Thursday 29 May 2014

There's pain and PAIN!

Pain Relief.
               A colleague of mine, in the health care 'Industry' recently told me this interesting story.  A relative of her's had recently pulled a hangnail and it had become infected.  She went to see her family doc and was appropriately prescribed an antibiotic.  This was  on a Friday and on Saturday morning  it was throbbing and painful.    Her Family doc was not available so she went in to a walk-in clinic to have it checked and to get something for the pain.  She was a little surprised when she got a prescription for SIXTY oxycodone -acetamin tablets, a potent narcotic.
             She show them to  her health professional  relative who recommended that she not fill them and to take Tylenol regular for the pain.  It worked well.
              This sort of  prescribing does nothing to help ameliorate drug abuse.
                Incidentally, the culture which was taken at the initial visit came back positive for yeast and was treated successfully with an old fashioned but effective treatment Gentian Violet, which long preceded the antibiotic era.

Saturday 24 May 2014

Making New Doctors.

 Residency Training.
        An interesting article and one which highlights how different medicine is from all other professions appeared recently in  the Globe and Mail.  Exposure to long hours of call and  sleep deprivation are inherent in a profession that tries to tender care twenty four hours a day, three hundred and sixty five days a year. The enigma of trying to provide continuity of care while ensuring that the care givers themselves have a tolerable life, goes on and is likely to continue to do so. Unfortunately, training for such a profession involves exposure to the twenty-four hour nature of the problem. The article went on to elaborate that a work week of sixty to ninety hours with shifts running as long as twenty-six  hours was not uncommon.  However, a recent article in  the Canadian Medical Association Journal noted that attempts to shorten shifts have unintended consequences focusing on handovers resulting in missing information transfer and less continuity of care. It also results in a less comprehensive training program and a diminution of personal responsibility.
        The very nature of being a physician has fundamentally changed in the last generation, partly as a result of medical care becoming 'the Health Care Industry'.
          A colleague of mine told me the following illustrative story.  In the middle of a complex procedure, his Resident (i.e. the student, already an M.D.) looked at the clock and noting it was five o'clock said, "Oh, it's five, would you mind if I leave now?"
          My colleague, a little put out by this request answered, "I wouldn't  care if you didn't come at all,"
Having been a teacher for a good part of my professional life, I was well aware that part of the quid pro quo, between teacher and student, was that the student assumed a small  part of  the responsibility for the provision of care.  For the most part, the teachers are paid little or nothing and as the Resident advanced within  the hierarchy he/she took on a portion of the load of the mentor.  In my day, such a request to remove oneself from that responsibility would have been perceived in a very negative light.
           "Why did you let him go?" I asked.
           "I didn't have that option, this is what his union has negotiated," was the answer.
            I have been reflecting on the implications of this ever since, because most of the hands-on skills I learned were learned out of hours.   That was the time when the competition for learning procedures was least.  Those were the hours when the folks on the bottom rung of the learning ladder got a chance to actually do  things under appropriate supervision  Tough as it was to have no limitations on hours of call and as inappropriate as it may have been, that was when I learned to do things that very few Family Physicians, or General  Practitioners seem to be able to do now.  That is where I learned to deliver babies, to put on forceps, to repair wounds and cuts  and cope with emergencies.   These are things that rural and remote family physicians still do, and for the most part do well.  In the urban  setting however, most of these skills have been lost.  Minor surgical procedures, joint injections and other procedures well within  the capabilities of the Family Dr are referred on, because that it the  way the Administridiots have planned it and that is why people who  need to see an Orthopedist or  non urgent Surgeon wait for a year for procedures that are within the capabilities of the generalist.     Administrative incompetence is a major factor as well as a poorly planned fee schedule and a subservient College. 


Thursday 22 May 2014

More Science Fiction (almost!)

More Medical Science fiction!!
A 3D printing company called Organovo has been experimenting with printing bits of human tissue including lung, kidney and heart muscle. This is called bioprinting. At the moment, this tissue is useful for research, drug development and testing and ultimately as replacement organs for patients ( a long long way away). I present this, only to make the point that the great creative force in scientific development came, not from academe, but from the creative genius of the great Science Fiction writers who were often ridiculed and from the political fantasists whose wildest nightmare scenarios have been exceeded!

Monday 19 May 2014

What the Doc says V What the Patient Hears.

       1.  A few years ago a Patient came in  to see me for an annual physical examination.   When  I asked him if he smoked, he said yes, and before I could comment, he asked me would it be safe for him to give it up now.
           "Of course," I said, " you know that",
           "Well",  he said, "when I  was in for  my check-up last year, you told me it could be dangerous if I quit now!"
              Of course, I  had never told him any such thing and corrected his misconception.  I have spent a lot of time trying to figure out what I may have said to that man and am still in the dark.   Go figure!

         2.   A colleague of mine told me the following story.  While taking a history from a patient, he was inquiring about her pregnancies and she told him her last baby was delivered by Caesarian Section.
              "Why did you need a C-section?," he asked.
              "Well, I don't think I actually needed it, I think it was because the Doctor needed the money," she said seriously.
               "What makes you think that?"
                "I was in labour and the specialist came around with his assistant and they were discussing my case and I heard him say - I can't afford not to operate!"
                 This is true - not a joke.

           3.  My lifetime best friend and colleague and I enjoyed what some might consider a slightly immature sense of humour.  Ian had a strong Edinburgh accent, which time in Canada had not made the slightest impression upon, in distinction to myself, where whatever Irish accent I had rapidly dissipated.  
                 In the days when physicians still made house-calls, I would sometimes phone Ian, put on a mock Irish brogue and try to fool him with a
                 "D'ye make house calls Dr, I  need someone to come out to the house right now?"
                 "Come off it, Stan.  You can't fool  me. I know it's you".
                  I met Ian for coffee after rounds one  morning.
                  "Boy, did you ever get me into trouble last night." he said.
                  " Why, what happened?"  I asked.
                  "Well, I got a phone call at about 11 O'Clock last night, and the voice said, in a phoney Glasgow  accent, 'd'ye make house-calls Dr, I need someone to take a look at m'wee bairn (child)?'
                  "Come off it Stan, I said, "you're not fooling me"
                .  'I'm no Stan, Dr,' said the voice.
                    I was determined not to be fooled,and it took  that poor patient five minutes to convince me he wasn't you, and another five for me to explain my response." said Ian.

Wednesday 14 May 2014

Adult ADHD

Adult ADHD.

I went to a presentation on adult Attention Deficit Hyperactivity Disorder last week. Now I think this is quite a rare disorder, although the impression one might have come away with is that it is quite common and always requires treatment with stimulant drugs. The diagnostic symptoms are fidgeting (swinging legs, tapping feet) constant motion, inability to relax,distractibility, impulsivity,difficulty in completing tasks they do not find interesting and so on, with activities that many normal people exhibit in varying degrees.
I find it perturbing that the approach to such variation in adults is often treatment with stimulants which can cause psychosis, behavioural problems and a variety of other symptoms, including sudden cardiac death.
I find it even more perturbing that drug dispensation for every human trait seems to
be becoming increasingly acceptable in the interests of achieving total unanimity in human behaviour.
I believe that is called social engineering.

Monday 12 May 2014

The Wisdom of the Scots!

Why do people who drink water out of plastic bottles which leeches toxins into their water ( they then throw away the toxic plastic) think they're 'eco-sensitive?'
Some of the leeched substances contain hormone-like substance that may account for the fact that forty year old males need Viagra and the new 'big pharma 'disease is "low T" (they don't mention testosterone because they are not quite sure what it is.).

Why do people who drive to everything think they're 'eco-sensitive?' Are they fracking mad? I'd be much more impressed if the Al Gorks of this world rode a bicycle instead of a personal jet.
The sheeple just don't seem to get it! When they stop agitating to get all they can from the practices that they condemn, they will be a little more credible!

As Robbie Burns said:
O wad some Power the giftie gie us
To see oursels as ithers see us!
It wad frae mony a blunder free us,
An' foolish notion:

Friday 9 May 2014

Gone to Pot!

I resent "Medicine" being manipulated by anyone, whether it's the government, Big Pharma, or any aspect of what is so appropriately termed 'The Health Care Industry' itself. The latest piece of social engineering is to plan to 'legalize' marijuana as a bone fide medical treatment,knowing full well that once this happens it will be freely available in much the same way as booze or cigarettes. (Indeed, it will not elicit the same witch hunt that cigs do today) Smoking pot, incidentally, may be quite as harmful as tobacco to the lungs, apart from its better known effects. I don't know of any medicinal uses of marijuana that cannot be as well served by medications now on the market. So, if society wants to legalize pot, let them do so without putting honest physicians in an impossible situation. The few unscrupulous ones will find a goldmine, one way or another. 

Of interest, a previous Minister for Health of this province has now entered the marijuana growing business.
At least he is now more appropriately placed than he was previously.  Or does he think he is promoting health?
The social implications of this remains to be seen, but there will be consequences. And remember, the pot today isn't the pot you smoked in College!
By the way, last week I had a letter from a company advising me of the various strengths they have available and asking would I like to register with them!

Monday 5 May 2014

Sci-Fi Medicine!

Sci-Fi Medicine.

When one of my favourite nephews phoned me last night I think I managed to sound as though I had not just emerged from my postprandial nap. After the usual solicitations he inquired as to whether I was near my Skype source.
"Would you mind taking a look at my little guy's eye?" he asked. "We took him to the clinic and got some eye-drops for an infection, but it seems to be looking worse and we wondered whether you would take a look at it."
"Sure," I said, logging on to Skype. (I know my family think I am omniscient regarding all things medical.) I managed to have a good look at the eye thirty seconds later and everything worked out well.
That set me to thinking about the days when this was pure science fiction stuff.
I became interested in practical applications of computer sciences in Medicine early on, when the huge distances in Saskatchewan meant that many people were far removed from medical resources and progressive thinkers were trying to figure out ways to do just what we so easily did last night.
The applications of technology and computerization in medicine can be enormous, as long as we control those applications rather than allowing them to control us. I'm afraid the bureaucrats my have rather different ideas as to how they should be used than the front line health care providers.