Tuesday 27 October 2015

Who's Playing God?


  Headline in the 'National Post':


               MDs playing God on euthanasia, ethicists say

    You got it wrong NP!  The article by Ms Kirkey says that, according to ethicists, the 'regulators' are playing god and assumes that the regulators will be MDs.  Ms Kirkey, the writer of the article has it wrong.  Most doctors have no desire to play God and many of them are resisting attempts made as a result of the ruling by the Supreme Court to coerce them into doing that.   Indeed, if a profession is to be found guilty of playing God in this instance, it is the legal profession.  It is the Supreme Court and society  in general want to play God, not physicians.   The whole euthanasia position is a societal one and I believe that those who want to avail of that new option have a right to do so as determined by the law.  That does not obligate physicians to be the purveyors of death and I  would  strongly recommend that those who find this contravenes their principles have nothing to do with it.  If there are not enough physicians  to fulfill the public need, it would be easy enough to train a corps of 'terminators'.  
     I continue to feel and believe that euthanasia goes against the very core of  medicine and if we allow it to becomes a part of mainstream  medicine, it will forever change the nature of medicine and the physician patient relationship.  
    Get your facts right, Ms Kirkey.

Sunday 25 October 2015

New York Times Bestsellers.

Class Act.

          I can remember when books dealing with these topics didn't need crass 'shock jocks' to try to hook a customer..  They hooked their audience by skill and  eloquence and ability to express their ideas, rather than by crude exhibitionism.  Then the folks are surprised that their kids can't express themselves without f**king swearing!!
           The decline continues.  Feel free to comment if you have any views on this.


Friday 23 October 2015


A. Quickie for Ontarians.

The Gov of Ontario has just committed the taxpayer to providing the teachers union with $2.5 million for their negotiating expenses. (You know how well they are doing their jobs these days.)  This is unrelated to any gains they may make (and believe me they will make gains.)
Compare This with how they are treating their physicians and their refusal to negotiate.
Are you surprised that health care is deteriorating?
You ain't seen nuttin yet!

Comment, if you have anything to say.

Wednesday 21 October 2015

The declining Health Care System.

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity.17 "
Commonwealth Fund, Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares
Internationally, 2014 Update

 What an indictment!.
                  And now look at what the Administridiots are embarking on to 'fix'  things.    The Baker Price Report.   Let's deal with that later.   First, I want to deal with the appalling dictatorial arrogance of  the Ontario Government.
            If the citizens of Ontario think they have it bad now, just wait.  Further, if the  physicians of Ontario think they have it bad now, just wait.  Unless, of course, they drop their feckless stance and stand up for their profession.  I used to think the government objective was to convert physicians into civil servants.  Right now, their status is way below that of civil servants.  Physicians have none of the benefits of civil servants and no recourse to the corrective action that they enjoy.  In fact, if the administration tried to pull the unilateral reduction of pay stunt, without binding arbitration on civil servants the government would be shut down.  
           There is only one way to deal with such a bureaucracy.    If they won't negotiate with us, we can't negotiate with them.  There is no such thing as unilateral negotiation.  However, being the humanists that most physicians are, they know we will never deny patients needed care and rely on that factor to do  what they like.   Despite the lack of  support from the Royal College, which seems to have become a Ministry of Health satrap, there are steps that physicians can take that will not hurt patient care.  Of course any such  steps will require considerable fortitude, which I figure has become increasingly rare in recent years.  Unfortunately, the alternate is to tug your forelock, bow your head, do as you are ordered and stop complaining.  I will describe some of the measures that physicians could take in a separate blog.
           Now the Ministry of Health is introducing "A new model of  population based primary health care."   The objectives are four fold.
1. To ensure that all citizens have a regular primary care provider.  (We used to call them general practitioners.)
2. To make sure patients who need related care can obtain it.
3. To improve integration between GPs and other parts of the system.
4. To provide adequate care after-hours and on week-ends.
            All things that physicians have been doing with greater or lesser degrees of success as long as I've been in  medicine (and that's long!)   It's the same old cheese and in a subsequent blog I will explain to you how they are planning to do it.

Thursday 15 October 2015

The Secret of Immortality!

     My kids have taught my wife and me, both recent octogenarians that it's never too late to have a helluva bash!  We were both a little reluctant and despite being in good shape were opting for a quiet family dinner in a good local restaurant for our joint 80th birthdays.  After all, getting old is easy.  All you have to do  is stick around for long enough.  
      In any event, it  is no use trying to resist the bullying of ones children, so  we reluctantly agreed to let the kids have their fun and go  along with  their desires as we have done for most of their lives.   My wife and I  have known each  other for most of our lives and started 'courting' (as we used to say in the old days regarding serious relationships) at about the age of eighteen..  Despite our lousy genes on both  sides of  the family, we have remained alive, remarkably active and  (I think) compos mentis.  
       Outside the 'Home Smith Jazz Bar' (yes, that really was the  name of the bar in The Old Mill!) where we all initially got together, was a sign that read:
                                  " Irene and Stan's 80th birthday,"
                  A young woman walking by said, "Hey! They must be twins!"   

      Aubie Blake, the great Jazz musician said on  reaching the age of 90, " If I knew I was going to live this long, I'd  have looked after myself  better."    We have done pretty well, my wife is starting to  look young enough to be be my daughter, and I don't look too bad myself.  Reflecting on Aubie's comments re looking after one's self better, one wonders whether that would have resulted in a significantly different outcome, or whether, short of frankly abusive habits it would make much difference at all.    Sometimes we don't know what habits are abusive until many years later.  (My parents gave me a silver cigarette case for my twenty-first birthday.  I could probably sell it as a marijuana case now.)  Dietary recommendations change frequently and drug  use is increasingly accepted despite the accepted risks.  The older I get the more I believe my parents advice of 'all things in moderation' is as close to a solution as we are likely to get.      Not that it will confer immunity against anything, but when one looks at the conflicting results of evidence based medicine research, until hard irrefutable evidence emerges it seems to be as good or better advice for good health and longevity as the recommendation of the month.
       So, at the advanced age of eighty and without any scientific basis whatsoever, here is my subjective advice  for immortality - and you can't prove it wrong - just yet!
        Passion.  Live with a passion.  Far from living each day as though it's your last,  live each day as though you are immortal. If you are going to be here forever, things matter!
        Persistence.   Churchill has said everything, but when he said, 'never, never, never give up'  he was giving advice that few today remember, care about or follow.    Very important advice if one intends to live forever.
         Partners.  Persisting in perpetuity requires the right partners.  The right spouse is absolutely necessary to keep one mentally and physically intact.  Day to day survival requires constant mental agility, liberal doses of humour and  the ability to laugh at oneself and each other, as well as physical agility in getting out of the way in a hurry, on occasion.   Remember, your children are not partners, they are your children, even though you have to be a little more subtle in disciplining them when  they are over fifty. 
         Perpetual motion.  You have to keep  moving, preferable with some sense of purpose.  Inactivity, even for short periods can be dangerous or possibly lethal.
          Personal contacts.  Love and frequent contact with loved one's is an essential ingredient.  While social networking is better than nothing, it is no substitute for direct contact.  Eye contact, a hug and a kiss cannot be transmitted over the internet.  Unfortunately, fewer and fewer people  realize this.  Nothing is more rewarding than time spent with the 'kids', relatives and friends.
          Pens.  Collecting fountain pens and other writing implements maintain awareness of the great heights that humans achieved when they could connect the brain with the fingers and have ideas flow freely onto paper, where they were captured in a pleasing and artistic form.   This helped to develop the brain - fingers interface rather than the dumbing down  effect of the keyboard,which leads to neuronal atrophy.
           Phamily. and phriends.  Nothing is more important   Without them one wouldn't need immortality!   From our kids to our brothers and sisters (we don't recognize "in-laws" in our family, we are all truly brothers and sisters, but that's a whole story in itself ), nephews and nieces, grandnieces and grand nephews they are all a fantastic crew.
           I have also found (and this is personal and may not apply to everyone, in much the same way as any  other medication may not be suitable for all), that fairly liberal but not excessive, doses of a fine Scotch (not generic) on a regular basis, works wonders and may indeed actually be the elixir of life!  I'm still working on  it.
            Our recent fabulous party thrown by our kids, ensconced us in Toronto's finest hotel in almost obscene luxury, surrounded us with relatives and friends old and young, from far and near for a weekend of re-union, fun and love.  It was all so wonderful that Irene and I have decided to stick  around for ever!   I don't know how our kids are going to top this for our 90th, which is only 9 years and 11 months away!
             We are eternally grateful to our fantastic kids for the extraordinary lengths they went to for us and thank them for rejuvenating us.

Tuesday 13 October 2015

The Computer-Brain Interface.

   Many years ago, I had a friend who was an accomplished physicist.  We would sometimes prognosticate where computer technology was going.  He had no doubt that the next big breakthrough in computer science would be the computer-brain interface.  Communication would be developed between the brain neurons and and an electrode which would interpret the micro-electrical potentials without the requirement for keyboards or the various other devices that have been necessary to communicate with the computer until recently.  Thinking, he maintained, would be all that would be necessary to instruct the computer.  As mentioned, this was long ago, and and even he realized that this was the stuff that science fiction was made of.
    Recently, a Johns Hopkins surgeon implanted a brain 'pacemaker' for Alzheimer's Disease as part of a clinical trial to slow memory loss.  Similar devices have been used to provide deep brain stimulation in the treatment of Parkinson's Disease. It is hoped that this technique will be able to boost memory and reverse cognitive decline.   The research focuses on delivering low voltage electrical charges directly to the brain that will be encoded with the patient's recent memories, thus compensating for the memory loss of recent events that is typical of Alzheimer's disease.  
      Science fiction sort of stuff  that elicits the frightening prospect of  the possibility of inserting whole series of memories and thoughts once this science falls into  the hands of  the State.
     Our brain cells, or neurons connect to each other across connections called synapses by electrical signals.  We are just at the early stages of understanding how those signals can be detected and interpreted.  Signals can also be generated and sent in the other directions so that the brain could be 'fooled' into seeing or thinking something.  In other words, series of memories could be implanted into the brain enabling the subject to clearly remember their trip to the Bahamas, that never actually took place.

Let me know if you are interested in this sort of stuff, or have any comments.

Wednesday 7 October 2015

Left in the Lurch!

Left in the Lurch. - this happened not long before I retired a little over a year ago.  I bring it up simply to emphasize the stupidity of the system.

            Although our Saturday morning breakfast meeting has nothing remotely  to do with health care, the conversation frequently turns in that direction.  As the only physician in the group, by default I am the one they tend to turn to when issues related to heath arise.

            A couple of months ago, Jim was telling us about his 84 year old mother, who lives independently in another province and had been doing remarkably well until it was discovered recently that she needed a pacemaker.  Because she had no immediate family where she lives, Jim arranged for her to have the procedure done here, in London, so that she could stay with him and his wife, while she recuperated.

            She had her investigations and procedures carried out, and everything went according to plan with no setbacks.

            "My mother and I were very happy indeed with every aspect of the care she had received," Jim said. "When she was discharged from the hospital, I came to pick her up.  She had been placed on an anticoagulant and we were cautioned about interactions with other medications.   The nurse emphasized the importance  of initially having a weekly blood test to make sure that there was no bleeding.  So I explained that mother would be staying with me for a couple of weeks and asked if they could give me a requisition.”

            "We can't do that," the nurse said.  “You’ll have to get the family doctor to look after that for you."

            "The problem is, “said Jim, "that mother doesn't have a family doctor in this area, she's just staying with us for a couple of weeks.”

            "Well, I suppose you'll just have to get your Family Doctor to look after it."

            "There's the other problem," Jim said.  "My doctor is away for the next couple of weeks, but if you could order the test, and phone or fax the results to me, then I could phone it through to her doctor in Halifax and he could adjust the dose by phone, until she gets home."

            "I'm sorry, we can't do that," the nurse said.  She sounded genuinely sorry.

            "Well, what do I do then?"

            "I suppose you'll have to go to emergency or something," she replied.

            He really couldn't see his poor old mother, feisty as she is, sitting in an emergency room for four hours waiting to be seen, Jim said to me later.  He knew he'd be having breakfast with me on Saturday morning, and thought I wouldn't mind ordering the blood test and faxing him the results, so he could forward them to her doctor.  I was glad to help out, but I couldn't help feeling a little embarrassed that he and his 84 year old Mom had been left in the lurch by the Health Care Industry.
            Commonsense, is getting less and less common.

Saturday 3 October 2015

Feckless physicians.

      I am happy to say that I come from another era, when medicine was a noble profession and most doctors gave of themselves in a manner unimaginable to new graduates.  Because of their professionalism, a term grossly misused nowadays, physicians put their patient's first, without any doctrine from a dictatorial government who want to use physicians to provide things they have promised but cannot afford.   Thus a cutback  of nearly 5% without any consultation or  agreement from  the physicians from whom  they are confiscating the funds .  (At the same time they are spending a considerable amount on an in vitro fertility plan that they cannot afford.)     I have been  the victim of various physician/ government negotiations over the years, but today's administridiots have drastically damaged the health care system by turning it into the Heath Care Industry.  Because of that, physician tactics have to change.  Honour, responsibility and fairness being things of the past, the health care industry has to use the tools that every other industry uses.
     All my life I have been opposed to the concept of physician striking regardless of the circumstances.  Most of my colleagues have abided by the concept of 'patient first', often to their own detriment, despite the tensions of dealing with pandering  politicians and their satraps trying to dictate how they should practice medicine.  The time has come to behave like an  industry and use that potent weapon that all industrial workers use.  Strike!   No other civil servants would take such treatment lying down.   I am not yet so callous that I would leave the patients without medical care and I  am well aware of the consequences to physicians.  The medical association is in desperate need of leadership. Initially,  the Medical Association should advice all physicians, to cease writing any medical records, just keeping the sufficient information  on their smart phone or tablets to protect themselves.   After a two week period, only emergencies should be seen.  If after these measures the government is not ready to negotiate other measures would  have to  be brought into play.  (I'd be prepared to consult for an exorbitant fee.)  
    Unless they are prepared to take such  action physicians will  have only two  options.  To take what is doled out to  them and shut up, or to  get out of the practice of medicine in the province of Ontario.
    Unfortunately, it is the citizens of Ontario who will pay the price one way or the other.  The people get the government they deserve and the same dictum applies to health care.
    As I see the system decline, I am  glad to no longer be  a part of it.

 Is this really how you want to see your health care dollar spent?

TORONTO | Ontario will spend $50 million a year to expanding coverage of in vitro fertilization to help about 4,000 would-be parents grow their families.

Health Minister Eric Hoskins says anyone with fertility problems, including non-medical factors such as same-sex couples and single people, will be able to access one round of IVF.

 Don't be afraid, comment!