Monday, 15 October 2018

Physician dissatisfaction and CMA incompetence.

The results of the biennial 2018 Survey of America’s Physicians, intended to “take the pulse” of doctors in the U.S., were recently released and tallied from responses of 8,774 physicians (along with 2,472 written comments). And the findings leave much to be desired.

Here are some of their findings: 
  • 80% of physicians are working at full capacity or are overextended
  • 62% are pessimistic about the future of medicine
  • 55% describe their morale as somewhat/very negative, while 78% report sometimes/often or always experiencing burnout
  • 23% of their time is spent on non-clinical paperwork (meaning unrelated to patient care)
  • 49% would not recommend medicine as a career to their children

    Depressing as the above may be I have no doubt that physician morale in Canada is much worse and declining rapidly.

  News release from Concerned Ontario Doctors 

The Canadian Medical Association Abruptly Resigned 
from the World Medical Association

Why is Canada Alone?
October 10, 2018, (Toronto, ON) - On October 6, 2018, the Canadian Medical Association (CMA) abruptly left the World Medical Association (WMA) Meeting being held in Iceland and resigned from the WMA. 

In 1946, Canada was one of only ten counties to establish an Organizing Committee of international medical doctors, then founded the World Medical Association in 1947 with 29 countries. The World Medical Association developed the modernized Hippocratic Oath with the Declaration of Geneva in 1948 after the World War II atrocities and has since had the highest standard of International Code of Medical Ethics. Now in 2018, the WMA includes 114 countries and represents more than 10-Million physicians globally. Just days ago, the CMA abruptly resigned Canada from the WMA following absolutely no consultation with Canada’s physicians.

The CMA is claiming that their sudden resignation from the WMA is about an “ethical” stand on “plagiarism”. But there is far more to this than meets the eye and this will impact all Canadians. 
     The CMA had been founded in 1867 (about 100 days after confederation) as a non-profit organization of physicians for physicians. However, the CMA’s resignation comes after nearly two years of physician membership resignations nationally from the voluntary organization as the CMA has increasingly acted against the best interests of Canada’s patients and frontline doctors. More recently, the CMA encouraged the legal loss of physicians’ conscience rights, unilaterally removed physicians from the CMA's mission and vision statements, secretly sold physicians’ MD Management financial firm (founded in 1957 by physicians for physicians and their families) to Scotia Bank for $2.6-Billion with absolutely zero consultation with CMA Council or CMA Membership, and is soon to implement an unethical Code of “Ethics”.

On October 4, 2018, while at the WMA Meeting in Iceland, the CMA and the Dutch Medical Association (KNMG) had planned to put forth a motion for the WMA to be neutral on (i.e. not condemn) all physician assisted suicide and euthanasia of patients (i.e. unrestricted). The CMA and KNMG had withdrawn their motion due to lack of international support.

    The CMA claimed it was withdrawing and walked out  because of because of a speech plagiarism by the newly elected chair of the organization - the speech  had been written  by a professional speech writer, the chair-elect admitted and apologized.  I think the CMA walked out because it was criticized for the disastrous job it has done in protecting the ethics of physicians in exercising their conscience, in refusing to be  party to killing and perhaps refusing to become part of the 'drug  pushing' community.  (When the president of the CMA cautioned regarding the dangers of wide spread marijuana use, she was forced to walk back her very real concerns!)
     The $2.6 billion  sale of MD Management to Scotia Bank without consultation with the membership is appalling and surely requires further investigation.

Monday, 1 October 2018

Knee. Gimme a knee!

   As I sat waiting for my bagel and cream cheese in Williams Coffee Pub,on Saturday morning, I found myself inadvertently drifting into my role as honorary medical consultant to the London (Ontario) Pen Club.  It's a role I quite enjoy, because like Marcus Welby, I have a manageable patient population to look after, (about a dozen) unlike the days when I actually had to make a living practicing medicine.  Although few of the members of our club are actually as mature as myself, most of them are old enough to have an impressive list of maladies that they appreciate discussing with an old-fashioned curmudgeon of an ex-physician.  Since this is once again my vocation, as once it was and not the way I make a living, I am free to express my convictions and views, without deference to the political correctness, that has distorted medical practice beyond recognition, as it does in so many other walks of life. Today's topic was  triggered by the story a friend told me regarding the distress his son was suffering as a result of knee  pain that is increasingly disabling him.  He is an otherwise healthy guy who has been told he will need knee surgery but not yet.  As working becomes a growing problem he wonders if he is going to be suffering for another couple of years before he goes back to the Orthopedic specialist to be put on the list to wait  an additional couple of years before his knee is replaced.   
   It is difficult to comment, because of insufficient information, but the above expectation is realistic if patient does or shortly will need surgery.   If it was me and my job depended on it, I would  seek a second consultation outside of the public system.   I'd probably go to the Cambie Clinic in Vancouver.
   The most recent damage to health care occurred in the Province of British Columbia, which is proposing to enforce prohibitions against private medical care, despite a long running constitutional challenge to the legal claim.  The provincial government is planning to close down all private clinics while the B.C. Supreme Court hearing is still proceeding.  This would close down approximately sixty clinics and close down the service to tens of thousands of patients per year.  The sort of private care that the government is prohibiting is already legally available to some, such as RCMP members, tourists, Workers Compensation cases and Federal prisoners.  The lawyer for the Clinics pointed out that adult patients are often waiting weeks and months beyond the maximal acceptable waiting time.
   "We say it is a punitive action taken by the government for no health care reason but to inflict harm on the private clinics during the course of this trial into the constitutionality on the prohibitions to access to private health care," he added.
  Simply put this is applying punitive measures to the administration of health care for purely political reasons.

   The Cambie Surgery Centre was opened in 1996 by a group of nationally and internationally renowned doctors and independent investors.  Dr.Brian Day, its founder is a British- trained Orthopedic Surgeon, who  wanted to build a facility where top  notch surgeons could perform surgery on their patients in an environment that offered the latest technology in a setting that emphasized exceptional patient care.  The clinic does indeed have an exceptional reputation and attracts patients from around the world.  The Worker's Compensation Board was one of the  first supporters of the Clinic, because patients were treated within weeks instead of the unreasonably lengthy waits of the public system.  This saved time, suffering and money by reducing recovery time and disability.  The CSC is one of the most technologically advanced surgical centres in Canada and has more operating theatre capacity than most hospitals in Canada.
   Unfortunately, much of the  Canadian public fails to realize just how rapidly our heath care system is failing.   Thriving private clinics emphasize the gross mismanagement of health care by the government and its armies of well paid, well pensioned administridiots.  
    No wonder they want to shut it down!

Saturday, 15 September 2018

The Old Quack Reminisces.

   Many of the people I know (or knew) couldn't wait to retire.  I never felt like that and it was with mixed feelings that I managed to convince myself at the age of seventy-eight that it was time to hang up my red cardiology stethoscope that I had grown so fond of.  It was not that I heard any better than I did with the bottom-of -the-line old grey stethoscope, but it looked so much more robust and the strong red colour inspired a level of confidence that an insipid grey or black could never do.   It could have been a traumatic experience, quitting after fifty-five years of practice, being a creature of habit that the strict routine of medical practice demanded.  It wasn't.
   I didn't miss the cloud that many physicians live under a lot of the time, concerned about the welfare of their patient, the adequacy of their management and indeed, the influence of the health care system itself.  I didn't miss the pre-occupation with medicine that frequently results in physicians doing less than justice to their own families.  And though I was never even threatened with a law suit, I didn't miss the growing tendency for the medico-legal lottery to attract frivolous legal suits and to adversely affect the practice of medicine.
   I didn't miss the Political Correctness that thwarts free speech where anyone in medicine, or any other position of responsibility is  threatened by job loss when are true to themselves (for example refusal to accept the risible new pronouns that some pseudo-scientific simpleton puts forward.)   I didn't miss the self satisfied pronouncements of the administridiots, who thought they knew everything and actually knew little about health care and how it should be administered.
   Frequently, friends or acquaintances who knew my previous life-style would ask me if I was bored.  The answer is always no.
   "Well, what do you do all day?  Have you a hobby or something?"
   "I go swimming several times a week and have developed a circle of friends and we lunch together fairly frequently  I meet some very interesting folks from diverse backgrounds and become friends with a few."
   "Do you have a hobby?"  they often ask.
   "Yes," I say, then " I collect fountain pens.  I belong to a Pen club that meets weekly."  I wait for the blank look on the face.
   "What?  What do  you do when you meet every week?"
   "We talk about pens. You know, pens that you write with."
   If the person is old enough, "Oh yeah, I had one of those in school.  I didn't think they make them anymore."
   Then I throw out, "Oh yes, many are collectors items, these days.   Some of them are worth quite a lot of money."
   That usually wakes them up.  "Like what?"
   " Anywhere from a few dollars to thousands."
   I wait for the next inevitable question.  It comes.
   "You know I think we have a couple at home, belonged to my dad, think they could be worth anything ?"
   "What make are they?" I ask.
   "Er, I think one may be a Parker," he pauses for a moment, "or maybe a Sheaffer?"
   "You should look on Ebay."
     Another common topic of conversation may go something like this:
   " I have a son/daughter thinking of going into medicine.  You used to be a  professor, didn't you?"
   "What's your specialty?"
   "Family medicine."
   They try not to show their disappointment and say," Maybe you would have a chat with him/her."   Occasionally, they would add, "you may have a few tips on how to get accepted into medical school: you must know the ropes."  The more subtle ones left that unsaid, trusting me to get the message.
   My answer often  caught  them by surprise.  It would go  like this:
   "Be delighted to talk to him/her.  I enjoyed my lifetime of medical practice, though I must tell you my briefing will be painfully honest and I will spend as much time on the downside as on the upside."
   A surprised look.  "You would do it again,wouldn't you?"
  "Extremely doubtful considering the decline in  the health care system, notwithstanding the miraculous technical advances, some of which I owe my life to."  I say.
   Astonished "What decline are you talking about?"
    Me, getting a bit bored with this whole conversation, "Listen, I have written three hundred and eighty one blogs many of them dealing with this very topic.  Read 'em and I'll be delighted to discuss the topics with you.  In the meanwhile, I'll be delighted to discuss choice of a medical career with your kid!"  I try to say all that with as charming a smile as I can muster!
   Needless to say, I never hear from father or offspring again!

PS. I did recently run into one such father.  When I asked him what his son had decided he told me he was studying Law!


Tuesday, 4 September 2018

Peer contagion and Gender Bending.

Gender Bending and Peer contagion

 Peer contagion (From Wikipedia, the free encyclopedia) refers to the "mutual influence that occurs between an individual and a peer", and "includes behaviors and emotions that potentially undermine one's own development or cause harm to others".[1] Peer contagion refers to the transmission or transfer of deviant behavior from one adolescent to another. It can take many forms, including aggression, bullying, weapon carrying, disordered eating, drug use and depression.[1] It can happen in natural settings where peer dealings occur as well as in intervention and education programs.  Awareness of influence is uncommon and it is often not intentional. Rather,"they engage in relationship behaviors that satisfy immediate needs for an audience or companionship" unintentionally.[1] Many processes of peer contagion have been suggested, including deviancy training.  Recent research has suggested that youth who are treated together for anti-social behavior may experience negative effects through deviancy training which occurs when peers reinforce each other for delinquent or aggressive behavior with the result that the 'group therapy' has the opposite affect to that intended.
  When I was physician to a Corrections Canada maximum security institution, I was sometimes surprised by the rapidity with which something I prescribed for an inmate (not allowed to use that nasty non-PC word any more!) was requested by a group of inmates who attended a subsequent clinic.  I am not particularly referring to drugs of addiction or indeed any drug at all, sometimes it could be for a knee brace or a tennis elbow splint or most frequently a particular type of footwear.  The aggressiveness of the requests was sometimes threatening.  So, when I read Dr. Lisa Littman's  (Brown University) paper entitled "Rapid-onset gender dysphoria in adolescents and young adults: a study of parental reports", and saw peer contagion addressed as a serious perpetuator of the problem, I knew she was on the right track.
   The entire paper is available on line free.  It is well worth reading and makes it clear that sensible well-balanced parents who resist this sort of medical abuse exercised on children are under attack by the aggressive Lunies of the Left as is Dr. Littman.
   In this study 256 parents completed a survey, the details of which are available.  The disorder predominantly affects females (82.8%) and the mean age was 16.4 years. Many of the young adult group (62.5%) had been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria.  The internet and social networks provide a rich forum for transgender identification and encouragement to "come out". Their range of behaviors included expressing distrust of non-transgender people, stopping spending time with non-transgender friends (i.e. normal people), trying to isolate themselves from their families and only trusting information about gender dysphoria from transgender sources.
   The American Psychology Association (APA) Task  Force on the treatment of gender identity disorder notes that adolescents with gender dysphoria  'should be screened carefully for any disorder such as schizophrenia, mania, psychotic depression that may produce gender confusion. 
   Unfortunately, many health care providers including physicians have abandoned their professional vows in favour of political correctness and are encouraging 'social engineers' to undermine the commonsense precepts of normalcy.
   The decline accelerates.

Addendum.  Britain's Royal Academy, one of the ultimate arbiters of artistic merit is to ensure that its next exhibition of nudes has an equal gender split of naked men and women.  How politically incorrect !  What about gays, trans, lesbians etc. etc?
It would make me laugh if I wasn't crying!!

So what do you think,if anything? 

Tuesday, 28 August 2018


Rapid Onset Gender Dysphoria. (ROGD).
    I've dealt with many strange disorders in my fifty-five years of medical practice, both physical and mental.  In most instance the medical and allied health care professions were helpful in bringing some degree of relief and comfort even in those that they could not cure.  Occasionally we made things worse,  through lack of knowledge or understanding but most of those errors were well intentioned blunders and were quickly remedied as soon as they were recognized. 
   But that was before Politically Correct Disorientation Disease (PCDD) became endemic in our society and the PCU (Political Crimes Unit) established Common Sense as one of the most dangerous and heinous crimes.
   The latest addition to the new encyclopedia of potentially fatal non-diseases is:
 Rapid Onset Gender Dysphoria.  This disease was invented by a seriously disturbed group of so-called health care workers, including, I am ashamed to say physicians, who interpreted children's play at being the opposite sex (Am  I even allowed to say that?) as a serious disease to be taken seriously.  This normal phase in maturation was recognized by most normal parents for what it was and cured by nature by coursing testosterone through boys and estrogen through girls until they were ready to reproduce.
   There is no doubt that in some families,the roost is ruled by the children and the guidance that normal parents give their children is subjugated to the will of the child.    When a group of adults such as school teachers, social workers, including some health care workers undermine parents instead of supporting them, we truly have a recipe for disaster, both for the children and for society.  I will leave it up to you to arrive at your own conclusions as to the political motivations that underlie this.  
  Lisa Littman, a researcher at  Brown University recently published study entitled "Rapid-onset Gender Dysphoria in adolescents and young adults: A study of parental reports".  The report explores "the psycho-social context of youth who have recently identified as trans-gender with a focus on vulnerabilities, co-morbidities, peer group interactions and social media use."
   This study is of particular interest because it deals with adolescents and young adults, whereas most of the trans-gender literature deals with children.   ROGD is identified by some as a new disorder because it starts after puberty with no previous indication of confusion or unhappiness.  The study indicates a high incidence of internet and peer-group influence and it affects mostly teen-age girls within a group, who 'come-out' together.  A high percentage of these girls report heightened popularity, while parents report worse relationships and worse mental health.  There are groups that deliberately plot to undermine parental authority and to vilify those who try to protect their children from what many informed parents and physicians consider to be a particularly dangerous and malignant form of child abuse.  The extreme damage perpetrated by such groups seems to be advocated predominantly by Left Wing Loonies, whose objective seems to be to destroy the role of the nuclear family in preventing society from destroying itself.  This is in order to denigrate all social values that would impair their objective of 'instant gratification' as the goal of human existence.   
   I haven't yet completed my study of Ms Littman's erudite article, but you can be sure that when I do, you will hear from me. 
   I can remember 'dressing up' as a girl when I was a kid.  It was great fun!  I can't remember a single person recommending surgery or even hormone injections.    



Monday, 20 August 2018

Re-writing the Language2.....

Image result for pictures of disabled parking passes

Image result for disabled parking pass picture

 Cripple: A person who is unable to walk or move properly through disability or because of injury to their back or legs. (Oxford English Dictionary).

The disabled persons parking pass has always been known in our rigorously politically incorrect home as a 'cripple pass'.  It took me years to convince my wife that her Intermittent Claudication, that sometimes limited her from walking briskly without experiencing pain or discomfort merited one.It was excessively hazardous when walking across a vast skating rink-like parking lot, which is what many of our parking lots are in winter.  I was particularly aggravated when, during my ' people watching'  I found that many emerging from the parked vehicle displaying the so-called Accessible Parking Permit pass, were a good deal more spry than my eighty - something year old corpus allows me to be.  Because we come a good deal closer to fitting the above definition than many of the persons I have observed abusing the demarcated spots, we have taken some pride in using this pass only for my wife who qualifies.  I do not regard myself as sufficiently crippled to merit such a privilege.
   To my horror, many Canadians have no such reluctance.  Horrified, I watch teen-agers screech into a designated accessible parking spot, sporting Grandma's 'cripple pass', laughing their way into Loblaws and knowing full well that as long as they display that pass, no-one is going to bother to check it.  I'm eighty three, a quintuple bypass patient, fibrillating and with degenerative disc disease of the lumbar spine and osteoarthritis of the right hip.  I don't have a 'cripple pass', because despite my disorders and the difficulties I  have to cope with, I can manage.  Unlike many of the folks I observe in the parking lots, abusing a 'cripple pass', I don't intend to apply for one until I fit into the Oxford English Dictionary definition that heads this article.  I will continue to ask my wife, during  the harsh arctic conditions that prevail in Canada's winter,
   "Hey honey, got the cripple pass?'  knowing full well that when we get there, most of the spots will be taken by folks who are far from cripples!!
   The decline continues.

Thursday, 16 August 2018

Re-writing the language.

   Here's a piece of 'educational research' that I  continue to get because  I  used to be a physician.    It is so tainted with 'political correctness' as to being  not only an opinion as to how a physician relates to  patients, but to suggest a whole new dictionary as to how physicians should record their interpretation of their interview with their patients.  George Orwell could hardly have dreamed up this piece.  
   Medical history taking is a highly skilled art, an art most physicians downplay today, because it is time-consuming and not rewarding.  Both the scientific community and the  masses grossly underestimate it, because in the long term, we all die.  History taking is not glamorous and much  of the time is routine grunt data collection, which is why in  our present health care system is almost exclusively done by medical students  and residents and even they realize that it is considered the 'scut work' and barely valued at all.  Although it is the bottom of the totem  pole, it holds the structure aloft.  I know the high tech stuff is much more exciting and achieves incredible results (sometimes!) but when the bottom of the pyramid is unstable, the whole damn thing is likely to topple.
   Remember, before Christ, the Romans were building bridges  that lasted a thousand years.  ( The Ponte Vecchio built in 1345 is still functioning today).


Stigmatizing language in chart notes creates negative impressions
Clinical question
Does negative language affect residents' and medical students' attitudes toward specific patients and influence their treatment decisions?
Bottom line
Think of how antagonistic common medical jargon is. Patients "complain." They "admit" or "deny." They "refuse" or are "noncompliant." The words we use can transmit, via a hidden curriculum, implicit bias to medical personnel in training. This study compared stigmatizing language with neutral language used to describe a patient with sickle cell disease that cast doubt on the patient's pain ("still a 10" vs "still a 10/10"), portrayed the patient negatively ("hung out at McDonald's" vs "spent the afternoon with friends"), or implied patient responsibility with references to uncooperativeness ("he refuses his oxygen mask" vs "he is not tolerating the oxygen mask"), Medical students and residents had more negative attitudes toward the hypothetical patient when described with stigmatizing language and suggested less aggressive management of the patient's pain. It's time to revise the medical scripts that convey negativity and bias about the patients in our care. (LOE = 1b)
Study design
Randomized controlled trial (double-blinded)
In this study, medical students (n = 233) and emergency or general internal medicine residents (n= 180) were randomly assigned, concealed allocation unknown, to read 1 of 2 chart notes with medically identical information about a hypothetical patient with sickle cell disease: one using neutral language (eg, "He has about 8 to 10 pain crises per year, for which he typically requires opioid pain medication in the ED") or stigmatizing language (eg, "He is narcotic dependent and in our ED frequently"). After reading the note, both the residents and medical students completed the Positive Attitudes toward Sickle Cell Patients Scale (range 7 - 35) and the residents selected a treatment for the patient from 4 options. Attitudes were significantly lower, on average, for participants presented stigmatizing language (25.1 vs 20.3; P < .001). Attitudes were progressively lower with years of training (correlation coefficient -.95). Residents were more likely to select less aggressive treatment (eg, a low-dose opioid or a nonsteroidal anti-inflammatory drug instead of higher dose opioid, along with less likelihood of redosing) if exposed to stigmatizing language (P <.001). Participants reading the stigmatizing note also were more likely to identify the physician who wrote the note as having a more negative attitude toward the patient.
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