Monday, 9 October 2017

Commonsense and the decline of the Medical Profession!

   For much of my life I was convinced that most of my colleagues exhibited a fairly high level of commonsense.  I still think that was true for at least the first half of my career.   I began to notice occasional nonsensical patterns years ago, but nothing like the present day behaviour.   Almost daily, I read about health care decisions that make no sense other than that it secures and extends the power and position of the government and their obsequious non medical administrators.  I can understand their actions, after all, they don't have to work very hard and they are rewarded generously and look forward to a relatively young pensioned retirement.  It is more difficult to understand the physicians who had sacrificed much of their youth learning the Art and how to apply it, accepting a role that is subservient to a group whose background is largely business/financial and who know and care little about the Art and how it should be practiced.  Populism, does not encourage good medicine, but even the very bodies who were originally devised to maintain the standards and professionalism of medicine have thrown in their lot with the politically correct social warriors.  I speak of such organizations as the Provincial licensing bodies, The Colleges of Physicians and Surgeons and of organizations like the Canadian Medical Association.  
   Examples abound.  In Saskatchewan, a doctor was disciplined for sending threatening emails to a colleague.  The doctor repeatedly called his colleague "an idiot" and threatened to beat him to death!
  His tone rapidly deteriorated and I will give you just a couple of his choice statements.
   "Fucking idiot, Swica.  Don't call me "MUZIMU, (sic) Evel spirit".
   "Idiot, I can stand feces better than you.  You are worse than feces. I just can't stand you, idiot."
   So, what do you think the College did?
   They didn't even have the courage to suspend this disgusting physician for such unprofessional behaviour.  Could it be that they are afraid of the consequences of doing the right thing? They ordered him to take an ethics Course!  The College is grossly derelict in its duties and in commonsense.  They board of the college in question requires basic education in ethics. 

Item #2.  
   The Wonderful Wizard of Oz, otherwise known as Dr. Mehmet Oz, a surgeon who has prostituted his profession to become a snake oil salesman, continues to hold a medical license in the great United States.  This has convinced me of the disinterest of the licensing bodies in protecting the public, a privilege granted them for that purpose.  Instead, they seem much more interested in protecting their turf, their jobs and their power.  (We are no better here in Canada.)
   Dr. Oz (it sticks in my craw to even call him Dr., but I'm from another century!),is recommending cannabis as an 'exit drug' for the opioid crisis.  Because he is a 'celebrity' and one with a medical degree to boot, the public will be raptly convinced that the way out of opioid addiction is pot. It is difficult to believe that the decent, conscientious members of my profession, do not rise up and demand that this snake oil salesman be required to provide proof of such a claim.  The potential for damage of such statements is enormous.  Who speaks out to challenge it?  Very few.  The opinions of the real experts are barely acknowledged.  After all, who would not rather hear that pot cures everything, than that it is just a harmful drug that keeps the masses a little more manageable?

Item#3.  The Good Psychiatrist.
   The opioid crisis and The Good Psychiatrist.
   I read an article this week in a medical newspaper entitled, "How to address the opioid crisis."  It was written by a psychiatrist, who commented that this was the first article she had read that made sense to her in how to curtail the 'opioid crisis'.  Its essence was, 'invest in social capital'.  
the psychiatrist suggests that the best way to address abuse and dependence on opioids is to help communities strengthen the ties between people.  This is 'social warrior' talk, that sounds good until you begin to analyze what it actually means.  It means that drug dependencies are due to factors that communities should seek to address.   She suggested that unemployment and economy difficulties cause a rise in the opioid emergency room visits and deaths.  She suggests society can change to accommodate and make life more tolerable for the unfortunate addicts.  It implies that society is responsible for the opioide crisis.
   Nowhere does she state definitively that no matter what society does, no matter how many injection centres or Narcan kits are available, the final call is with the addict. Unfortunately, my observation has been that despite such measures the problems continue grow. 
  

Sunday, 1 October 2017

An Emergency Happy New Year!



                                          Happy New Year!



        It was my first night on call in the Emergency Room, all by myself, away from the legions of senior supervising residents and  experienced physicians and specialists of the teaching hospital, in a smallish city in Kent.    Me, the brand new intern, alone for the first time and terrified.   

        At half past eleven I had finally seen all the patients and the waiting areas were empty.  It wasn't that it had been so busy, but there had been a constant stream of patients all evening.  New years eve and  I was going to get to the midnight ‘Ring in the New Year' party on West One after all. 

        "Ready for a nice cuppa yet, doctor?" asked Mary Hand, the nurse.

        "No thank you.  Have to leave room for a tiny drop of whisky at midnight."  I grinned.

         "Yes, I'll go down with you for a few minutes and we'll leave Jane to mind the shop.  Then, I'll come back and she'll go down for a while."

          Another patient trickled in with a bad backache that she had had for four years, but seemed a bit worse tonight.  As she was on her way home after the late shift and passing by, she thought she'd drop in and have it looked at. I had no sooner packed her off than the dedicated line to the ambulance service began to ring. Jane came running down to the Cubicle where I was still completing my notes.

          "I just had a call from the Ambulance driver.  They are bringing in a man who has just been hit by a train.  Real bad they say he is.  They’ll be arriving in five minutes."

           I felt a wave of panic pass over me.  Until now, I’d always been in a large teaching hospital, with its hierarchy of students and physicians of increasing experience, capabilities and specialization.  This meant that there was fierce competition when the 'big stuff' came in.  The sharks from the specialty services were constantly cruising the water to see that their trainees were getting exposure to enough clinical material.  Consequently, junior interns were pushed aside, and although present, often didn't get the hands-on experience that is so important. 

         The sirens screamed as the ambulance pulled up to emergency bay.  The nurses had prepared the acute trauma room and directed the ambulance men pushing their gurney into it.  I rushed in, suppressing the overwhelming desire I felt to run away.  The sight that greeted my eyes justified my fears.  On the gurney lay a man of about forty-five, motionless and intact, until my eyes came up to his head.  The scalp and underlying skull were avulsed from just above eyebrows carrying with it a fair chunk of brain all hanging on a hinge formed  by a delicate flap of skin.  It was an injury that no-one could possibly have survived.  That much was immediately obvious to me as I attempted to suppress the gasp of horror that came to my lips.  The two nurses, who had rushed to the bedside with IV fluids and other emergency equipment, also gazed at the corpse in horror.  I didn't know what to do.  Medical care for the patient ends at the moment of death.  But wait a minute; everyone knows that the first thing a physician has to do is certify the patient as dead.  There are three clinical signs of death, dilation of the pupils, absence of heart beat and absence of breath sounds.  As I learned so well in later years, when you don't know what to do, you do what you know how to do.  

         "I called the Senior Surgery Resident.  He'll be right down." Mary said.

         'Don't just stand there, doctor, do something.'  The prevailing philosophy might often better have been 'don't do something, doctor, just stand there'.  But it wasn't, and I felt compelled to take action.  I took my pen flashlight out of my white coat pocket, retracted the blood-encrusted eyelid of the unfortunate dead man and shone the light into the dilated pupil, knowing full-well that he was dead. 

         Just then, a tall well built, blond man, in a white coat, strolled into the room, with an easy stride.

         "I'm Rhys-Jones, the surgical resident," he introduced himself, smilingly, with an Oxbridge drawl.  The he laughed.  "What the hell are you doing?"  He laughed again and then went on. "The man's brain is lying beside him on the bed and you're looking for pupillary reflexes.  You're not going to find any, he's dead!"

         I felt stupid, not for the first time and certainly not for the last.  I knew it doesn't last long.

         "You must be the new intern from Ireland, Lord save us," he said, with a mock Irish accent.  

         "Bejaysus, that I am," I answered, in my mock Irish accent, to disguise my embarrassment because I had very little accent at all.

         "We better give the coroner a call, this will require an autopsy.  Only, of course," he chuckled with a wicked grin, "if you didn't get a pupillary reflex.  And since you have cleared the waiting room, you might just want to stop in at the residents lounge on your way home for a quick glass of Kentish cider."
           I was only too eager to oblige!

Monday, 25 September 2017

The great Medical Dictatorship and The light of Day.

   While Canadians are being denied excellent health care by their government under the pretense that allowing duly qualified physicians to provide care on a private free enterprise basis to those patients who opt to pay for it, there are some rays of hope that some buds of the two-tiered system are sprouting up in various areas in Canada.  They are often in areas where they are not too easily standing out from the weeds, for fear of being ruthlessly stamped out by the dictators who don't want the folks to discern that there is an alternative.
   One such sprout is Dr.Brian Day of the Cambie Surgery Centre.   Dr.Day, is an orthopedic surgeon, who has served as President of the Canadian Medical Association and is an Honorary Associate Professor of the University of British Columbia.   He has launched a lawsuit challenging government laws that ban private insurance for medical services.  The Supreme Court of Canada abolished laws banning private health care in Quebec, stating that "access to a waiting list is not access to care".and "The evidence shows that delays in the public health care system are widespread and patients die as a result of waiting for public care."  There is something very wrong when citizens of one province enjoy constitutional rights that are denied to others.  The Government is denying Canadians the right to buy services that they are unable or unwilling to provide.  It is difficult to understand how the government has managed to convince citizens that allowing a private parallel system would result in a deterioration of the standard of care when in fact, it would result in an improvement of available services and a significant shortening of waiting times.  It would also shorten pain, suffering and disability times. There is a reason government resorts to these unethical tactics with very specific goals in mind, which I will go into later.  In the meantime we will return to the story of Dr. Day.  Dr. Day contends that if the government cannot provide a medical service within an acceptable time then it does not have the right to prevent those suffering from obtaining healthcare privately.  Dr.Day and some patients are challenging the constitutional right of the government  to prevent patients from buying health care.  Nine years ago Dr. Day  and the clinic filed a charter challenge to BC's ban on private health care, as they violate a section of the Canadian charter of rights.  This case is still going on nine years later.  The trial did not start until September 2016 and it looks as though it will continue for a long, long time at an inestimable cost.  After initial judgement it will, no doubt go on to the Supreme Court.  It will cost millions and millions of dollars and government will do everything in its power to delay it and to have the other side run out of money.  They don't have to be concerned, because they are spending your money and if they are running low, well they'll just put up your taxes a bit.  They think you're too stupid to even notice - and they may just  be right!
   If you are willing to put up with one of the worst, if not the worst health care systems in the developed world, then you just have to be satisfied with what you get when your time comes and you or a member of your family needs timely and compassionate care- and it will.  Meanwhile, those who do their research and prepare themselves properly will at least be aware of the options when and if the time comes.  Because, while third class care is better than none, most of us want something better for ourselves when something serious comes along, especially the politicians and their serfs.  
   Finally, as one who has practiced medicine for more than half a century, let me tell you most physicians have grown exasperated and weary of having the course of medicine determined by a group who have little insight into health care and are not interested in learning about it.  Most of the dedicated physicians I know are looking for a way out, not because of greed but because of the Stupidity Quotient (SQ) of the elites in administering the service and the deliberate disrespect they show to physicians.   Early retirement is increasingly attractive when conditions of practice becomes increasingly intolerable and taxes become increasingly punitive.  We are already losing some of our most experienced and talented physicians.
   In the meantime for the sake of the public and for the sake of the profession, I hope Dr.Day and the Cambie Clinic are successful.
Please do not leave a comment if you do not care what happens to the health care system in Canada.

Monday, 18 September 2017

Health Care! Who gives a f**k anyway - until you are sick!


WHAT? Trudeau Actually Attacked The Opposition For “Standing With Doctors”


  I've been talking to people for years about the health care system and what they are doing to it and allowing to happen to it, what they expect from it and what they can realistically expect from it.    I've listened to folks complaining about health care and what they want and demand from it, because, 'damn it, I've paid my taxes for it and I'm entitled!'  But who have they paid their taxes and from whom are they entitled?   Certainly not from the physicians who dedicated their lives to medical practice and who had given them such a high standard of care.  They are entitled to make demands from the government who promised them everything they could desire, although lacking the means to provide it, but they are not  entitled to expect the medical profession to fulfill the promises the politicians have made to get re-elected.  In fact, a group of petty politicians have promised my service at a price they determine, to everyone.  They expect a special level of care for themselves.  (Of course it does need to be just a little better for the politicians and their ilk because they serve the country so well!)  I spent years training family doctors and teaching them how to look after their patients and their obligations to them, but, unfortunately I  spent no time training my students to look after themselves and their families.   In return for the exceptional dedication of physicians to their patients, it became accepted as the norm.  No other profession I  know of  is expected to provide such commitment.    Indeed, physicians have come to  be regarded as some sort of government lackeys.  Everyone is entitled to justice, but if  you can't afford it, you take what you can get!  But remember what Ronald Reagan warned us,   "The nine most frightening words in the English language is, ' I'm from the government and I've come to  help'.  What could be more true.  Physicians and nurses and others who spend their  lives administering health care do know much more about health care than the administridiots, most of whom are from a financial background and know little about health care, but nevertheless rule the  health care domain with  a hand of iron.
   So, I've decided that since most of the folks don't really care about health care or about nurses or about others who provide their health care until they really need it, why should I.  I did it for long enough.  I'm retired. I care about the people I care about and the people who care about me.  I don't wish to subsidize legalization of gateway drugs such as marijuana that the government wants to use to dope down the masses together with other drug encouraging measures they are initiating .  The resources they use are often wasted, there are more seriously ill people to help.  
   Meanwhile, if people need real health care in a timely fashion  or are in pain  and discomfort as a result of long waiting time I would encourage them to explore what is available in the second tier within Canada as well as without.   You may be surprised at just how much  is available. After all, surely avoidance of a year in  pain and discomfort is worth some money, regardless of what the government thinks.
Anyone got the guts to comment on this?
  
 

Monday, 11 September 2017

Health Care Rationing in Canada.

   "Administrators maintain waiting lists on purpose, the way airlines overbook. As for urgent patients on the list who are in pain, the public system will decide when their pain requires care. These are societal decisions. The individual is not able to decide rationally." — Dr. Charles Wright, previous member of the Health Council of Canada and a former vice-president at Vancouver General Hospital, quoted in a Reader's Digest article.
   It is a sad fact that somehow the government and its administridiots have managed to convince the Canadian public that they have a successful health care system, when in fact it is one of the worst in the developed world.  It was not always thus and in  my early practice years in Canada we actually did have one of the best and most envied services in the world.  Many of the public, particularly those who have had no health care needs continue to think that.  Because the public is notoriously unable to distinguish between good and poor medical care, and because the service is increasingly run by people who's expertise is in  business and finance the ability to  distinguish between good medical care and barely acceptable care has been whittled down  to precariously few.  Thus, the administration is able to place the blame for the inadequacies on others: on a shortage of doctors and surgeons, that they themselves produced in the 90s. ALL the provincial ministers of health, cut medical school positions across the land by ten  percent.  This despite the fact that I and all the other chairs of Family Medicine in Canada and many others warned them that this was a most imprudent move.  Their "money men" had advised them that the  costs of health  care was directly related to the number of doctors and that they could cut the  costs of health by having fewer doctors.  The fact that as medicine was progressing and becoming so much more sophisticated that investigations and procedures that were not available before and that required expensive equipment and  manpower did not seem  to occur to them.  Or perhaps it didn't matter that much once they got  beyond the next election.  By the time they did understand, there was an acute shortage of doctors, so they began scavenging doctors from the poorer countries, instead of training our own.   Mean-spirited and immoral, but they didn't care as long as they thought the folks would be fooled into  thinking this was all someone else's fault.  This is what happens when health care is put into the hands of those who know little about it.  Those responsible, well paid civil servants, with generous defined pension benefits and even more generous sick benefits, paid holidays and other allowances began to feel threatened by  the people who really did know about health care and they recognised they had to do something to protect their jobs.  And that is when the  government and their sycophants realized that they must do everything in their power to diminish the influence and authority  of physicians.  This they attempted to do largely by appointing lackeys subservient to their superiors to 'run' the health care system.  There was only enough room for physicians in this equation to allow the committees to boast of physician involvement in their decision making and conclusions and appear to legitimize them.  Often the physicians were absent because he/she had patients to look after and the administrators liked as far as possible to have their meetings during business hours.  I hardly need to say that most of the physicians in the past did these tasks on a pro-bono basis. 
   Things have changed now, and there are enough physicians and surgeons to go around.  So why have waiting lists grown longer when there are skilled surgeons sitting on their hands?   The politicians would have us believe that there are not enough operating rooms and not enough beds, not enough skilled physicians and nurses.  None of that is true, there are empty operating rooms and empty beds that cannot be used because the administridiots will not provide the staff to support them.  They believe and are largely right that they can shift the blame from themselves to the people who provide heath care and manage to somehow make it work, albeit at a pretty dismal level.  A major part of their plan is to attempt to diminish and vilify physicians and other true health professionals who know so much more than they do and therefore represent a threat to their life style.  If you want to see just how well they do, look up the 'sunshine list'.  The other thing that terrifies administration is that even a small tranche of private health care will so awaken the consciousness of the present care recipients that they will demand something better.  
   That is why the BC government is doing all it can to prevent an Orthopedic surgeon Dr Brian Day and the private Cambie Clinic from continuing to offer outstanding care in a timely fashion and our governments across Canada are doing all they can to prevent people from spending their own money to avoid obscene wait times for alleviation of their suffering.  But at least they will be able to treat themselves with all the pot they want, and perhaps a few opioids.
   More about this next time!
   

Thursday, 7 September 2017

Stop Whining about Health Care, Canada!

   I'm tired of listening to people who once enjoyed one of the best health care systems in the world and threw it away, whinging and whining about a health care system that is nosediving into the ground.  Despite its deterioration and being near the bottom of the standards for the developed world, Canadians are getting better health care than they deserve on the backs of Physicians and other health care workers who have managed to maintain standards that are surprisingly high considering the manner in which the politicians and their administridiots have treated them.   I know many physicians, folks who went into  medicine to do good and certainly not to make money, who dedicated their considerable talents to helping people (as corny as that may seem to  today's  LWLs), who are rightly disillusioned by today's attitudes.  No wonder they think that they have to put their children and families before their job, a mistake that many of my generation foolishly failed to recognize.  No wonder they feel demoralized by a government and  a public, who don't bother to think that they don't have a pension, like the over subsidized and over unionized teachers group and auto workers, many of whom get much more than they deserve.  No wonder that they resent that they have no benefits, no sick leave, no safety nets but are expected to continue to provide the exceptional  health services that Canadians have come to expect as the 'rights' the government promised them.
    Doctors are demoralized and so they should be.  When they find that even their patients, who many had come to regard as friends begrudge them a decent living, well, what do you expect?   Why should they get up at three o'clock in  the morning?   Go to the ER, whatever you get is good enough for you.  Why don't you call your parliamentary representative (who, by the way, gets quite different health care than you!)
   And you re-elect them.
   Maybe you deserve exactly what you get.  Maybe you are getting better than you deserve!
   And the decline accelerates!
   Good Luck!

Monday, 4 September 2017

The Great Canadian Healthcare Dictatorship gains momentum

   There is a steady erosion of health care  but you haven't seen anything yet!   Your government, which states they cannot afford to maintain the current system and has already applied cutbacks that most folks haven't noted yet, including substantial cut backs to physicians and nurses, invites largely inadequately screened immigrants into the country.  They generate huge, and I mean huge expenses to the system in general and to the health care system in particular \while Canadians wait and wait (and sometimes die waiting).  Physicians who can afford to, take an early retirement, or partially retire, while others move to provinces with a more respectful attitude.  Meanwhile, Canada will continue to try to fill the gap by scavanging the world, (particularly the poor countries) for foreign medical graduates whom they can control by restrictive licensing practices.  It is certainly cheaper than training our own, even if it is immoral.
   The dictatorial decree that our political masters have issued, in preventing those who do want to pay for their own care from doing so, is inappropriate.  As a result of this, they force some Canadians to shop abroad and spend their hard earned money supporting out of country health care systems, when it could be so usefully used by ours.  In an attempt to appear politically correct they care not one iota for the distress and suffering they cause to many.      Another example of the idiocy of so -called political correctness!
   Most developed countries do have a two-tiered system, in that those who wish to pay for health care directly or through private insurance are perfectly free to do so.  This injects extra funding into the health care system on a voluntary basis, shortens waiting lists in a very significant number of ways that I will deal with later.  The public generally don't know that there is no shortage of doctors ( surgeons, in particular ) and that the long waiting lists are deliberately construed by government as means of rationing care without appearing to do so by closing down operating rooms and hospital wards.   When challenged, health care administridiots will deviously explain it all as due to lack of support staff as though they were not responsible for the support staff cut-backs.   To simplify, while you the patient, are painfully waiting a year for your hip surgery, there are empty operating rooms and underemployed orthopedic surgeons readily available.   Your government is frivolously spending billions of  your dollars, while our once splendid health care system is embarrassingly at the bottom of list.   Despite all the facts, the government has succeeded in fooling most of the people most of the time.   Don't you wonder how stupid your government is to give a murderer and terrorist ten and a half million dollars when an elderly citizen has to wait a year for a hip replacement?
   Not all of the people are stupid.  Many know that the talk about inequality resulting from a two tiered system is a face saving governmental excuse for presiding over a declining system that they themselves dance around,all the time.  A couple of disgraced senators declared that worse than losing their unearned stipends was losing their 'special' health care benefits.   As a general practitioner in a University Hospital setting, I can't tell you how many times an administrator or their family members presumed special service was their right.   
   It's time for Canadians to wake up and to demand to know how much of our health care budget goes to the self serving administrative classes and how much to actually serving the sick and disabled.
   In the meantime there is a growing private sector in health care that is truly necessary, otherwise why would citizens be prepared to pay for a service they have already paid for through their taxes.  If they were getting what they were promised it wouldn't be necessary.