Sunday 25 December 2016

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!"

Tuesday 20 December 2016

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.

Friday 16 December 2016

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
P.S.Feel free to make comments. I'd like to know what you think.

Tuesday 13 December 2016

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!!

Friday 9 December 2016

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 .

Monday 5 December 2016

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.