Monday, 26 September 2016

Health Care Hypocrites.

   The folks really put up with too much bullshit from the so-called 'elites'.    Unfortunately, the 'elites' have managed to convince the folks, through some magic I don't understand, that they are looking out for them, when really they are looking out for themselves.  Take the 'two-tiered system' that they are always telling the electorate will result in their getting a lesser quality of care.  They know perfectly well that they are lying and that the politicians and the administridiots have been enjoying a two tiered system for a longer time than I remember, and I'm over eighty.  They hang onto this benefit come hell or high water and all  their civil service satraps enjoy a greater or a less degree of the benefits as supplementary (i.e. tier #2) health care.  Why, those benefits are so valuable that a disgraced senator who had been abusing her expense account whined most piteously at the loss of her special health care benefits that would have put her in the same category as the poor one tiered slobs.  So our government and their employees will defend the so-called one tiered system, to the last drop of your blood as long as their privileges are maintained.   And just in case you think this is hurting the rich, it ain't. They can go private by slipping across the border or to a list of countries where the health care is as good or better than Canada's failing system.  
   In the lower levels of the civil service, in teaching establishments and Universities, those tier-2 privileges are already being whittled away.  A friend of mine was voicing her dissatisfaction recently regarding the fact as soon as she became a 'geriatric' (reached 65) her extended benefits cut back in favour of the public drug plan,  Until reaching that age her drug plan paid all her prescription fees and the mandatory first $100 that she now has to pay herself.  So, in fact, the government penalized her for reaching the grand old age of 65.    She, being a woman of action, tried to call her member of parliament, but they didn't want to know.  She was told: "That's the way it is."  End of conversation.
   So, if the government is totally committed to the Canada Health Act, let them lead by example and do away with all the special benefits associated with being 'the Peoples Servants' and let them have the benefits the Canada Health Act makes available to each and every citizen and nothing more.  
   Don't hold your breath! 

Thursday, 22 September 2016

Ethicists for the Third Reich

Ethicists for the Third Reich.
Professors of medical ethics at Queens University in Canada and Oxford University in England say doctors' beliefs have no place in the health care system!  The names of these morons and you should not forget them are Udo Schuklenk, chair in bio-ethics in Queens University in Canada, and Julian Savulescu at Oxford, in England. Their opinion lends credence to George Orwell’s quote that there are some ideas so absurd that only an intellectual could believe them. These pinheads go on to say that ‘authorities’ should bar doctors from refusing services like abortion and assisted death on moral grounds and screen out potential medical students who might impose their (or perhaps any) values on the practice of medicine and the care of patients. Conscientious objection, they state is clearly unprofessional.  They go on to state, "Doctors must put patients' interests ahead of their own integrity".  These are dangerous academics, who have no understanding of health care, medical professionalism, integrity or morality.  They would shut down the argument, as most of the left wing academics would if they could, by either not allowing admission to medical school or failing those whose opinions differ from theirs.  They propose exactly what was required of physicians in the Third Reich.  They are a menace to the future of medicine.  They may be bio-ethicists, they certainly are not medical ethicists.

Monday, 12 September 2016

Docs for Dope!

Is this what physicians are doing now?
   A proud tradition of medical practice is being sacrificed to a group who feel that their every whim should be satisfied and that their opinion of drug availability and use, is equal  to  the opinion of the experts in  the field.  Incredibly, they do find physicians who agree with them.  The politicians and the administridiots are only too  pleased to grant their wishes because adequately drugged citizens ask fewer questions and are more easily manipulated than those with a clear mind. I understand what the pot seekers want and how they feel, but it is difficult to understand how a group of physicians pander to these people and profit from their addictions.  A generation ago, most physicians were sufficiently principled  to take a stance in dealing with such  drugs of addiction and were not easily led astray by easy money.  Pushing drugs was viewed very seriously and the consequences were very serious.  Many a physician lost his license or went to jail for the offense.   Could these modern purveyors of pot really believe that they are doing good?  I doubt it.  In another era they would have lost their license or worse.
   Unfortunately, those screening applicants for medical school  are probably as misinformed as many of those they recommend for acceptance.  High marks alone are not enough.  Honesty, integrity and good judgement in the practice of medicine are at least as important.  Sadly, it is  patients who will pay the price.

Thursday, 8 September 2016

Immortality, who needs it?

   Living longer - and longer, seems to be the objective of an increasing segment of  humanity.  Everyone wants to be rich and everyone wants to be happy, but quality apart, longevity seems to be a major objective almost regardless of the quality of life.  In response, you may quote the growing number of 'euthanasia enthusiasts' and certainly such a group exists, but they are far from being the majority and most folks want to live to a ripe old age and some would like to live forever. Despite the assertions of groups of fringe loonies, as medicine progresses, longevity certainly increases,   People live longer healthier lives and life expectancy has increased beyond our wildest expectations.  A lifespan of 104 or so seems to be tossed around  and regarded as a normal achievable goal by both physicians and patients.  All that sounds sweet, but.............
   We seem to be having increasing problems with people living as long as they do now, often into their eighties.  The health care system is  having great difficulties with  providing for  many of our  elderly people now.  Lengthy waiting lists  for patients requiring urgent care is the norm, and anything less than urgent is treated with a level of  indifference (unless just before an election!) that is downright callous.  Yet, our politicians are quite indifferent as long as the whole situation can be kept low key, until  before the election.  Then, an unlikely and never to be put into effect solution is paraded out in the hope of garnering votes.  Even at our present population levels, many old folks, and I am talking about people in their seventies and eighties, go without adequate attention and care.  Those who do  not have family members to care about them and act as advocates, suffer most.  Many live in conditions that we would not tolerate for jail inmates.  Indeed, having provided both geriatric care and correctional institutional care, I think I can say with all honesty that the latter get better care and attention.  
   Even those with families often become a burden in a two earner family, and that results in them having to live in an assisted living environment situation.  Despite our avowed dislike of 'two-tiered' systems they avail of the level of care depending on  what they and their families can afford or are prepared to  spend., because this can  be a multi- tiered system, the lowest of which is dreadful.
   Prolongation of life, which  to a variable degree in available today, can be greatly enhanced, but it will be expensive.  Very expensive.  The quality of the expanded life, is and will be variable.  Very variable.  As the population gets older - and older, who is going to pay for the incredible increase in expense that will  keep these people alive.  Living expenses, medical expenses, special care expenses.  We can barely keep our present second-rate health care system running.   The pyramid has become inverted and the younger population resents and will  increasingly resent supporting more and more elderly people.  Because, although we can prolong life and will become increasingly skilled in doing that, we still won't be able to turn old  people into young people and old brains into young brains.  Body parts wear out and though we may be able to repair them or replace them. they will be old replaced or repaired organs.   Pension plans and benefits are bankrupting countries already, think about who is going to provide for a bunch of centenarians! 
   Maybe I'll have to review my views on euthanasia!

Please don't make any comments unless you wish to live into your eighties!

Monday, 5 September 2016

The Great Canadian Medical Dictatorship.

   Dr. Brian Day, a Vancouver orthopedic surgeon, runs a clinic that combines a private practice with his medicare practice.  Dr. Day has the temerity to challenge the Canada Health Act and is fighting for Canadians right to health care free of lengthy waits for consultations or care, by paying for it out of their own pockets.  In a country that prides itself on its democratic principles, that would seem to be a perfectly reasonable position to take but many Canadians seem to think that other people's right to buy health care with their own money, somehow depreciates what they have come to regard as the entitlement of 'free' health care.  Instead of considering the injection of private funds into the health care system a benefit, they are irrationally afraid that the second class health care they are getting now, will become third class.  They are afraid that some folks would be able to buy better health care than they can get 'free'. (There is no free health care!)  The wealthy already have a two tiered system in that they go to the United States or other places and inject their funds into their systems instead of our own.
   A significant part of our health care budget does not go to health care at all.  It goes toward supporting an  ever growing hierarchy of politicians and administridiots who look after themselves obscenely extravagantly and who are more interested in appearances than in  the quality of health care.  It funds programs that are politically popular even when they have little (or  sometimes nothing) to do with health care.  In face, the administration of health care in this country is a disgrace.
   Dr. Day is fighting for a principle, even though a concurrent private system would benefit him financially, the litigation costs will be so outrageous that he could lose everything.  (The cost of legal proceedings is so expensive that it is the most explicit example of the fact that equality for all  is a myth perpetuated by the ruling classes to try to 'fool all of the people all of the time', a goal in which have largely succeeded.)  Dr. Day is simply saying that Canadians should have the right to buy health care as they have the right to buy anything else and that the additional money they would inject into the health care system would free up resources for others.  Those who would pay for the services are not looking to get more than their share.  To the contrary, they are offering to contribute additional funds to support the health care system in addition to the taxes they already pay.  In fact, as mentioned above, wealthy and not so wealthy patients already have a two tiered system.  They can and do leave Canada for their care and contribute to other countries.  In 2014,  52,513 Canadians traveled abroad to get health care and the number is rising and will continue to rise until we take the control of the health care system out of the  hands of self-serving politicians and administridiots and place it back into the hands of those who provide it and understand it.
  Our health care in Ontario is declining rapidly.
   Is no one interested??  Apart from the sick, that's the way it looks and if the folks don't smarten up, they are going to get some very nasty surprises.  Soon.  Good luck, Dr.Day.

 “If you think health care is expensive now, wait until you see what it costs when it's free.”
P.J. O'Rourke


Friday, 2 September 2016

Reflections of a dumb GP.

The type of artistry that Professor Cecil Erskine's painted of Versalius' diagram's that adorned the panels surrounding the theare

Medical School.  Day 1.
   Nineteen years old and here I was.  Medical School.  Day one! 
   The University environment was not strange to me, I’d spent two years doing ‘pre-med’.  The medical school at Trinity College, Dublin, which was founded in  1711, was the venue in which we studied the basic sciences of chemistry, physics, botany and zoology.  We were privileged, even at this stage to have been instructed by some of the leading scientists in each of those disciplines.   
   Ernest Walton, nobel laureate, deigned to educate us first year medical students.
   Bronte Gatenby.  James, (Golgi body discoverer) was an eminent zoologist, of the famous literary family, the Brontes.
   Gatenby Peter. Ireland’s first full time professor of Internal Medicine.  (In those days a Professor meant something, unlike N.America, where it  means teacher.)   I could go on.
   Men, with international reputations, bothered to teach, pre-medical students, the lowest form of academic life.  I suspect that they recognized that the most important thing they could do was teach and inspire a bunch of  kids what science was and often what honorable human behavior was in relation to science and medicine.  Don’t get me wrong, there were almost as many fakes, frauds and con men around then as now, but it was much harder to get away with  it.  When they were caught, there were dire consequences.
   But I diverge, Trinity College, Dublin, in the sixties was still one of the notable European seats of knowledge, comparable to Oxford and to Cambridge, and was educating  many of the future world leaders and scientists, as it had done for several centuries.
   So, here I was, a nice Irish-Jewish boy, son of an upholsterer eking out a living, starting his medical  studies at Trinity College, Dublin.
   Anyway, lets get back to the story.
   The anatomy lecture theatre at Trinity College Dublin, was an impressive sight for a young man (see above picture).  The terraced layers of seats were numbered, so that should a student be absent, it was immediately apparent.  The walls of the huge lecture theatre, were adorned with large hand painted reproductions of the great sixteenth century Anatomist, Andreas Versalius, still recognized as the father of modern anatomy.  His book, De humini corporus fabrica, was fully illustrated with drawings of his own dissections of the human body and his erudition and artistic genius are unequaled.  The paintings around the lecture theatre, were painted by our anatomy professor, a gifted artist, who would draw such beautiful illustrations on a blackboard, with multi-coloured chalks, that we hated to see them erased at the end of the lecture.  If only we all had smart-phones with quality cameras to capture those educational and artistic diagrams for posterity!
   So there I sat, placed under S, as our seats were allocated based on  our initials.  To my left, Spencer, to my right Stavely O’Carroll.
    Brian Spencer, to my left, was an unexceptional pleasant young Englishman with not quite the right accent for the Trinity Anglo-Irish, who, in those days were proud of their Protestant British upper class origins even though most of them were born in Ireland.   His main claim to fame was that somewhere in the North of England, from whence he came, he had an old Bentley car, that he liked to refer to whenever the opportunity arose.  For to someone like myself, whose main ambition was to get a small engine that drove two hundred mile per gallon, screwed onto his pedal bike, owning any sort of car was near miraculous.,
   On the other hand, to my right, sat the very exceptional Maud Stavely O’Carroll, who was to become one of my closest friends.  She turned out to be one of the most remarkable women I ever met.  She was one of perhaps a dozen women in our class of about eighty, she looked terribly old (to me) and she was about six months pregnant! She was the proto- type of the liberated woman, before that term had even been devised, had three young children and  one on the way and a who husband who was a doctor in the Canadian Air Force.   Their agreement was that once he graduated and started earning she would commence medical school.  They were both Irish Catholic, who attended. Trinity College, a staunchly British foundation.  In those days the Catholic church frowned on Catholics going to Trinity, and  I remember Maud telling me of a visit by her parrish priest, who told her she was a poor Catholic for going to Trinity, instead of University College, Dublin, the Catholic University.  Maud was not a woman to be intimidated by anyone and continued on in her own determined way.

Saturday, 27 August 2016

Negev ramblings. Pt 4.


Physicians and Patients,
Life changing stories of Primary care.
University of Wisconsin Press.
Is the name of the book, and to my surprise is still available.  (a niece who saw a copy in my house wrote to the Press and was able to get a copy!)
Jeff Borkan, a member of the Department of Family Medicine, was an editor of this book in the making and asked me would I recount one or two stories for the book.  It so happened, that during the first part of my sabbatical at Duke University I had taken a writing class, so I was quite enthusiastic to test out my newly enhanced writing skills.  I wrote two patient stories that in due course I sent off to Jeff entitled - The Alternative Patient, and The Next Generation, both of which were published in the book.

Thur 16th Feb.1996
       I took the day off and Irene and I drove to Tel Aviv, only about an hour away to drive from B.Sheva.  Unbelievable how small this country is in the huge Middle East, and how the Arabs resent its creativity, prosperity and industry and would, for the most part like nothing better than to wipe it off the face of the earth. Walked around down town looking at the buildings, the people and the shops.  Some turkey backed into my car downtown, trying to turn in a street about 3 feet wide with cars parked on each side. Since there was no damage done to either car we parted amicably after a polite exchange.  We drove down to the seashore along the coast road and then parked and walked up to Ben Yahuda St. where we found some very nice restaurants and settled on one called Bebeles, and enjoyed a very good 'typical Askenazi Jewish' meal including chopped liver, fried kreplach, cabbage rolls, tzimas and salad. We were getting a little tired of hummus, tahini and falafel etc.

February 16, 1996
       Today we went to Ashkelon, this is where Delila cut off poor Samson's hair and drained his strength, where Herod was born, and where there was much evidence of places where crusaders and Romans had dwelt. Ashkelon has beautiful beaches, and a National Antiquities park, in which are some fascinating archeological finds including some remarkable sculptures. By this time it was getting dark, so I hoped my photos by flashlight would do them justice.  We will certainly have to go back by daylight and take another look at this area.  Earlier we walked along the beach coming to a little cluster of restaurants and shops, including a scuba rental store.  Went in and got some information re rentals etc. in case David comes.  Apparently they have weekend diving locally, as well as excursions elsewhere.  Drive to Beer Sheva took under an hour.   

Feb 17th
       Went to visit Nimrod Shosun and family at his Moshav (village) in the western Negev. The Moshav is called Dekal. Nimrod is a Family Physician who is a part-timer in the Dept of F.M.,and invited us to visit him as soon as I arrived in the Dept.  He lives in a moshav in the W Negev, about 50 km SW of Beer Sheva.  His wife is a nurse who works with him in the Kupat Cholim Clinic. He also looks after a couple of kibbutzim in the area.  In addition to their medical duties, both of them operate a mango and lemon farm.  The fields are behind their home, and the sandy soil in which they grow, requires irrigation and fertilization. Soon after we arrived Nimrod took us on a tour of the orchards and showed us with pride the lemon trees which bear fruit in all seasons, and the mango trees which give fruit in the fall.
       After a pleasant and prolonged lunch,Nimrod took us on a tour of the surrounding district, showing us a monument to the dead of the six day war.  Here, in the centre of the monument is a very tall observation tower.  A staircase winds upwards in tight recurrent spirals to an observation deck from which can be seen the meeting of three borders, Israel, Egypt and the Gaza Strip.   From here we headed out along the road to Gaza.  We soon arrived at the check-point and stood taking  photos of the crossing until the soldiers on guard came up to us and told us politely that we weren't allowed to take photos at this point and that there was a notice saying this.  For a while I wondered whether they were going to take the film away, but they didn't,  finishing up with 'have a nice day',in English.   Went back to the Shosun's and chatted for a while before taking off for home.
       An enjoyable and interesting day.

Sunday Feb 18th
       Work for a change.  Worked on the low back pain project.

Monday Feb 19th
       Left for Kibbutz Katura to visit Jeff  Borkan and wife  Suzanne. Drove by the Mizpa Ramon route, past the great Ramon Crater.  the crater is 40km long and 2-10km wide. The story of its formation is fascinating. Truly astounding scenery most of the way.  On the way down we passed Sde Boker, David Ben Gurion's Kibbutz in the Negev, to which Ben Gurion would retire for renewal for time to time, and to which he ultimately retired.  What a visionary he must have been!  At a time when Jerusalem and Tel Aviv were regarded by most as the most vital areas of the country, Ben Gurion already realized the vital importance of this part of the country and stated that Israel's future lay in the Negev. The scenery was spectacular and diverse.  The mountains of Jordan to our left as we drove south presented an ever changing kaleidoscope of colours, oranges, rust-browns, copper-greens, grays, pinks and reds.  To the right were the smaller ranges of the Judean Hills.  We stopped to admire the scenery, take some photographs, and have some lunch.  After lunch we continued on through the forest of spontaneous growing foccacia trees to Kibutz Ketura, opposite a date-palm oasis.  We drove in through the kibbutz gates, and I used one of my few Ivrit phrases, "speak English?"  Everyone did. So I asked, "where's Jeff's?"  We were pointed in the right direction anad made our way to Jeff"s .  The kibbutz surroundings were attractive and Jeff and Susanne, the couple we were visiting live in a small bungalow, together with their three children.  The living quarters are very small, and we were accommodated in a separate apt., which was probably one of the original kibbutz homes.  We had supper in the dining-room, a sparse meal, mainly of salads, cream cheese and herring, adequate but not appetizing, and short on the protein. We took a walk around the kibbutz, where one family had a pet camel tied up outside their house, which the children came out to feed.  The camel makes a strange roaring sound like a lion, and contrary to usual camel behaviour seemed very good-natured.

Tue 20
       We woke up at the crack of dawn to the sounds of the birds - and the trucks.  we grabbed a quick bite of breakfast, suspiciously reminiscent of the previous nights dinner, and headed out to a nearby kibbutz, where Jeff carries on a clinic. Irene went for a walk while Jeff and I saw patients at the clinic. The chair of the department had asked me to make observations and recommendations regarding the many rural clinics I visited and comment aout how they compared with Canadian rural practices. There was a considerable cross-section of clinical disorders, ranging from the minor to the major.  It was of interest to me that the Kibbutz employs a number Thai workers, mainly as fruit-pickers.  Jeff thought the official figures were 30,000 Thai workers.  Probably there were more, he thought. We saw a couple of them at the clinic.  It was very difficult as they spoke  only Thai.  The technique was to phone an interpreter, and once on the line the patient would relate the problems to the interpreter, who would then relay it to the doctor.  Then the phone would be passed back and forth, and the story relayed.  Time consuming and sometimes the translators skills aren't the  best, but it's the best that is available.
       After the clinic was over we drove to Eilat.  Following along the awesome Jordanian Mountains, the border a mere few hundred metres to our left, we arrived at the Red Sea and Eilat in a short while. We spent a while on the beach, then walked along the promenade, looking into various shops, then around back to our car.  We drove back up the Eilat Road back to Beer Sheva by the Dead Sea route.  Took us about two and a half hours to get home.

Wed 21 Feb.
       Went to work this am and picked up a bunch of mail that was dispatched express from home. It took 11 days to get here. In the mail was a sad note informing me of the death of my old school friend, Bernard Green.  The note was from his wife, with no return address.  I must try to get her address so I can send a note. Bernie and I were the closest of friends during our formative years, and were in and out of many scrapes.