The Death of Medical Confidentiallity.

 Bill 41 and the end of  Medical confidentiality. 

  The ultimate death spasms of medical confidentiality which has taken place in Ontario, will come as a surprise to many citizens when eventually it affects them.  Most folks have never even heard of Bill 41  which was recently passed and which  is going to drain the health care system and the tax payers pockets.  It will result in the creation of a whole new layer of administridiots with their cohorts of assistants, secretaries and clerks with generous salaries, benefits and pensions but as far as I can make out will add no new resources to actual  health care.  no new doctors or nurses, no reduction of waiting times for procedures and no extended health care.  It has been given the euphemistic name of the "Patient's First Act", although that is exactly what it is not.  Truly, it is the "Bureaucrats First Act" although it is the patients who will be paying for it.  The Act is there for everyone to read, though unless you happen to have a law degree, which  I don't, it is difficult to fully comprehend.  But I do get enough to tell you some of the effects it will have on  you and me.
   1.  Medical confidentiality, which has been dying for years is now soundly dead.  This act gives the government access to your medical records.  Now, the confidentiality of medical records has been  under attack for years.  Those who can gain access to your medical record may gain access to information that you desperately want to keep private.  I can recall being forced to give information in court that I didn't want to divulge as it was not in  the best interests of my patient.  I was informed that if I refused to I  would  be found guilty  of 'contempt of Court' and could go to jail.  I was also  informed by the court that I didn't have to worry about being sued by the patient because I  would be protected by the 'Canada Evidence Act', which I had never heard of until then.  So even  then they had you where they wanted you.
   With the introduction of  Medicare patients willingly surrendered a major component of their privacy, because all billing submitted  to the government had to have a diagnosis attached.   Some physicians, who really respected the patient's desire for privacy would sometimes disguise an unpalatable diagnosis to prevent the patient from embarrassment, but the administration soon caught on to that  and cautioned physicians regarding the consequences of so doing.  Occasionally patients requested to pay in  cash, to prevent a  billing slip with  the diagnosis going to  the billing agency.
   Bill 41 allows the government or their agents to access your medical record on very slim guidelines that offer you little protection.  Government knows that information is power and wants to know all about you.
    This is what George Orwell had to  say:"There was of course no way of knowing whether you were being watched at any given moment. How often, or on what system, the Thought Police plugged in on any individual wire was guesswork. It was even conceivable that they watched everybody all the time. But at any rate they could plug in your wire whenever they wanted to. You had to live—did live, from habit that became instinct—in the assumption that every sound you made was overheard, and, except in darkness, every movement scrutinized."  Now the folks do much of the work for them on facebook and  twitter!
   2. Bill 41 gives the Ministry of Health total dictatorial power over the the main Health Care providers without requiring other than token input so as to appear as though they are involving the key players like physicians and nurses in their decision making.   Most of those administrators, with no medical knowledge whatsoever, some with a minimal amount, are making medical decisions that will eventually affect every person  in the province.  To be successful in  their endeavours they have to minimize physicians and nurses and to reduce them to obedient  technician status.  And make no mistake, they are well on  the way to doing that.
   3.  Medical resources, scarce enough already are going to become even more strained to support the new bureaucratic layer.  There will be no benefits to patients in  terms of improved health care.

  Remember Ronald Reagan's caution:  The nine most terrifying words in the English language are, "I'm from the government and I'm here to help!"
      
  

Child abuse - blame the Doctor!

   One of the latest headlines in my favourite newspaper:  "Doctors zeal to protect children was his undoing".  The story was of a Montreal pediatrician, Dr. Alain Sevard, whose diligence in attempting to protect children from violence resulted in such reaction and criticism, because he was not always right, that he felt his only recourse was suicide.  The story is of a caring pediatrician, with a reputation for  being an expert in child abuse, frequently consulted by emergency departments in cases of suspected child abuse, who became a victim of his own caring because he was not always right.   Consulted in many cases of brutal child abuse, Dr. Sevard always hoped he was making the best decision, but when in doubt suspected the worst and turned over the case to the child welfare services and for this he was demeaned and punished.  That was because on occasion  he was wrong and indignant parents and family were more concerned with their own reputation than with child protection.  They were slighted and they had to have their revenge.  The folks who so fearlessly demand more aggressive pre-emptive action by physicians and child welfare agencies in cases with tragic outcomes, are the first to criticize those who act decisively often to their own  detriment.  Particularly disturbing, is that the Provincial College of Physicians, a body that often hypocritically voices concern over the physical and mental health of excessively stressed physicians ( and I can inform you from personal experience that few physicians are not excessively stressed, unless they work for the government) seem to enjoy participating in the witch hunt.  What message does this send to young physicians?
   Most of the time Dr. Sevard's suspicions were correct, but on occasion they were not. Outraged parents reported to the media that Dr. Sevard had reported them to Child welfare for suspected child abuse, based on the evidence he had observed.  That was precisely what he was supposed to do, if he had grounds to be even suspicious of such circumstances.  That is what he did. But the media make a feast of such situations and once the folks smell blood, they are relentless in their pursuit of he who embarrassed them.  The results of the chase was that the College of Physicians, (who should have known better than to pander to the press's demand for immediate action) and the hospital, which I presume thought doing something would make them  look good, revoked the privileges of the caring doctor and subjected him to calumny and contempt.  The sad epilogue was that the physician, humiliated and depressed, his life's work and his reputation forever sullied by the media, the College and the hospital, took his own life.
  A man who appears to be blameless, was punished mercilessly because in his attempt to protect defenseless  children he had offended some innocent parents.
  The message is clear.  Don't stick your neck out.  Too bad if some children get abused and/or  battered to death.  That's just the way it is in the just society.
  

You can hug a tree, but don't hug a patient!

  Below, my response to an article  in a medical newspaper giving the impression that perverted physicians, who sexually  abuse their patients are a great deal more common than they actually are.  Our College is doing a poor job in allowing the very small percentage of offenders to be portrayed as commonplace.   The Canadian Medical Association is doing an even poorer job in making the truth clear.  'Hugging' for a practitioner of Medicine has become a crime, just at the time when everyone else is lauding the miraculous effects of a hug!

   I've been retired for a few years now.  As I follow the medical news (one has time to do that in retirement!) I'm horrified by what I read.
  I delivered the babies of many patients and I delivered many of the patients I originally delivered, of their babies.  Hugs were common-place and any attempt to attach a prurient context to them only serves to reveal the lascivious mind - set of the government and medical administridiots, who cannot distinguish normal human warmth from perverted behaviour. 
  I am also horrified by the fact that my colleagues have taken all this BS lying down (if one is permitted to use that term in this 'politically correct' kakocracy.
  I liked most of my patients and they (for the most part) liked me.  That is what used to make medicine a great and rewarding career.  So sue me!!
Thank God I'm retired!!
 
 Stan Smith
medicalmanes.com
P.S.Feel free to make comments. I'd like to know what you think.

And Justice for All - including doctors.

   "No trial but doctor is guilty, judge rules"

   That's a headline in the National  Post today.  it goes on to state that this is probably a first in a class action law suit against a doctor.  The doctor in question had a very high infection rate and was very likely guilty of negligence, but surely everyone is entitled to due process?  There was no allegation of malicious intent. After all, no one would deny that even a murderer caught in flagrante is entitled to a trial.  The lawyer goes on to gloat that this is a victory against the Canadian Medical Protective Association for 'too vigorously' defending the doctors.  He mistakenly claims that the CMPA is largely tax-payer funded. It is not, it is funded by people like me, the physicians who hope they will never have to use their service.  Why does it not shock me that a lawyer would like to deny a group due process.  If this was suggested for any other group he'd be outraged. 
   The animosity against  physicians in recent years is alarming.  There is no condoning negligence but society's rules must be applied equally to all.  The 'Elites' are determined to control health care.  They must first subjugate physicians.   God help us all!!

Medical morale and Health Care Decline. Bill 41.

   Bill 41 is a piece of recently passed Provincial legislation that will have a devastating effect on your already failing  health care system.  Awareness of its existence is almost unknown outside the health care professions.  Couched in the usual and deliberately unintelligible legal mumbo-jumbo, I am still studying it to try to determine how far reaching its effects will be.  For those of you interested, I will be dealing with the bill and its implications in a separate blog.  In the meantime let me over simplify it by saying it will result in a completely new layer of civil service administridiots who will dictate what health care will be available and how it should be provided.  Bear in mind that most of these folks have little or no health care experience.   It is my understanding that your files and documentation will be available to them.  Their salaries and benefits including pension will be an additional drain on the already strapped health care budget.
   The letter I have shared below expresses the concerns of the College of Family Physicians on this topic.
   The name the bureaucrats have given this new bill is "Patients First Act!"

Pulse on Family Medicine primary care policy update

The Paradox of Putting Patients First Without Engaging Family Physicians

The OCFP is disheartened that the framework for Patients First implementation is now law through the passage of Bill 41, Patients First Act, 2016 when there is a deep and growing impasse between the Ontario government and physicians, including family physicians.   This impasse has destabilized the profession and devalues the significant role that family physicians play in keeping Ontarians healthy. The adverse environment is not supporting the meaningful engagement of family physicians that we know is the key ingredient for any sustainable and effective primary care transformation efforts.   Our research of other jurisdictions that transformed primary care confirmed that without meaningful family physician engagement, efforts were not successful, stalled and failed. The OCFP has been monitoring the planning of primary care to support Patients First, much of which has been done without the benefit of full engagement with frontline providers. A top down approach does not reflect frontline experiences, needs or realities of practice.   Family physicians are aware of the challenges that they and their patients face every day. They are also aware of opportunities to improve both primary and secondary care. Many family physicians are leaders in clinical improvements, primary care networks, medical education and mentoring, hospital coordination of services, and provincial and regional committees, all aimed at changing the delivery of health care to meet the needs of their patients and communities.   In Ontario, family physicians have often provided their expertise without support for their time because of their genuine willingness to improve the system for their patients, and with a genuine belief that their input mattered. The frustration that exists currently among Ontario's family physicians will make engagement more difficult, and any real change challenging to implement. Further, many new family medicine graduates and residents are facing barriers to entering into or establishing the kinds of comprehensive team-based practices in which they have become familiar through their training. This will have consequences for the future of family medicine.   The bill's passage now enables moving from planning to implementation of Patients First. The government now needs to address the issues that are challenging for family physicians in practice such as wait times for specialists, inconsistent information to improve coordination between primary care and the hospital sector, patient accountability, and equitable access to inter-professional health-care provider resources.   The OCFP hopes the Ontario government will place a high value on the services of family physicians and not continue to expand the services of other providers without a vision for primary care, the Patient's Medical Home, that supports the critical role of the family physician working with an inter-disciplinary team to provide comprehensive, coordinated and continuous care for patients.   The Board of Directors of the OCFP is discouraged by the ongoing tensions between the government and the medical profession, and will continue to advocate for the Ministry of Health and Long-Term Care to reach a negotiated agreement with the OMA, ratified by the membership.   Building a strong primary care foundation requires frontline family physicians to be engaged in planning that is clear enough to reduce variability, but innovative enough to develop local solutions that can be implemented effectively because they reflect the realities of local practices, community context and the population needs being served.   The OCFP will continue to support members to address clinical priorities through continuing professional development and mentoring networks. And we will continue to promote the Patient's Medical Home as the vision for primary care - a patient-centred model where comprehensive, continuous and coordinated care is provided by an inter-professional team led by a family physician.   We continue to listen to your comments and feedback in all the ways that we are able. We know that family physicians want faster access to specialists, better tools for providing care, better access to mental health resources, and support for managing patients with chronic pain and addictions. We will advocate for e-consults and meaningful digital tools to support access to care, improved resources for palliative care and medical assistance in dying, better integration and coordination between primary and secondary care, and additional inter-professional resources to help you to support your patients.   We hope that the messages expressed are helpful to you should you wish to make your views known either to the OCFP or within your primary care networks, and that they represent the important priorities of family physicians. Please let us know about other issues you want the OCFP to address at ocfppulse@cfpc.ca .   Links: OCFP's Evidence Brief: Preparing for a Devolved, Population-Based Approach to Primary Care  Patient's Medical Home  Bill 41, Patients First Act, 2016  Bill 41 Summary of Amendments Affecting Family Physicians

Free Speech and Intimidation of Nurses.

   In Saskatchewan recently, a nurse, who posted on her Facebook page her concerns regarding the treatment her grandfather had received in a long term facility, has been found guilty of professional misconduct.  The nurse had written about the 'subpar' treatment her grandfather had received.  She had written the post as a caring family member, not in her professional capacity as a nurse and was not in any way involved with the treatment team who provided the care.  The Saskatchewan Registered Nurses Association, ruled that she had violated the act by harming the reputation of nursing staff at the facility and had undermined the public's confidence in the staff. They also stated that she had not used the appropriate channels to bring forward her complaints and did not conduct herself professionally when using social media.  In  other words, they were saying that because she is a nurse she did not have the  right to voice her concerns in a public forum because it might make the public aware of some inadequacy of treatment and undermine confidence in  the staff or the facility.  This may be precisely what is needed.  It is called transparency, which everyone is in favour of, except when it applies to them.   The Association ignominiously expressed the opinion that unfavourable comments by one of their members in good standing should not be divulged to the public, no matter how accurate it may be..  What arrogance!  What unmitigated gall!  To want to punish a nurse for speaking out her mind regarding the treatment her grandfather received is unbelievable in an era when we pay such lip service to freedom of speech. 
   Her punishment has not yet been revealed. 
   She gave some specific advise re improvement of care which the facility might be well advised to take.   Perhaps her message will persuade families of long term facility patients to  monitor the treatment of their loved ones more closely, which would be a good thing for all concerned.
   Freedom of speech means others are free to express their opinion, even when  they don't agree with you!  This is a gross contravention of civil rights that I hope the nurse will  pursue . 
  Saskatchewan Registered Nurses Association have to realize that opinions such as these should not and cannot be suppressed.  A culture of intimidation of nurses for voicing their opinions and concerns is no longer acceptable, unless it breaches the nurse/patient relationship or involves malice.
 

DSM and Profile of a sociopath.

Profile of a Sociopath.

 Today more than ever we need to brush up on antisocial personality disorder, as so many of our world leaders exhibit them to a greater or lesser degree.

 This website (www.mcafee.cc/Bin/sb.html) summarizes some of the common features of descriptions of the behavior of sociopaths.

• Glibness and Superficial Charm
• Manipulative and Conning
  They never recognize the rights of others and see their self-serving behaviors as permissible. They appear to be charming, yet are covertly hostile and domineering, seeing their victim as merely an instrument to be used. They may dominate and humiliate their victims.
• Grandiose Sense of Self
  Feels entitled to certain things as "their right."
• Pathological Lying
  Have no problem lying coolly and easily and it is almost impossible for them to be truthful on a consistent basis. Can create, and get caught up in, a complex belief about their own powers and abilities. Extremely convincing and even able to pass lie detector tests.
• Lack of Remorse, Shame or Guilt
  A deep seated rage, which is split off and repressed, is at their core. Does not see others around them as people, but only as targets and opportunities. Instead of friends, they have victims and accomplices who end up as victims. The end always justifies the means and they let nothing stand in their way.
• Shallow Emotions
  When they show what seems to be warmth, joy, love and compassion it is more feigned than experienced and serves an ulterior motive. Outraged by insignificant matters, yet remaining unmoved and cold by what would upset a normal person. Since they are not genuine, neither are their promises.
• Incapacity for Love
• Need for Stimulation
  Living on the edge. Verbal outbursts and physical punishments are normal. Promiscuity and gambling are common.
• Callousness/Lack of Empathy
  Unable to empathize with the pain of their victims, having only contempt for others' feelings of distress and readily taking advantage of them.
• Poor Behavioral Controls/Impulsive Nature
  Rage and abuse, alternating with small expressions of love and approval produce an addictive cycle for abuser and abused, as well as creating hopelessness in the victim. Believe they are all-powerful, all-knowing, entitled to every wish, no sense of personal boundaries, no concern for their impact on others.
• Early Behavior Problems/Juvenile Delinquency
  Usually has a history of behavioral and academic difficulties, yet "gets by" by conning others. Problems in making and keeping friends; aberrant behaviors such as cruelty to people or animals, stealing, etc.
• Irresponsibility/Unreliability
  Not concerned about wrecking others' lives and dreams. Oblivious or indifferent to the devastation they cause. Does not accept blame themselves, but blames others, even for acts they obviously committed.
• Promiscuous Sexual Behavior/Infidelity
  Promiscuity, child sexual abuse, rape and sexual acting out of all sorts.
• Lack of Realistic Life Plan/Parasitic Lifestyle
  Tends to move around a lot or makes all encompassing promises for the future, poor work ethic but exploits others effectively.
• Criminal or Entrepreneurial Versatility
  Changes their image as needed to avoid prosecution. Changes life story readily.

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Other Related Qualities:

1. Contemptuous of those who seek to understand them
2. Does not perceive that anything is wrong with them
3. Authoritarian
4. Secretive
5. Paranoid
6. Only rarely in difficulty with the law, but seeks out situations where their tyrannical behavior will be tolerated, condoned, or admired
7. Conventional appearance
8. Goal of enslavement of their victim(s)
9. Exercises despotic control over every aspect of the victim's life
10. Has an emotional need to justify their crimes and therefore needs their victim's affirmation (respect, gratitude and love)
11. Ultimate goal is the creation of a willing victim
12. Incapable of real human attachment to another
13. Unable to feel remorse or guilt
14. Extreme narcissism and grandiose
15. May state readily that their goal is to rule the world

(The above traits are based on the psychopathy checklists of H. Cleckley and R. Hare.)

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NOTE: In the 1830's this disorder was called "moral insanity." By 1900 it was changed to "psychopathic personality." More recently it has been termed "antisocial personality disorder" in the DSM-III and DSM-IV. Some critics have complained that, in the attempt to rely only on 'objective' criteria, the DSM has broadened the concept to include too many individuals. The APD category includes people who commit illegal, immoral or self-serving acts for a variety of reasons and are not necessarily psychopaths.

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For more information.
DSM 1V and DSM V 
DSM 5 Criteria- becomes increasingly  amorphous and were reviewed in 2012, but here is the essence as plagiarized by me.  ( I  am all in favour of plagiarization as long as it is freely confessed.  How else are we to progress?)

-
 Criteria for  the Personality Disorder antisocial Personality Disorder:

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three
(or more) of the following: having hurt, mistreated, or stolen from another.
1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4  Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5.Reckless disregard for safety of self or others.
6.Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7.Lack of remorse..   

Obviously there are various degrees of affliction with  this disorder, nevertheless the salient points are recognizable in many past and present  leaders.  If you can't name half a dozen you need to  read more history and news.  My comments column sits empty!
   

Transgender and Plastic Bottles.

National Post Headline.

‘I feel like a boy, mom:’ Doctors seeing an increase in preschoolers convinced they are in the wrong body.

     This National Post headline confirms my growing conviction that the inmates really are running the asylum.  Increasingly, parents are run by the children and doctors are run by the patients.  I sometimes hear children admonish their apprehensive parents so authoritatively that I'm beginning to wonder if some don't know more than their benighted parents. The little girl above, identifies as a boy.

   The story goes on to talk of a little boy as featured in the headline, who socially transitioned from male to female in nursery school at the age of four.  I'm not sure if it was pride or something else that led the parent to proclaim that at a school function her son (identified as a girl) was described by another parent as "the girliest girl," she had ever seen.

   Taking a four year old child's assessment of having been born with the wrong set of genitalia would seem to me to be more indicative of a problem with the  parent and /or the doctor, than with the child. I can't fathom how a four year old's decision as to feeling they belong to the opposite can be identified as being other than a fantasy or game in the face of the genetic determination of their sex.   The idea of such children being subjected to surgical intervention horrifies me and gives rise to concerns as to what is happening to the medical profession as well as to society in general.  Social engineering is morphing into psycho-social-physical engineering and the future development of the human race is being directed by highly questionable 'elites'.
   Nevertheless, there may be another factor  influencing the epidemic of transgenderism.  As an increasing segment of the population prefers to trust water from plastic bottles to tap water and as containers such as baby bottles and cups have become the norm, the entire population is exposed to bisphenol A (BPA).  BPA has been shown to  interfere with the hormonal system and has been shown to be capable of affecting brain and behavioural function.
BPA and another polymer found in plastic bottles - polyethylene terephthalate (PET), have been shown to  mimic the effects of estrogen and can have an effect on the prostate.  Although government agencies assure the public of the safety of these agents, much more research is required.  
   So, perhaps the transgender epidemic is  simply  the result of the toxins the ecology savvy parents are feeding to  their children!  In the meantime, let us not accept the mutilation of children as bonefide medical treatment.
     

Hemorrhaging heathcare & the Free Market.

   You're living in Regina, Saskatchewan and after waiting for several weeks to see your family doctor, you just recently saw the specialist he sent you to, after several more weeks of waiting.  The specialist determined that you need an MRI and the hospital told you it might take several months before they could 'fit you in'.  By now you are getting acutely anxious, even a little desperate.  Then your friend informs you that she heard that you can have it done privately. You make some inquiries and find out she is right.  The Saskatchewan government recently announced that two MRI clinics have been licensed to do MRIs privately, for a fee.  You phone and find that instead of waiting months, that you can have it done within a week.


   Wow!    In the land of Tommy Douglas, which gave birth to Canadian medicare, they realize that to give the folks the option of buying the care they need when the government can't afford is a no brainer.  I practiced in NDP Saskatchewan for almost thirty years and thought I'd never see the day.   Amazingly, the Saskatchewan Medical Association is opposed to what they label a two tiered system. Now the whole country is recognizing that if the folks can't buy it here in their own province or in Canada at all, they'll buy it somewhere else, thus making it even more exclusive.  That is, the whole country except our chosen political servants, who have appointed themselves our political masters.  In every province in Canada there are private facilities, obviously more available in the densely populated parts of the country.
   Waiting time for medically necessary treatment in Canada is not improving.  A specialist survey reported a median waiting time of 18.3 weeks to treatment, from the date of referral by the GP.  This is almost double the time it took in 1993. For less urgent problems or procedures, it is not unusual for the  delay to be a year or greater.  Many of these waits subject patients to pain and suffering and sometimes outcome risks.
   So, you may ask, how much is an MRI going to cost me?   Here are the rates from one private MRI Clinic.

Rates
All scans include radiologist’s report and a CD Rom copy of the images.

Brain
Routine Brain	$895
Brain for MS	$895
Brain for Seizure	$895
Facial Bones (no brain included)	$895
Temporomandibular Joints (no brain included)	$895
Brain & Facial Bones	$1,120
Brain & Orbits	$1,120
Brain & Sinuses	$1,120
Brain & Pituitary	$1,120
Brain & Circle of Willis MRA	$1,120
Brain & Internal Auditory Canals	$1,120
Brain & Trigeminal Nerves	$1,120
Brain for Tumor (contrast included)	$1,195
Brain Trauma with Susceptibility Weighted Imaging (SWI) (for mild traumatic brain injury)	$1,245
Brain Stroke (includes SWI)	$1,245
Carotid MRA (contrast included)	$1,470
MS Brain & Cervical Spine Combination	$1,500
Brain & MRA Circle of Willis, Contrast Enhanced Carotid	$2,270
Brain & Spinal Cord for MS Combination (cervical & thoracic)	$2,395

Body
Chest (mediastinum, chest wall)	$895
Soft Tissue Neck	$895
Sternum, SC Joints	$895 each
Brachial Plexus	$895
Specific Muscle	$895
MRCP	$895
Pelvis	$895
Abdomen	$1,095
MRA (renal or aorta)	$1,200
Dynamic Liver(contrast included)	$1,395
Abdomen/Pelvis Combination	$1,545
Whole Body Health Screening Program (see video) (2000+ detailed images including specific screening for brain, aortic & abdominal aneurysms, compression fractures of the spine, gyneacological cancers, liver lesions and pancreatic, kidney, biliary disease/malignancy)	$2,450

Extremities
All Extremities (ie. knee, wrist, ankle, etc.)	$895 each
Foot/Ankle Combination	$1,590

All rates subject to change without notice.

Feel free to comment.

Hemorrhaging medical care and the two tiered system.

 The hemorrhaging medical care system and private clinics.

"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."

   Despite the fact that the hubris of the government of Canada results in attempts to violate the rights of citizens to buy health care, government either refuses or cannot afford to give, private clinics continue to quietly surface.  They do so with a minimum of publicity, just enough to be visible to those who seek it and hopefully not enough to bring them to the attention of the "health commissars".  If they can keep their heads below the radar for the present, perhaps they will thrive as the public gets used to better, more timely care.  The fact that many people are prepared to pay from their own pockets, in addition to the considerable taxes they pay, surely makes it clear that the system is unsatisfactory and this is the only way they can get better care.  When I started looking to see what already exists, I was surprised.  As  I  started searching it became  apparent that private medical care is already more developed  than I had imagined.   I had only been looking a short time when I hit upon: findprivateclinics.ca.  Their web site attempts to list all of the private health care facilities available.  If you are prepared to pay, that MRI that was going to take a year can be obtained this month, or maybe even this week.  Need to see an orthopedic surgeon?  Instead of waiting a year you can do it this month, or possibly this week.  You can even get your hip or knee replaced in short order, if you are prepared to pay for it.  Most of these services are available in Canada but for some it may be necessary to travel to the U.S.   In some cases the U.S. has come to us.  The Cleveland Clinic, a global non-profit academic medical centre opened a 26,000 sq foot medical facility in Toronto in 2006.   Located in a prestigious building in Bay Street, the Cleveland Clinic Canada, is a part of a clinic that enjoys an international reputation.  Have a look at their web site :http://my.clevelandclinic.org/canada.  

      findprivateclinics.ca is an easy to use comprehensive web site that lists most of the private facilities in Canada.  Obviously, they tend to be clustered in the most populous parts of the country, but they are found everywhere. Because private health care keeps a low profile for obvious reasons, some are a little slow to come to light.  The facilities are listed by province and the opening menu lists by specialty icons, starting at A for Allergy and ending with W for weight loss.  Just click on the subject of your interest and voila, the clinics are listed, most of which have a detailed web site of their own.  Even if you are not contemplating using private health care facilities, this is worth taking a look at.  The site gets about eight thousand monthly visits.  The only thing I could not easily access was cost.   So, the much maligned two tiered  system is already here.  The government doesn't want to admit it because it emphasizes their failure.  The doctors and other health professionals like to keep a low profile, for fear of waking up government.  The folks who need it and can afford it want to see it thrive and prosper.

Do you think we need a two tiered health care system? 

   

The Medical Dictatorship violating my rights.

"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."

   The government is violating my rights. Publicly funded health care is a wonderful and necessary thing.  No civilized country should be without such a safety net.  However, that should not preclude me from spending my own hard earned money on aspects of my or my family's health, particularly with regard to services the government cannot afford or chooses not to cover.  The header above this article makes clear that the government finds it satisfactory for us to rank tenth out of eleven health care systems (though by now, we may be eleventh).   The only reason imaginable for their reluctance to allow willing providers to provide service to patients on a voluntary insurance or cash basis is that it is a de facto admission of the failure of the public system to  provide adequate care. It is not as though those who would like to avail of such a system are seeking to avoid the large tax burden of the public system.  Quite to the contrary, they are offering to subsidize the system by buying their own care through cash or private insurance.  They are shortening waiting lists for the public system and saving it money.  When they buy services or investigations such as MRI they are making space in the public system.  Folks with money do this already, they shop, they frequently go across the border and leave their money in  other country's exchequer.  Our government addresses these problems by systematically introducing layer after layer of bureaucrats, each layer draining funds for salaries, benefits and pensions.  None of these administridiots contribute anything to the delivery of health care or the care of patients.  It would be interesting to know what proportion of the health care budget goes to maintaining this hierarchy. There is an urgent need for services the government cannot provide in a timely fashion.  There is no consolation in constraining the availability of service to the lowest common denominator to satisfy government ideologues. Patients die while on waiting lists.                                         Fifty two thousand five hundred and thirteen Canadians traveled abroad for medical care in 2014.  The large number coming from Ontario is not entirely explained by the larger population of the province.  Private health care clinics are springing up all over the country, while keeping as low a profile as possible to avoid the consequences of  contravening the Canada Health Act.  In Quebec in 2005 the Court ruled that a one year wait for a hip replacement violated the provincial human rights law.  Dr.Brian Day, an orthopedic surgeon has a Charter challenge going on in BC, that is finally before a judge after an eight year wait.

  I believe the private clinic concept is going to thrive despite attempts to  prevent it doing so.  In the meantime, those who can afford it will just continue to go abroad when they can't get satisfaction at home.  Next, we will explore some of the services that are available in Canada - right now!                                                  

                                                                    

 

Why waste leisure time on eegits?

   I'm getting fed up trying to educate a few interested in health promotion and politics, who don't need education or a disinterested majority who are either ineducable or just not interested until they are seriously ill themselves and wonder why  the health care service is not working  for them.  Having spent a lifetime as a physician trying to promote awareness in health care to patients and professionals alike, I have decided the time has come to stop trying to help the folks allocate the health care budget in a constructive way and to try to stop them from depreciating our second class health care system into a third class one..  So, instead of continuing to attempt to educate the public re health care, I am going to direct my efforts in a different direction.  This will require a much less delicate approach than the one I have availed of in medicalmanes.com, so expect something entirely different.  I will continue medicalmanes for the  moment, although not as frequently as before.  The new blog I am considering will be politically inclined (surprise, surprise!) and not to everyone's liking.   It will focus on the prejudices and politically incorrect behaviour of  the   holier than thou Canadians and others who in the name of political correctness behave in a wholly prejudiced and hateful way.  There is a rapidly growing hate movement in Canada.  We need to look at it carefully and to address it aggressively. I'll let you know when I come up with a name!

Family Medicine Curriculum. A Letter to my doctor.

   I recently sent this letter to my doctor whom I have known and appreciated for many years.  I sent it because I  think she should know how resources are wasted and how a procedure well within the scope of any family doctor was being referred on to a specialist by a family medicine resident who should have known how to punch biopsy a small lesion and if she didn't should have been taught to do it on the spot by her preceptor. A ten minute procedure.  Instead, a costly consultation was to be set up over a year away.   It is time to re-visit the core curriculum of family medicine.

 

 

Dear *****

   Hope you are keeping well.  This note is just for your information to make a point about our rapidly dissipating health care industry, regarding which I frequently blog.

   About two months ago I came in with a small lesion on my ear which was bleeding and not healing.  Unable to convince your very pleasant resident to punch biopsy it, she suggested a consultation with an ENT specialist.  

   Having heard nothing after a month I phoned in, still no word about even approximately how long the appointment might take.  Yesterday, well after two months I got a call from your office telling me Dr ENT, after triaging the request said she could fit me in over a year.  Hard to believe this was not a joke!

   Meanwhile I had this dealt with  ( it took ten minutes or less).  Without having met her, I find Dr. ENTs attitude on taking over two months to inform me she could not see me for over a year, inconsiderate at the least.  I could go on, because I really think the procedure was well within the scope of an average GP, but I don't want to sound like the old curmudgeon that I am.

   I hope you are not upset by this letter, but I think you need to know about it.

   Regards as always,

     

     Stan.

    

     I never did get a reply to this letter and I choose to think it must be because it got lost in cyberspace.  

      

Destroying the Medical Profession!

  Despite my resolution to reduce medical blogging, it's hard to do. You see, I see my previous profession as being deliberately denigrated, belittled and manipulated by a regiment of obtuse politicians and administrators who know little about medicine but think they should be able to dictate to those who provide health care, not just how to organize medicine but how to practice it.  They call their new bill. Bill 41 and it is designed to remove all power in health care from the people who provide it, to the administridiots. Not only do they want to dictate how medicine is practiced, they want to be the arbiters of what is moral and ethical in the practice of medicine.  It is difficult to think of a group less fit to do this, since many of them seem to be utterly lacking in both morals and ethics.  As they have taken over admissions to medical school they have eroded the personal and ethical values of the candidates in the interests of social engineering.  I know, I spent many years on admissions committees  and have seen many excellent candidates excluded.  Unfortunately, most of the candidates had to lie to get into medical school and tell the admissions body what they wanted to hear.  The ones who were honest often didn't get in because despite being appropriate candidates they didn't tell the committee what they wanted to hear.  Some of them learned by the following year! 
   I spend a good deal of time thinking about how the influence of the administridiots can be diminished and other than very major action, I don't think it can be done.  
   Medical students and physicians need to be guided by Rudyard Kipling's poem "If".  Read it if you're not familiar with it and particularly pay attention to the following few lines which sums up the situation so well:
 
   If you can bear to hear the truth you've spoken
Twisted by knaves to make a trap for fools,
     Or watch the things you gave your life to, broken,
And stoop and build 'em up with worn-out tools: 

   I'm glad I'm not a doctor anymore!

Write a comment if you have any views!

Health Care - Only when it's me!

   When I first started writing a medical blog I thought I'd have so many readers, writing so many comments, that I mightn't be able to  keep up with it.  After all, I'd been practicing medicine for fifty five years and on virtually every social and other occasions, no  matter how hard I tried to steer the conversation away from medicine, there seemed to be no escape.  None of the people I was interacting with were my patients but they all  assumed that I would have an overwhelming desire to  listen to their health stories and those of their families, every one of them unique, from their mother's gallstones (the biggest the doctor had ever seen!) to their grandfather's prostate.  Many of them wanted to point out the inadequacies of the health care system and particularly of the physicians and nurses they had to deal with.  I must add, a few, a very few, wanted to tell me about the excellent care and consideration they had received but they were few and far between.  Some, seemed to feel that not only was the whole profession incompetent and uncaring, but that I  personally was responsible.
   I listened endlessly to complaints, some subtle and some resentful, about the vast amount of money doctors made, from folks with a thirty-five hour work week, benefits and fat pension, when I was working twice as  many hours with no benefits and no pension (until I was smart enough to become an academic and working for he University, which is, of course a civil service job).  When I pointed out some of these facts, they would point out  to me, sometimes rather aggressively, that it was I who decided to go into medicine and I knew what that implied before I made the choice.  I didn't bother to point out to them, that no young person, inspired by idealism and excitement and glamour of  a medical career really has any idea of what it is going to cost them.  It costs them their youth and many of the joyful and carefree experiences that most young persons enjoy.  It exposes them to all of the tragedies and catastrophes and suffering that is the human burden, that most people of their age can't even imagine.  That has a high price tag.
   One of the most irritating aspects of the chats encountered in the social milieu was from the folks with no medical or scientific background, who were determined to inflict me with crackpot alternate medical treatment for various conditions. They usually were not so  much interested in discussing the possible scientific merits of whatever they were advocating, as in receiving an endorsement of whatever they were proposing.  When they didn't get that, they were in no doubt that it was because of the vested interests of the medical profession, who were really only condemning it, because doctors would lose money if they let people find out that almost any condition could be cured by a gluten free diet or coffee ground enemas that they could get in  Mexico for only a few thousand dollars.  No one ever seemed to grow tired of medical tales, especially when they were telling them.
   So when I started my medical blog,  I thought folks would be thrilled to have a forum in which they could discuss any and all issues related to health care, personal, community, practical or theoretical.  Interesting and unusual stories, serious and not so serious, amusing and funny incidents.
   Two years later, after blogging twice a week with a variety of articles and anecdotes, I found that there was no discussion, few comments, no raising of interesting issues other than those I raised myself. Not even any complaints. 
   Then the light turned on and it dawned on me!   People are only interested in medicine when it effects them personally.  If one is currently not involved with the health care system it really doesn't matter very much.  It seems to be there, was once admired and even now isn't that bad, although some people seem to be complaining.  That's why Canadian health care is now near the bottom of the list in the developed world.
   And that's why I'm cutting down on the frequency of medicalmanes.com so I can turn my attention to a completely different type of blog!  I will appear here from time to time, but not on a bi-weekly basis as in the past.
   Your comments if you have any, will as always, be welcome.

The Stethoscope. Is auscultation obsolete?

   On the occasion of the 200th anniversary of the invention of the stethoscope, one of our National newspapers featured a piece debating whether the stethoscope is, or soon will be obsolete.  Now that we have ultrasound, CT scans and MRIs should we be throwing away the stethoscope?   That's like saying now that we have calculators and computers should we stop learning 'times tables'.  Some would say yes, and that has been a part of  our decline.  I think  the same about the art of auscultation, a vital tool in the understanding and diagnosis of what is going on in various parts of the human body.  

Invention of the stethoscope

René Laennec wrote the classic treatise De l'Auscultation Médiate, published in August 1819.^[2] The preface reads:

In 1816, I was consulted by a young woman laboring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. The other method just mentioned [direct auscultation]  (i.e. putting the ear directly on the patient's chest) being rendered inadmissible by the age and sex of the patient, I happened to recollect a simple and well-known fact in acoustics, ... the great distinctness with which we hear the scratch of a pin at one end of a piece of wood on applying our ear to the other. Immediately, on this suggestion, I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear.

 Here's a picture of Laennec's stethoscope:

 

 Here's a picture of my stethoscopes:










So they have changed a bit with the passage of time!

 When I read some of the comments made by many of my modern colleagues I have the uncomfortable feeling that they are not physicians st all.  Admirable technicians and scientists, yes, and much more capable than I at interpreting computer data aimed at many complex diagnostic problems.  On the 200th anniversary of the invention of the stethoscope some doctors have already written it off an obsolete diagnostic instrument.  Many of us who have used the stethoscope over a lifetime found it to be a valuable diagnostic instrument that is portable, inexpensive, noninvasive and capable of giving much information to those who have learned to use it efficiently.   Many doctors and nurses can pull out their stethoscope at any time of the day or night and get an immediate answer to the pressing question they need the answer to right at that moment and not just in auscultation of the chest, but of the bowel and other locations.   No waiting around to find the right piece of equipment and sometimes the right technical expert to interpret what it may mean. 
  Another and perhaps tenuous relationship is the real-time connection between between the doctor and the patient, the conduit between the physician's brain and the patient's body, during which the doctor can modify and localize the examination in accordance with his findings.  It is only after a careful clinical examination that  high tech instruments should be introduced in an appropriately directed manner, bearing in mind that inappropriate use is not only expensive but can be dangerous in unleashing the medical cascade that has cost more than one patient his life.
   Let me finalize my feelings for the humble stethoscope with an ode I composed a couple of years ago on the occasion of hanging up mine:

     Ode to a Stethoscope

I lay you, faithful stethoscope to rest,
Against how many hearts have you been pressed?
 The secrets of the airways all laid bare,
As you measured sounds of heart and air,
No MRI or CAT scan will astound,
The way you did, just listening to the sound.

Oh mighty stethoscope you told me so much,
And confidence exuded from your touch.
Now relegated to a lowly role.
I still think that you head the Honour Roll!