Wednesday 30 May 2018

The Decline of Canadian Health Care.

   That mainstay of medical diagnosis and of the doctor patient relationship, the annual physical history and examination is  under  attack.   The mandarins of medicine have decided that vital part of medical practice, the complete history and physical examination are non productive and too expensive to be universally applied.    Very sad, because for generations that consultation was the base of the pyramid of medical care.  There, the patient had an opportunity to voice his or her concerns to the physician, whether logical or not, have a hearing and an opportunity to determine whether the concerns were grave or not.  The doctor got to know the patient and the patent got to know the doctor.  The patient and doctor get an opportunity to decide if they are a good fit for each other and if their relationship is productive.   Every patient is an individual and requires some difference in approach and possibly differences in therapeutic approach.  The bureaucracy wants to make everyone the same, except of course, themselves and the elite that they serve.   Most of them have a background in  finance and business and knew nothing about medicine until they entered the political arena, after which they pooled their mutual ignorance to become self designated 'experts'.   They also decided that this was not only a good money making career, but possibly an entry into politics and a very rewarding way to garner votes.  They were prepared to make unrealistic promises that they thought they could bully a humanistic profession to make and they were right.   Early on, many physicians seemed quite happy to go along with promises the administridiots were making because it made them look like heroes too.  Unfortunately, it was not long before it became apparent that the bureaucracy wanted the kudos of providing health care at no costs to themselves.   In other words, they wanted the jobs, the pensions and the votes that a world class medical service would enable without doing the work or providing the services.  They wanted to gain their fame and fortune on the backs of physicians and nurses.  Shamefully, the bodies who should have been looking after the interests of both physicians and patients were timid and ingratiating and served neither the best interests of physicians or patients.   The game is still being played and choosing wisely, a program that could be valuable in helping to define what consultations, tests and investigations are being used unwisely is discouraging that inexpensive baseline of medical practice, the complete history and physical examination.
   No wonder Canadian medicine ranks eleventh out of twelve in the developed countries.
   Tragically, the Canadian public bury their head in the sand instead of demanding change.   Things can only get worse!

Thursday 24 May 2018

The Intern/Pathologist!

   He had missed the beginning of the Academic year, when all the internships and residency positions were matched, so he knew it wouldn't be easy.  He had arranged an internship abroad, but illness had forced cancellation.   Their meager savings weren't going to last very long.

    In those days in Dublin, teaching hospitals were smaller institutions, totally unlike the huge, impersonal institutions of today.   They inspired a fierce sense of loyalty and pride, and a feeling of competitive collegiality, that doesn't seem to exist today. That sense of loyalty extended as much to recent graduates as it did to professional forebears who had found fame and fortune in the medical texts, as well as consultants and teachers over the past couple of centuries.   So, it only stood to reason that he should start at the Meath Hospital, the breeding ground of such immortals as Stokes and Colles and Graves, many of whom had diseases or syndromes or clinical signs named after them.   This was the hospital he had done his undergraduate studies in so even though he  was out of sync with the clinical year he  was hopeful  that they would find a job for him.
     "We were on our way to Manchester, Connecticut, when my wife became ill and we had to turn back," he said to Dr. Pickles, the administrator.  "I know I've long missed the deadline for an internship, but I really need a job.  I can't afford to wait until the next selection date, which is more than four months away."
    "I'll do whatever I can," Pickles said sympathetically.  "All the regular internship positions are filled, but I'll try to find something for you.  Why do you look more familiar to me than most of your class?"

     Stan smiled uneasily, there had been one or two pranks in his student days that might have brought him to Dr. Pickles attention! "I guess you just saw me around."

     "Just give me a day or two.   Why not drop in on Wednesday, I'll probably have an answer for you by then.
     Stan  knew why he had looked familiar to him.   It was all about Dr Graves of international fame as the discoverer of thyrotoxicosis, also known as Graves Disease.  A bust of the Great Man decorated the main atrium of the Hospital, which was atop a broad flight of concrete steps.  Dean Eleftry, was an older medical student from Vancouver, BC, who had come to Dublin to study medicine.  He was a nice guy, who everyone liked to poke a little fun at because he was considerably older than the rest of students and also because he spent a lot of time polishing his little old Ford convertible.
      That night, a motley crew of students were heading back to the hospital after a good night at the local pub.  All three sheets to the wind, the older ones handling their booze a little better than the younger.

        "Let's do something with old Eleftry's car," Tom Snowdon said, in a loud self-assured English accent.  "I'm so fed up watching him polishing and nursing it, I think it's time we taught him a lesson."

        "Yes, maybe let the air out of his tyres," Pete Sangster responded.

         "For God's sake, don't be childish Sangster, can't you think of anything more original than that," Snowdon responded scornfully."

        The rest of the noisy group suddenly quietened down, wondering where this was going next.

        "Why don't we carry his stupid little car up the steps and deposit it in the main lobby of the hospital.  That would certainly create a little pandemonium in the morning." Snowdon said.

       Hoots of drunken approval emanated from the group.

       "We'll get into terrible trouble if we're caught," Stan said.

      "Don’t be such a funk," Sangster said contemptuously.

       The herd mentality was kindled and there was no stopping them now.                                          
     "Do you think we can lift it?" Sangster asked.

      "Let's give it a try," an anonymous voice suggested.

            As many pairs of hands that could squeeze around the little car tried to get a good grip on some lifting point and heaved.

            "It's as light as a feather," another responded.

            Twenty or so, able -bodied students lifted the car and slowly carried it up the twenty - eight concrete steps that opened onto the main lobby of the building.   Others held the large twin doors open, while the car was quietly placed in the centre of the lobby.

            "It looks wonderful there," drawled Ronny Snowden, "but it would look much better if we put that bust of Robert Graves behind the steering wheel."

            "Christ,"said Stan, "all hell will break loose."

            A contemptuous glance from Snowden, while  a couple of his followers struggled to get the bust into the front seat behind the steering wheel.

            "Let's put a scarf around his neck and a cap on his head, just to complete the picture," Snowden added.

            One of the more fashionable members of the group volunteered his scarf and rather racy hat which he carefully arranged to give the centuries deceased Graves a decidedly sporty appearance.   Even Stan had to admit that the effect was dramatic.  They stealthily withdrew to the students residence before releasing their whoops of apprehensive delight at their daring act.

            Stan awoke in the morning slightly hung-over and reflected on the previous nights action.  He got up as quickly as he could, anxious to see the damage.  He walked out into the courtyard.  About twenty maintenance workers were laying wooden planks in parallel tracks down the concrete steps.  The car, with Dean Eleftry sitting behind the wheel was purring gently, having just been driven through the twin doors and was now being secured by ropes attached to the front axle, so that it could be lowered slowly down the parallel planks to street level.  A large crowd stood in small groups at various vantage points around the courtyard.  Some laughing, some talking in hushed tones.  Dean was now anxiously supervising the maneuver to make sure his beloved car wasn't damaged.

     The next morning Stan was in the line-up that the students and interns were ordered to attend, when the perpetrators were exhorted to turn themselves in, so that the entire class wouldn't suffer the consequences for the desecration of the venerable and internationally respected [except by us!] Robert Graves.  Of course knowing that there's safety in numbers, no-one claimed responsibility and no-one remembered there ever being any consequences.  Steve hoped that was not why he was remembered by Dr Pickles.

   When he showed up at Dr Pickles office on monday morning he was greeted by a pleasant smile .

"I have good news for you, Smith," he said to Stan.  "Although all the regular internship positions have been filled, there's a vacancy in pathology, that normally would have be filled by a second year pathology resident, that we have been unable to fill, so we can offer that to you for four months and that will bring you into sync with the regular rotations. It will be quite a valuable experience as well as allowing you to earn some money "

            Stan was relieved to have a job, but a little apprehensive about his ability to do justice to a position normally occupied by a person with one or two years more experience than he had.

            "Thank you, sir, but do you think I'll be able to manage it satisfactorily?"

            "Oh don't worry about that.  You'll be working directly under the supervision of Dr. McMurray, and she'll give you all the supervision you'll need.  It will be a wonderful educational experience because there are no more senior residents between  you and your consultant.  You'll get the opportunity to do things that a junior rarely gets near."

            Monday at eight-thirty Stan arrived at Dr. McMurray's office, ready to start work.

            "Good morning," the pleasant -faced middle-aged secretary smiled at him.  Then, in a slightly remonstrative way, added, "Dr. McMurray is down in the morgue doing an autopsy.  She said that you're to go down there right away.  She starts at eight sharp, you know.  Don't worry  though, I'm sure she will take into consideration that it's just your first day."

            "Gee, I'm sorry, I thought we started at nine." Stan answered apologetically.

            "Just take the elevator at the end of the corridor down to the basement and turn left.  You'll see a big gray double door in front of you.  Walk right in."

            Stan followed the directions  and found himself facing the doors.  He turned the handle and walked in.   The smell of formaldehyde was overwhelming.  Standing at the operating table was a woman clad in operating room attire, a scalpel in her hand and so pregnant that she could barely reach the corpse.

            "I glad you could make it," she said irritably. "now get yourself gowned and gloved.  I need a hand."

            "I'm sorry, Doctor, I thought we started at nine.  I should have checked with you.  It won't happen again."

            As he slipped off his jacket and tie and secured the rubber apron that protected him from neck to ankle he felt like a butcher about to butcher a carcass.  He pulled on a green gown, tied it up at the back and stepped up to the mortuary slab.

            "Okay," said Dr. McMurray, "step up here and get another suture around the esophagus, above the one I've already secured, I can barely stretch that far, with this in front of me," she said pointing to her swollen belly.

            Stan leaned forward, still a little shaken from what, in those days was the rather bizarre picture of a very pregnant woman doing an autopsy.

            "Okay, cut right here, between the two sutures, then dissect away from the posterior thoracic and abdominal wall right down to the duodenum, and then cut between the lower two ligatures that I had secured earlier.  That way we can get the whole segment of bowel out, without spilling gastric content all over the peritoneal cavity.  Unless, of course, you puncture the bowel wall.  And, by the way, don't get a fright when Jim starts the saw going.  Jim, this is Dr. Smith," she added by way of introduction.

            Jim was the operating room orderly.  He nodded his head at Stan and smiled.

            "Ah, you'll get used to all this stuff quickly enough, doctor.  Just don't mind the noise."  He added this as he continued a transverse scalp incision and then pulled the apron of scalp forward to cover the face.

            Meanwhile, Stan continued his dissection carefully, anxious to avoid the humiliation of perforating the bowel, let alone the miasmic odors that would follow.  The loud vibrations of the saw cutting through bone provided the background for the next half-hour, while Dr. McMurray carried on dissecting and supervising Stan at the same time.  Following the gross dissection, Dr. McMurray showed Stan how to section the removed organs and place the specimens in formalin for later histological microscopic examination.  They were all finished before noon.

            "Do we have another to do this afternoon ?" Stan asked.

            Dr. McMurray laughed.

            "We don't kill all our patents, you know.  I've assigned you to Tom Morgan, the chief laboratory technician.  A good pathologist has to be able to do and to supervise everything a technician can do."

            Stan thought it would be imprudent to mention that he had no interest in being a pathologist.
            Between autopsies, learning to do routine lab tests, clinicopathological conferences and the general house staff call he had not escaped, Stan kept busy.  He slept in the hospital only when he was on emergency call.   
            For some reason he could never figure out there was an extra small stipend for doing an autopsy and this make a big difference to a penniless intern in those days when an intern got nothing like a living wage.
             So when Dr. McCarthy went into labour a week later, he was more than willing to do the autopsies despite his lack of experience!  

Tuesday 15 May 2018

O Cannabis - our new national Anthem.

   Canada's claim to fame in the 21st century may well be being the first pot producer on the New York Stock exchange.  Indeed, drug pushing may be one of the very few things we are exceptional  at, as Canada earned a "C" rating in global ranking as investment levels  slump, ranking 12th of 16 developed countries for innovation.    "Indeed" is a job placement agency headquartered in Austin, Texas. Looks  like Cannucks are employing them to recruit for our drug pushing industry,though you'd think that would be something we could do adequately ourselves!!   Read on!  RN/RPN 
O Cannabis Clinic - Scarborough, ON
Full-time, Part-time.Find similar jobs: RN Rpn jobs - O Cannabis Clinic jobs


O Cannabis Clinic is a Nurse Practitioner led medical cannabis clinic. We are growing rapidly and require more RNs & RPNs to join our team!
The successful candidate will:
  • ‪‪Be excited to work in an emerging and evolving healthcare field
  • Be willing to work from home
  • Have a good quality computer (or be willing to get one)
  • Have strong internet connection and webcam
  • Accountable for own actions and decisions, comfortable making decisions within the scope of the position
  • ‪Be passionate about providing exceptional patient care
  • Excellent written documentation skills that are clear, thorough, concise accurate and timely
  • Be in good standing with the College of Nurses of Ontario
  • Have liability insurance
The successful candidates will receive training on company assessment policies, medical cannabis, and the current Health Canada Access to Cannabis for Medical Purposes Regulations (ACMPR), though prior knowledge is an asset.
Responsibilities include:
  • Screening patient charts to determine if patients have met the requirements to be eligible for a medical cannabis consultation
  • ‪Maintaining detailed EMR notes and records
  • Providing counseling and educational cannabinoid information to patients about medical cannabis
  • Performing consistent follow-up with patients
  • Helping with current research studies
Hours & Availability:
  • We have both FULL & PART time positions available now.
  • We have schedules available 7 days per week.
  • Daytime & Evening.
  • Our clinic is open 9am-9pm M-F; 12-5 Sat & Sun.
Job Types: Full-time, Part-time.

Ah well, perhaps some of the taxes that will be generated may be used to prop up our failing health care system as well as generating a whole new layer of bureaucrats!

Tuesday 8 May 2018

Medical Malapropisms etc.

     Someone sent me the list below a few days ago.  Quite funny, but they pale in the face of medical malapropisms which can often be much funnier, for instance the patient in my early days of practice in Dublin, who informed me she had 'High - pretensions' or another who informed me her doctor told her she had 'Acute Vagina'!  God help the poor doctor who would be accused of saying that today, even though it be a medical malopropism. 
     Men, commonly mislabeled their prostate as their prostrate.
    Some other terms from my student and intern days in Dublin:
     Bilious - meaning naseated
     Grippe - meaning the 'flu'
     Fester - meaning pus forming or suppurating
     Chillblains - small cyanotic (blue-ish) inflamed areas on hands and feet due cooling and then rapid heating in front of the fire.  Were very common in all age groups in the winter.  In half a century of practice in Canada I have never seen one.  I had my last one when I boarded the Empress of England (Cunard Line) en route to Canada.
      Beeling - throbbing
      Nerves - meant anything from mild anxiety to major psychotic disorders.
      And of course 'Liverish', which has 93 synonyms!
      There were many others that I can't remember that I will try to recall.
      Equally quaint to my ears was when I first had a nauseated patient in Canada tell me that he felt as though he was "going to toss his cookies!"

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If you have any quaint or amusing examples, please send them to me.