Tuesday 27 November 2018

A Modern Medical Hero!

   If you have followed my blog even occasionally, you will be aware of my admiration for Dr. Brian Day, an Orthopedic Surgeon from Manchester, England, who spent most of his professional life enriching Canadian Medicine.  Dr. Day, practicing in Vancouver, British Columbia, established a clinic, the Cambie Clinic, that made available to Canadians, procedures that they would have had to wait years for, sometimes dying in the interim, or go to the United states or elsewhere to have that procedure carried out in a timely manner.   Despite delivering care to thousands of Canadians, who would have waited years to receive treatment or never have received treatment at all (we all die sometime!) the BC Government (perhaps embarrassed by their own inability to do the job), decided to put into force new financial  penalties, that would have put the Clinic out of business.  Dr. Day, after years of  costly litigation, so costly that most would  have been beaten into submission, finally won a significant victory.   The BC Supreme Court, sided with doctors, patients and private clinics that make available to patients treatment, at their own expense, that the government can't or won't provide in a timely fashion.  For now, the clinics will stay open and will continue to provide services to patients who otherwise would have to leave Canada to get treatment.  Unfortunately, the victory is temporary for the moment, but I do hope it indicates some perception of what is necessary to  prevent Canada from becoming a third class health care system.

  The Court's decision speaks for itself:
"In summary, for the purposes of the Injunction Application, I have determined the following:

a) Taking into account the circumstances of this constitutional litigation and a preliminary assessment of the evidence, the Plaintiffs have established that injunctive relief is appropriate in this case. I make that determination based on a preliminary assessment of the evidence and finding that the Plaintiffs have established that there is a serious question to be tried in that:

i. Some patients will suffer serious physical and/or psychological harm while waiting for health services;

ii. Some physicians will not provide private-pay medically necessary health services after the MPA Amendments take effect;

iii. Some patients would have accessed private-pay medically necessary health services but for the MPA Amendments;

iv. Some patients will have to wait longer for those medically necessary health services that could have been available but for the MPA Amendments and impugned provisions;

v. A sufficient causal connection between increased waiting times for private-pay medically necessary health services and physical and/or psychological harm caused to some patients.

b) The Plaintiffs have established irreparable harm in the context of a constitutional case that has proceeded in a manner that is consistent with public interest litigation in that some patients, but for the prohibitions, could have obtained private-pay medically necessary health services much sooner at a private clinic (such as Cambie) and the subsequent delay in receiving treatment causes some patients to endure serious physical and psychological suffering. The nature of this constitutional case complicates the assessment of damages at the interlocutory stage.

c) The Plaintiffs have established that the balance of convenience tips in their favour. This is so despite the Court’s conclusion that the MPA Amendments are directed to the public good and serve a valid public purpose. The Plaintiffs have tilted the balance by establishing that restraint of the enforcement provisions will also serve the public interest in that private-pay medically necessary health services will be accessible [throughout the course of the case]."

The decision can be downloaded and viewed here.

Thursday 22 November 2018

A minor medical inconvenience.

A minor medical inconvenience.

A couple of days ago I noticed I was low in a couple of the many medications I take. I phoned the pharmacy and they informed me that one of the medications that I have been on for eons was expired and they would have to contact the doctor for a renewal. They would let me know when to come in and pick it up. Two or three days later, I got the call. They had called the Doctor's office and the nurse (who knows me well) told them they hadn't seen me for a year and I had to see the doctor first. As I was out of my pills and my very own doc is out of the office more than she's in it these days, I knew I might be dead before I got the appointment. Since I attend the Family Medicine Unit at St. Joe's hospital, a teaching unit I always feel obliged to let students and residents have a learning look at me before taking over my own care! I can always get an appointment with a resident because they are always in need of bodies to inspect, palpate, percuss, auscultate etc.
I phone the unit. "My prescription has run out, I need to see the Doctor to get a refill. I need the appointment today. I will see anyone."
I had said the magic words.
"We can fit you in with one of the residents. Two 'clock or three?"
It was already one thirty, so I opted for two. "Who should I ask for?
"Oh it doesn't matter, just check in at reception and they will tell you."
That actually meant that they didn't know yet and that they would grab one of the residents who didn't look too busy.
I arrived at a few minutes to two o'clock and barely had time to open my tablet and start typing when the nurse came in.
"Hello, Stan, we haven't seen you for a long time so I thought this was a good way to drag you in. It's over a year you know and you need some updates in your shots and I wanted to talk to you about the new pneumonia shot." She checked my blood pressure. "Uncross your legs!"she barked.
She did it again. "There, that's better."

    She gave me a lecture about having a colonoscopy and staying up to date with my immunizations.   She told me I  should come more than once a year.  I nodded my head queisciently. 
She put me in the examining room. "The Doctor will be in in just a moment."
Again, I barely had time to fiddle with my digital toys when the door opened and a little girl came into the room. She looked about fifteen, a trifle over five foot tall and about 95lbs soaking wet! However, I had been in the game far too long to let anyone's appearance of youth fool me.
"Good afternoon Doctor, pleased to meet you," I said, shaking hands.
"Pleased to meet you, Dr. Smith," Ah, so she had been briefed.
"Are you a local grad," I asked her.
"No," she said, "I'm an Ottawa graduate, but my partner has a job here in London so I moved here."
The world has changed a lot since I was young!!
She gave me my prescriptions which was the reason for my visit and so that the appointment would really be worthwhile I got her to look at a little warty thing on my back, which she did willingly. It was nothing.
I guess she hasn't got to the stage yet of "only one complaint per visit!!!

    Oh, by the way, the pharmacy informed me that if I couldn't get a timely appointment with  my doctor a pharmacist could sign an interim prescription for only fifteen dollars!!

Saturday 17 November 2018

Smoke it, eat it, you can even...............

Cured Nutrition Cured Dough

  Even if you don't smoke or perhaps especially if you don't smoke, the 'Key opinion leaders' and your government are determined to make marijuana intoxication as available as possible.  You can smoke it, eat it or drink it, the elites who rule you don't really care as long as you are 'happy', top up THEIR treasury and remain sufficiently stoned to give them as little trouble as possible.  They don't even care if your kids get stoned, as long as they don't get blamed for it.  They want to outpush the pushers and usurp their millions and think they can do that because they have the law on their side - because they make the law!  They are well aware of the damage they are doing to the citizens and to the country, but they really don't care.  After all, they have only the next election to worry about.  If they win that there is nothing to worry about.  Their pensions are secure.  I will be supporting them for the rest of MY life.  You too, unfortunately, most of the folks don't seem to get that yet!!
  If you have any opinion make a comment!

Tuesday 13 November 2018

The Old quack Reminisces. Pt 4.

   The Medical Arts Clinic, where his Canadian medical career began, far exceeded his expectations.    Situated in a clean new medical building, it housed about sixty physicians representing general practice and most of the major specialties of the day.  About fifteen general practitioners worked shoulder to shoulder with general surgeons, thoracic surgeons, internists,pediatricians, radiologists, pathologists working together in an atmosphere of collegiality that, I am sorry to say, no longer exists.  Many of the doctors who founded the clinic, were WW2 veterans from the prairies, whose goals were to come back to Canada and establish a clinic comparable to the renowned Mayo Clinic, in Rochester, Minnesota.
   They were motivated primarily by idealism, not money and were largely successful in their endevours.  I was impressed, not only by their standard of medical practice, but by their decency as human beings.  As a new doctor in the clinic, I was assigned to a mentor, to whom I could turn when I had questions or problems and whose mission included 'keeping an eye on the new man'.   His name was Jamie MacIntosh and to me he was the quintessential Canadian.  Tough, no-nonsense, kind and compassionate, I can still hear his clipped Canadian accent - at least that's how it sounded to  this recent immigrant from the Emerald Isle.  A fighter pilot in WW2, he stayed lean and mean, smoked like a trooper and when  in  later years he sustained a heart attack, he got into his car and drove down  to  the emergency room and told them they better see him quickly because he was having a 'coronary'.  They did, and shortly after he had a cardiac arrest, was resuscitated, went back to work and practiced medicine for several more years.
   The young docs at the bottom of the totem pole in the Medical Arts Clinic got the house calls.  

He awoke a moment before the phone rang knowing it was going to scream at him if he didn't get it immediately. He got it at the first ring before it woke anyone in the house. She moved, turned and resumed her quiet snoring. He looked at the bedside clock. It was 2.55 am. He slid out of bed as he put the phone to his ear. It was the answering service "we have a call for you, doctor"  the operator said. 
"Take a number and tell them I’ll call back immediately" he said. He didn't want to wake the baby; he’d call back from the spare room.  Two minutes later he was wide awake and calling the number back. 
A female voice said "I have terrible stomach pains, doctor, can you send me something out?" 
 "I can’t send you something without seeing you" he said knowing he had just committed himself to a house call. "What's your address?" 
She gave him an address on the seamy side of town. He sighed "I’ll be right over. "

      A few minutes later he was in his car, braced by the cold Canadian winter. He hadn't a garage in those days, and after he had scraped the icy night from his windscreen, the frozen the base of his tires thudded him awake. The car thumped along the street, the bright moon throwing it's bluish white light against the snow, reflected back towards the sky. The car traveled across the city quickly, despite the icy roads as Stan piloted the car with the confidence of someone used to driving in these conditions, which he now was.  Not bad for a guy from the Emerald isle! As he approached South Railway and the CN station where he had first set foot in Regina the neighbourhood became perceptibly seedier, until he found himself outside a run down hotel. He checked the address.  There was no mistaking it, he thought gloomily, this was it. He pulled his car into the parking lot, left the engine running (he wanted it to be warm when he came out: if someone stole it, too bad), threw his cigarette away, picked up his medical bag and walked through the door into the dimly lit hall. There was no sign of any sort of caretaker or watchman around. He did have a room number, 23a, and he guessed that might be on the second floor. As he walked up the creaky staircase it seemed to get darker. He got a sour smell, a combination of beer, urine and tobacco. He walked along a stark landing and looked at the numbers. 23a somehow seemed to look worse than the adjoining rooms. The smell of urine seemed  overwhelming and the whole building seemed unbearably hot. He loosened his down parka and he felt the body heat it had captured waft past his face. He hoped it would be cooler in the apartment.  He decided to try one more time then he was going home. He banged on the door loudly this time, hopeful that it would not be answered. It was.

      The man who opened the door was a dirty and disheveled  and smelled of booze.
   ” Come in, Doc" he slurred. 
   Stan hesitated, and then walked into the sparsely furnished, dimly-lit room. He looked around. The room was shabby and untidy with a torn, shapeless sofa, on which a woman of about 35 reclined. She was clad in a black slip and not much else, held a smoking cigarette in her hand and took a deep drag on it before she spoke.
"Am I ever glad to see you, doc" she said.

"Good evening” said Stan,” I’m Dr.Smith. What seems to be the trouble" He wondered whether he should have framed his word differently, in the circumstances.

“I was to see one of the doctors in the clinic the other day and he said I have gall-stones, and if I get the pain again I am to call up the doctor on call for a shot of Demerol.  I've been in terrible pain all night" she said.   

      "Why did you wait until three o'clock in the morning to call me?” he asked.

"Oh, I didn't want to bother you, doctor," she said.

Stan sighed, "okay, step into the bed-room and I’ll examine you." 
 "oh,I don't think I need an examination right now, just give me the shot and I’ll come into the office tomorrow for a check-up."

Stan looked at the woman, apart from looking tired and dissipated, it was obvious that this woman was in no distress.

Stan, young, but not inexperienced, assessed the situation and now decided the time had come to be firm. This woman was obviously looking for drugs. He hadn't decided exactly what her relationship was with the shabby looking man.

He was now sitting in the room's solitary armchair chatting incoherently either with himself, or to Stan.  Stan caught "Party in Seattle and then this guy pulled out a gun." He decided it was time to be firm, deal with the situation and get out of the apartment as soon as he could.

"You either let me examine you or I'm leaving without prescribing anything. You don’t seem to be in any pain right now"

She looked as though she was about to tell him to fuck off but then seemed to think better of it.

"Well, if you could just leave me a few Demerol or Talwin pills in case the pain comes back during the night, then I’ll come into the office tomorrow for an examination" 
Stan was about to tell her that he was leaving nothing and if the pain came back she could go to the emergency room, when there was a loud knock at the door. All three occupants of the room froze. Stan clutched his medical bag with its considerable variety of drugs, tightly in his hands. No one attempted to open the door. Again a loud knocking, this time more insistent, demanding an answer. Stan was just on the point of quickly opening the door, walking down the corridor and getting into his still running car, when with a loud crack, the door flew open. Two men stood in the doorway. Stan sized them up quickly. One tall, fairly well dressed, tough looking, the other fat and rather shabby. Stan noticed that as the short, fat one burst into the room, his jacket swung open revealing a holstered gun. (Tomorrow's Leader Post headlines flashed in front of his eyes. "Young Physician shot in Drug Shootout") He clutched his house call bag firmly in his hands. If they got that it was going to be over his dead body! He decided that it was now or never. He pushed past the two men, hoping they would be so busy with the occupants of the rooms they wouldn't bother with him. He walked briskly down the corridor, head down making for the car, engine still running to keep it warm. He knew once he got there he would have no problem. He glanced over his shoulder - my God, they were after him. He broke into a trot, and so did they! He felt a heavy hand laid upon his arm as he was spun around. The small shabby man's hand went to his holster. Stan wondered whether to run for it.

"Sgt. Sam O'Hanlon, Regina City Police Dept." he said. ”Afraid you got caught up in a drug bust, doc." He shoved his police department badge under Stan's nose. "I just have to establish for the record that yo teve's nose. "I just have to establish for the record that you u didn't leave any narcotics at the address, so that when we lay charges they can’t say that it was just stuff the doc left."

Stan said, "no, I didn't leave anything"

"We may have to call you for evidence, doc."

Stan nodded "Okay, will that be all?"

"Yeah, that's all, doc".

       Stan walked out to his car. It was warm and cozy, as he drove himself home. He parked his car in his carport and plugged in the block heater so the car would start in the morning. He crept up the stairs so as not to waken the baby. On the landing he removed his clothes, slipped into the bedroom and felt the cozy warmth. As he snuggled up beside her she stirred.
       "Have you got to go out? " she asked.
       "No” said he.

Thursday 1 November 2018

Good-bye Canada.,hello Cannabis!!

Looks like the Future of Canada is in the hands of Big Pharma.  This is what I  received in my mail today:

Medical Cannabis: The Future is Now
Realities and Practicalities for Prescribers

Dear Doctor,

We are pleased to invite you to join Shoppers Drug Mart for an exciting educational event, Medical Cannabis: The Future is Now; Realities and Practicalities for Prescribers.
Shoppers Drug Mart will be hosting evening events in the following cities:
  • Calgary on November 6th
  • Vancouver on November 8th
  • Toronto on November 12th
  • Ottawa on November 15th
Each city will offer a unique, educational, and engaging experience. You will walk away with a better understanding of the science behind medical cannabis, including practical tips and clinical tools to capably and confidently authorize medical cannabis for your patients. You will also gain a solid understanding of the authorization process and of the next steps in treating your patients.
Shoppers Drug Mart is dedicated to providing the highest level of care to patients and wants to include you in this effort.
Please click the link below for more information and to register to attend.
Anyone who scans through my blogs knows I am no supporter of legal weed. It is a gateway drug that predisposes to addiction, psychosis, lung damage and probably brain damage. That the Canadian Prime Minister who was probably born with a high THC level and who witnessed the devastating effect the drug had on his own mother has so aggressively pushed this program forward must be more than a coincidence. Turning Canada, a nation with a devastating record of drug addiction into a major purveyor of marijuana is a great mistake. The hurried manner in which this was introduced assures us there will be no adequate technology to measure impairment in the automobile or the workplace. The combined effect of pot and alcohol will surely increase traffic fatalities and injuries as it did in Colorado. The health system spent millions of taxpayers dollars in guiding smokers to give up the habit, only to replace it now with a more dangerous one. Last week an alert mother picked up a weed impregnated candy that was given to her seven year old.
There are only two reasons for this unconscionable action. One is money and the other is votes. Some might suggest a third, to make segments of the population more easily manipulated.
The decline continues.