reputation than with child protection.  They were slighted and they had to have their revenge.  The folks who so fearlessly demand more aggressive pre-emptive action by physicians and child welfare agencies in cases with tragic outcomes, are the first to criticize those who act decisively often to their own  detriment.  Particularly disturbing, is that the Provincial College of Physicians, a body that often hypocritically voices concern over the physical and mental health of excessively stressed physicians ( and I can inform you from personal experience that few physicians are not excessively stressed, unless they work for the government) seem to enjoy participating in the witch hunt.  What message does this send to young physicians?
   Most of the time Dr. Sevard's suspicions were correct, but on occasion they were not. Outraged parents reported to the media that Dr. Sevard had reported them to Child welfare for suspected child abuse, based on the evidence he had observed.  That was precisely what he was supposed to do, if he had grounds to be even suspicious of such circumstances.  That is what he did. But the media make a feast of such situations and once the folks smell blood, they are relentless in their pursuit of he who embarrassed them.  The results of the chase was that the College of Physicians, (who should have known better than to pander to the press's demand for immediate action) and the hospital, which I presume thought doing something would make them  look good, revoked the privileges of the caring doctor and subjected him to calumny and contempt.  The sad epilogue was that the physician, humiliated and depressed, his life's work and his reputation forever sullied by the media, the College and the hospital, took his own life.
  A man who appears to be blameless, was punished mercilessly because in his attempt to protect defenseless  children he had offended some innocent parents.
  The message is clear.  Don't stick your neck out.  Too bad if some children get abused and/or  battered to death.  That's just the way it is in the just society.