Wednesday 26 July 2017

" Medical care in Canada.-time to drain the swamp!

   Someone finally had the guts to come out and say it!  Brian Lee Crowley, of the Financial Post, on July 5th had the appalling honesty to say what many Canadians know but don't even like to mention, or hear mentioned by others, that we have one of the worst, if not the worst health care system in the developed world.  The heading of Crowley's article is :
     "This report just shredded every myth claiming Canadian medicare is superior - or fair"
  The report he refers to is the report of the Commonwealth Fund comparing health care systems in the rich industrialized world and it is regarded internationally as being highly reliable.
  The humiliation of having deteriorated so rapidly from  among the best to the present sad state is so damaging to the pride and hubris of those who boasted 'one of the best health care plans in the world' that they can't cope with it.   There are some who still think that, but it only testifies to their lack of knowledge or contact with the system.  I know that occasionally folks have good luck but the majority of people who have to depend on the health care system are poorly served.  I also know that there are those who know how to manipulate the health care system and that there are the 'elites' who push their way to the head of the queue.  No politician or bureaucrat or their army of administridiots stand in the line with the rest of the folks.  Oh yes, they will claim all are equal, but as George Orwell said, "some are more equal that others!"  The fairness that boast of doesn't exist.
   How is it, you may ask, that we declined so rapidly from the best to the worst?  Regardless of the fact that we spend a fair amount of money we get poor value for it.  A very disproportionate amount goes to paying armies of civil-servants, many of whom are neither civil nor serve very well.  Most are not health care professionals of any kind and of those who are, few have real experience serving in the front lines.  They attend meetings where they like to hear the sound of their own voices and are frequently resentful of health care professionals who are wiser and more experienced.  Large amounts of money are sequestered to provide generous pensions and benefits. 
   Many of the administrative services that were intimately related to health care were for years provided by doctors and nurses on a pro bono basis - they did it without any personal reward other than that they cared.    They were committed individuals, usually with extensive experience in many aspects of health care.  Most of them knew what worked and what didn't.   Today many hospital administridiots have come up through the financial ranks and know nothing about health care but consider themselves experts anyway.  
   Because our government is not interested in individual health (unless it's a glamour story) but in votes, they have directed resources away from individuals and towards populations from whom they think they can win the most votes.  They play the 'statistics game' and the 'evidence based medicine game', they reward doctors for doing what they and their 'statistical experts' tell them will be cheap and effective and they penalize physicians for spending time on individual patients.  The fee schedule has been manipulated to make doctors do what the government want them to do and the Canadian Medical Association  and the licensing bodies has kow-towed to them. 
   The privilege that most free and prosperous societies  enjoy of allowing citizens to spend their own money on buying their own health care services is too threatening to the Canadian government, because they don't want the population to realize they are now getting second-rate care.  This would save money because some of those closed down operating rooms and wards would become productive, bring more money into the system and shorten waiting lists.  Think the government wants that?  It is that very lack of competition that allowed the disastrous deterioration to occur virtually without  public notice in the first place.  
   The decline will accelerate as the government brings in more and more unscreened refugees, hands out tax payer dollars by the millions and throws away opportunities that could make life better for all Canadians.
   They just want you to go on thinking we have the best health care system in the world!  


Thursday 20 July 2017

This is how Canada treats its sick patriots.

   My close friend has been struggling with cancer for many years.  He's no cissie and I've rarely heard him complain.  He has been impressed by the care that all health care professional have given him, doctors, nurses, physio, investigatory facilities.  His attitude is upbeat, he has many interests and enjoys life and is determined to continue doing that for as long as he can.  Just yesterday, he had a scheduled check-up and was informed that he was no longer a candidate for further surgical interventions (he had many in the past) and that the options for further treatment were limited.  The best option, he was told by his cancer specialist would be a new pharmaceutical that would cost thousands of dollars a year and was not covered under any health care plan.
   My friend had volunteered for the Canadian Navy in WW2 and had served under perilous conditions for King and Country.  After the war, he continued to serve this country and after a period as a police officer here in Ontario, he worked in various sales positions.  He married, had five children and brought them up as fine, hardworking Canadians.  But, Ontario Health has decided that they won't underwrite his medication.  Our Federal Government has just rewarded a terrorist and murderer with an absolutely obscene amount from taxpayers money and a Canadian patriot is left to do what he can.
   You may have a word to describe that, I call it dispicable.  We need a government that cares about Canadians.  Trudeau must go.
Comment if you care.

Sunday 16 July 2017

Decline and Fall of the Health care System/


   Something strange has happened to medicine in the last decade or so.  Most of the physicians I studied medicine with and most of the physicians who preceded me had something in common.  Their focus was on interacting with and caring for an individual patient.   I know how corny it sounds to 'modern' folk, but one of my teachers and mentors used to say "Remember, the patient is king", and he actually meant it!  I can imagine the response I would have got a few years ago if I had said that to my students!  A visit to the doctor was an interaction between two people, the patient and the doctor and the focus of the doctor was what the patient was complaining about that brought him to the doctor.   That was called 'The Presenting Complaint' and it was emphasized that it should reflect the patients own words.  I have discussed the significance of a complete history in a previous blog, my point being that if at the end of the history taking the doctor couldn't locate the system which was primarily effected by the disease, he'd better ask some more questions.  The step-wise progress of the history and examination was to pin point exactly what was going on in that patient and it took time, usually more than the ten minute consultation which seems to be today's average and the 'one-complaint only per visit' that some physicians have the temerity to  impose.  Treatment aimed solely at symptom relief was an interim measure until a precise diagnosis could be made.  Until then you could label the case as being 'open', in much the same was as a murder investigation remains unsolved, until it's solved.  Both the physician and the patient were aware that there was a missing peace in the jigsaw puzzle and decided how much time and/or money should be committed to finding the missing piece. 
many optional procedure were discussed  and evaluated when the patient had to pay some of the costs, but when everything costs 'nothing', well, why not have an MRI for your headache, whether you need it or not.  After all, you pay enough taxes, you should  be able  to have anything you like!
   When Government took over health care, they weren't interested in individual needs when the numbers were small, they were interested in 'big numbers' needs, because that's where the votes are.  Statisticians helped them a lot, because the information they provided enabled government to calculate the 'vote value' of any maneuver they consider.  In effect, they were able to calculate maximum returns to them, for every dollar spent.  After all, why waste money investigating or treating rare conditions that would only benefit individuals.  The 'evidenced base medicine' evangelists came on the scene like prophets in the desert, promising to revolutionize medicine and this they did.  They made it clear that experience and know-how really don't matter, that any new or under-educated physician was just as competent as the expert and experienced, as long as they followed the algorithms of the 'holy ones'.  They could and they would decide what was worth spending the tax dollars extracted from us and what treatments, according to their lights, should be preserved.  Money wasn't to be wasted on anything that was not substantiated with what they considered to be an appropriate clinical trial, even though in the opinion of some experts many of those trials are questionable.    The administridiots and groups of 'useful' physicians (to provide medical legitimacy to their deliberations) established committees to define profession guidelines, standards and rules and what comprised good care and what did not.   Frequently their guideline was cost reduction and certainly public care was emphasized and individual care discouraged using statistical evidence to suggest it was wasteful and not worthwhile.  The bureaucrats don't care about you.
   The government has worked hard to impose on physicians and other heath care personnel that they are no more than technicians and in no way exceptional.   They have impressed on physicians and nurses that there must be no deviation from  mediocrity and that above average care and below average care are equally unacceptable. Services have increasingly been taken for granted and expectations and demands have become unrealistic and inappropriate litigation is
commonplace.   As government increasingly deals with physicians in an unacceptable manner, they undermine professional standards and ethics and they work hard to fool the public that they are getting good medical care, despite the severe demoralization of the profession.  They are not, but they are getting  exactly what they deserve, because just as the population majority gets the government they deserve, so do they get the health care they deserve.  Canada is eleventh out of twelve in the quality of health care in the first world.  Soon we will rank with third world countries, unless doctors stand up and tell the country how poor our health care is and what is necessary to redeem it.  The administridiots aren't going to do it, so if the public doesn't get behind the initiative for major change, they deserve exactly what they are getting - and what they are going to get.  Further, a demoralized profession is  incapable of providing the traditional high standards of care that most physicians were once proud to provide. 
   if you have nothing to say I take it you like it the way it is.

Thursday 6 July 2017

Once a doctor always a doctor.

    For a long time after I retired I took a certain pleasure in responding to the usual medical questions that physicians grow used to fielding on a daily basis from patients and friends alike, with a dumb smile and a jaunty, "don't ask me, I'm not a doctor!"  Eventually that wore pretty thin when I realized how desperate folks really are to find out what's going on with their health in particular and the health care system in general.   Physicians, often seem to be doing a poor job in communicating with patients regarding the implications of their conditions on their life and on their life-styles.  Yes, they give their patients the raw scientific data, but when an anxious patient is sitting in front of a physician the level of comprehension is often minimal.  The physician is busy, in a hurry with a waiting room that is full of scowling patients who have been waiting too long and the priority is to get the patient our of the office and get on with the next one.  The art of medical conversation is dead and the patient, despite state of the art treatment, often remains apprehensive and generally poorly informed.   Thus the necessity for the emergence of the Honorary Doctor, an unpaid, 24/365 position highly prestigious post.  All it takes is a medical degree and fifty-five years of experience and the gift of the 'conversation', which is almost extinct. 
    My case load this week (all identifying data is omitted) has been as follows:
    One case of chest pain in a friend that occurred while the patient was visiting a different city.  She was rushed to hospital where she was initially informed after a CT scan that she had fluid around her heart. Apparently cardiac studies showed no evidence of heart muscle damage and they booked an MRI.   She didn't know the doctor and decided she had enough and wanted  to sign herself out of hospital and go home to see her regular physician .  Her husband phoned me from her bedside.  I talked to her at some length, explained the reasons for staying and the risks of discharging herself.  It was a three hour drive home and we didn't know what was wrong.  Too risky. She decided to stay and have her workup completed.
    The next case in my honorary casebook dealt with a man with a longstanding neurological disorder who had been waiting for a subspecialty consultation for an unreasonable lengthy time, increasingly typical of our health services, while our government grossly mismanages the tax dollars entrusted to them. We discussed his management and the deplorable waiting lists. Unfortunately there was little I could do, apart from offering a little comfort.  
    Case number three was a family member who presented to the emergency with an acute respiratory problem.  After some emergency treatment he spent seventeen hours on a guerney in the emergency department, coughing his bacteria over a room crowded with sick and debilitated patients.  So whatever their problems when they came in they were likely to be considerably worse by the time they got out.  The reason for the lengthy delay was that there were no available beds, but when he was eventually admitted and I visited him there are empty beds all over the place.  That was because those beds were out of service and that, in turn,was because the the hospital budget couldn't afford the nursing staff.   This in a country where the PM can afford to give a jihadi terrorist killer $10000000 of taxpayer's dollars.  Canada has to get rid of this confused PM!  Incidentally, my parking fees were $14 and I couldn't but feel sorry for folks who have family members in hospital for weeks.  Maybe a little of the terrorist reward fee could go towards helping them out.  I'm sure Canadians would rather see their tax dollars spent that way.
    Other issues were minor, a sprained ankle, a couple of teeth broken in an accident, shingles, a benign cardiac arrythmia.  
    Retirement is a full time occupation.
    I can't wait to see what next week will bring to the Honorary Doctor.

If yoi have any horror stories, or delightful ones you want to share leave a comment.