Sunday 26 November 2017

Health Care System is bleeding a lot faster than my Nose!! .

Wasting resources for a bleeding nose.
   A number of  years ago I had a series of nose bleeds.  I tend to take such events more seriously than I  might otherwise do, because I am on anti-coagulants (blood thinners).  It's not that the nose bleeds were severe, but with waiting times, between seeing my doctor and then being referred to an ENT specialist a fair amount of time passed between the initial incident and the specialist diagnosing and removing a small benign lesion to cure the problem.  Should I have any further episodes in the future I  was to come back.  Had I not been a physician and able to monitor my own anti-coagulant levels and adjust my own medications I anticipate that there would have been at least another three visits to my family doctor and perhaps even a couple of visits to the teeming overcrowded emergency room, to spend a few hours waiting to be seen and have the appropriate tests, etc.  Instead of one visit to the family doc and a timely referral to a specialist, our bleeding health care system generates multiple physician and lab visits, which  is not only expensive, but bad medicine.
   So, when I had a couple of very minor nose bleeds recently, I wasted no time.  Since our health care system requires  a new referral and the wait times are so lengthy I decided I  had to strike pre-emptively despite the fact that when I  had my blood test it was satisfactory.  While in an efficiently functioning health care system I would have been quite satisfied to wait and monitor my progress, knowing if I has a  serious nose bleed I could be seen by the specialist - in the emergency room, if necessary,  I know that in our system I would be seen by a medical resident and receive emergency treatment, usually after a lengthy wait and then had a consultation request for ENT which could well have taken months.   Instead, I made an appointment to see my friendly family physician and because the system wastes her time as well as mine, I had her review the three year old letter from ENT saying that they would like to see me again if there was any further epistaxis (nose-bleeds).  She obliged and now I have an appointment being set up, in case I need it.  In the meantime I have had no further nose-bleeds, but my doctor told me to go to emergency if I  do!!  It's a shame we have to work the health care system that way.
   The health care system is bleeding a lot faster than my nose!!

Saturday 18 November 2017

Opioids -damage control in a nation of victims.

   "Something," think the social warriors, "must be responsible for the lethal epidemic of opioid addiction (and almost every other form of addiction).  God knows, those suffering from every physical and mental pain that the human flesh is subject to, could not be to blame.  In fact, when it comes down to it, they must be the victims.  It must be the fault of those bloody rich, privileged physicians, brainwashed and bribed by the drug companies, that put patients on whatever medication will get them out of the office as quickly as possible."
   You may think I  am being flippant, but that's exactly what many folks think and are encouraged to think, by our elected leaders and their bureaucrats, in order to divert blame from  themselves.   It does not occur to them, or bother them that patients who are awaiting surgery for an excruciatingly painful hip or back,or whatever, are suffering during a deliberate two year waiting list and need serious relief from  their pain.   That the mild to moderate analgesics that their physicians start them on become less effective after a while and physicians are forced to titrate their patients pain with the most effective medications that are available to relieve it.   It does not occur to patients that the very lengthy waiting lists is a deliberate policy by their elected representatives to cut the health care budget under the pretense that it is due to a shortage of physicians and nurse.  It is not, it  is due to misallocation of funds that results in surgeons unable to get operating room time, despite empty operating rooms and nurses being unemployed.   They certainly don't consider Canadians first in allocating tax dollars, so we see the ridiculous payouts to terrorists and others to whom they dispense huge sums that would be available to treat our failing health care system.   They continue to  generate layer after layer of  administridiots,  who convince themselves that they are the health care providers and that doctors and nurses are simply their serf technicians That is why we, in Canada, are at the bottom of  the list in quality of health care, in almost every category, compared to other developed nations.  When physicians and nurses ran the health care services we were near the top.  
   When  patients are in  pain, physicians and nurses will do almost anything in their power to relieve pain  and  suffering.   So, a patient who is on a two year waiting  list and visiting their physician regularly, complaining quite justifiably of constant disabling pain, expects to have their pain relieved.  The administridiot, who never comes face to face with the patient, and is oblivious to the patient's suffering suggests that physician's cavalierly dispense narcotics to get the patient out of  his office or for financial gain.   No, the physician sitting across from the patient is trying to help the patient, to relieve his pain.  He/she tries to do this without addicting the patient to pain relieving drugs and sometimes this is interpreted as callousness, or indifference to patient suffering.  The College interpreted such complaints, whether justified or not as an 'under-prescription crisis' and instead of meticulously investigating and researching the situation began to 'educate' physicians to prescribe narcotics much more liberally, often assuming that addiction was rare in people who were prescribed narcotics liberally for the relief of pain.  Meanwhile opioid poisoning lands sixteen patients in hospital each day in Canada and there has been a 15% jump in the past ten years.  The administridiots continue to place the blame for this on physician prescribing habits and sometimes this is true and partly as a result of a concerted effort of educational organizations a few years ago that were encouraging physicians to prescribe narcotics very liberally to relieve non-cancer pain.  The results were disastrous, ranking Canada second only to the United States in opioid abuse.  In an attempt to correct the damage the Royal College of Physicians and Surgeons of Canada published the " 2017 Canadian Opioid Prescribing Guideline", a document so prosaic that a final year medical student could have written it.
   Meanwhile, what is the government of Canada doing?  Well, the Minister of  Health is planning to hold meetings on allowing different drugs such as heroin to be administered outside of  hospital settings: she plans to allow drug checking services at all authorized supervised consumption sites: she want the provinces to establish temporary overdose prevention sites. None of which is  likely to have much effect.
   In fact, there are some who recommend the decriminalization of all illicit narcotic use.
   Unfortunately, we are unlikely to make much progress in this area while the administridiots are making medical decisions that they are unfit to make.  The obvious first step is to rely on experienced health care professionals to develop whatever solutions may be available.
   Making marijuana and other drugs available for recreational purposes is going to compound the problem, not alleviate it.

Comment if you have any views on  this.

Wednesday 8 November 2017

Marijuana - Damage control.

   The lunacy of legalized recreational marijuana is almost upon us.  Reality forces us to accept that that is what a sizeable proportion of the public want and that is what the government want.  The public want it to help them to feel good, to  help them believe a host of things that are difficult to  believe, without a euphoric stimulant.  The government has more realistic goals.  First and foremost is the cash grab that drives pushers to push, second is the votes it wins them and third is the advantages they derive by keeping as much of the public as they can dumbed down.  Not to mention that many of  the 'elites' are consummate drug users themselves.
   One of the major concerns voiced at many levels has been the concern that road safety will deteriorate and the difficulty in discerning the degree of driver impairment in suspected cases of marijuana related accidents, will make offenders difficult to identify.  There is some good news for those with such concerns.  A company named Cannabix Technologies Inc., has developed marijuana breathalyzer technology and has filed several patents related to breathalyzer analysis for law enforcement and the workplace.  Some of the devices are for a marijuana ignition interlock device.  A marijuana Ignition Interlock Device ('IID') requires a driver to blow into a device installed in the car. The driver has to blow into the analyzer to confirm that he is not so loaded with marijuana that he is unfit to drive.  If he is so loaded that he is unfit to drive, the vehicle will  not start.   With regard to alcohol, an IID has been a requirement for drivers convicted of driving under the influence of alcohol or drugs for some time. Some families are voluntarily choosing to install  Ignition Interlock Systems in their vehicles as a precaution against  family members or friends driving under the influence. In our climate, a stabilizing component that is consistent in cold as well as humid  temperatures has been tested and seems to work well.
   Cannabix Technologies seems to be developing the technology to enable law enforcement agencies and workplace safety organizations to monitor traffic and workplace drug abuse.
   May they succeed in their efforts for everyone's sake.

Saturday 4 November 2017

Patients and Friends..

Patients and friends.

  The son of a very old friend sent my wife and me a beautiful memorial card he had printed in tribute to his mother, which incorporated postage stamp photographs of her at key periods in her life. His mother was one of the first patients I had in Canada when I started medical practice in 1963. She didn't actually choose me as her doctor. I was a new doctor in a large clinic and the busy established physicians used to offload patients to the 'new boys' to lessen their own burden. If the patients liked you they tended to stay with you because you were available. Thus were medical practices built in those days. Tweelee (that wasn't her real name, but the one she liked to be called by) became my patient and soon she and her husband became close friends with my wife and me. A life-long relationship that only death could end.
    The cover photograph was a beautifully composed picture of her, probably in her mid-eighties, sitting upright on a beautiful period couch, slight smile on her face, looking for all the world like a duchess from a previous century. Indeed, she so fit into that model of a duchess, that years earlier I liked to tease her by addressing her as 'Duchess'. I think she liked that.
    She was a remarkable woman. Born in Burma in the early part of the Twentieth Century, her father was in the British Military and her mother was a Burmese Karen, (Sino-Tibetan). She was one of the few Eurasian girls who went to a very select private girls school in England. She would return to Burma or travel around Europe and England in the summers with her uncle. After her schooling in England, her father sent her to 'Finishing School' in Paris, where Tweelee joked, she spent her time studying young Parisian Men and taking in the Parisian life.
    While returning to England on a ship, she met Ralph returning from his WW2 Navel Service and they fell in love, got married and lived happily ever after.
    Not only was she educated and elegant, she was eloquent. Sometimes it wasn't easy being her physician, because she had very much her own ideas about medical care and management. She loved to argue them, in her unique good humoured way and was always ultimately co-operative when she had finished extracting explanations. Exquisitely feminine, she was as tough as nails, when need be.
    Ralph and Tweelee were not only wonderful friends, they had values and principles that they lived by. They were fascinating. Impeccable manners from another era enhanced the remarkable tales of British Colonial life and Ralph's stories of his not inconsiderable adventures in WW2 , (particularly those aboard HMS Petard, a P-class Destroyer). His naval commitment continued for many years as Commander of HMCS Unicorn naval reserve division in Saskatoon. He and Tweelee were truly regal in their full regalia at the Royal United Services Institute functions in Saskatchewan, where Tweelee was often referred to as the real 'Commanding Officer'.
  Their wisdom, knowledge, incredible sense of humour, as well as their loyalty as lifelong friends have proven to me that that the old saw that a doctor should not have patients as close friends is poppycock! 
I miss them both.