Sunday 26 May 2019

Don't shoot the Doctor!

   Just about five years ago I started warning you.   I warned you that euthanasia would be the thin end of the wedge.  I warned you that if you let the lawyers and administridiots decide that taking life is permissible, then they would want physicians to do the slaughtering just as they do with babies.  Politicians and administridiots, many of them lawyers are legislating when it is appropriate to take life.  Ours is a profession, dedicated to the preservation of life and the amelioration of suffering even when we can't cure the disease.  The Supreme Court of Canada, has just told physicians if you can't make your conscience acquiesce to what we tell you to do then you are free to seek another job!   If you won't kill people because the State tells you  it is what you need to do for the good of the 'State', Medicine is not for you!  Find another job.
   I warned you it wouldn't be long before scraping a few fertilized cells from the uterus would become morally equivalent with killing a newborn.  It has.
   I warned you that the indications for euthanasia would become unrecognizable and they have.  It is no longer acceptable to even use that word.  It slipped to 'assisted suicide' for a while, before that too became politically incorrect.   Now, ridiculously it has become MAID -Medical Assistance In Dying.  (After all, what sane person wouldn't like a maid?)
   The politicians and the administridiots are often very smart.  They start off cautiously when they support a new position assuring us their only motive is 'serving the people'.  Very often it is the bottom line they are concerned with..   It is very expensive to keep old people alive sometimes and if we can so easily dispose of neonates (the newly born) surely we shouldn't be too squeamish about helping the elderly on their way.  After all, they've had a long life and if they want to feel really good about it they can donate their organs while they are still alive.  Surely death by organ donation is as noble as one can get.
   Now let me give you one more warning.   Nepotism trumps everything, including money.  Even talking (or writing) about cannibalization indicates that's what some folks are thinking about.  After all, if my thirty four year old son needs a heart and your eighty year old father has one - hey folks, let's be reasonable, why should we spend a fortune on  someone who has had a good life and is going to die soon anyway.  "Let's give the 'old guy' a comfortable death," they say and give my son (who  happens to be a high-ranking civil servant who has served the state all his life) the break he deserves.   After all, he has so much more to offer the State.
   The 'Elites' are much more concerned with their own health, both physical and financial, than they are with yours.  I worked in the system for long enough to realize that when the CEO of the Hospital or whatever brought the deputy minister down to the 'Department' to introduce him  to  the Department Head, there was often another agenda.
   That's enough warnings for today, but fear not, I  have plenty more, not least of which is what will happen if the administridiots remain successful in determining the future role of physicians!
   If you are a patient or about to become one soon, don't read this blog.  It may kill you -sooner!

Tuesday 21 May 2019

A failing health care system.

   When I decided to emigrate to Canada, it was partly because I felt that I could live with her Health Care System.  I had been an Assistant General Practitioner in a practice in THE London, where I  worked for a group of physicians I liked and respected.  They reciprocated the feelings, at least based on the references they gave me.  (I still read them with some pride fifty-eight years later!).  They offered me a partnership arrangement, based on the prevailing arrangements of the day, which  I rejected.   One of the issues that prompted me to emigrate was the increasing influence of the administrators of National Health Service of Great Britain, not only on the delivery of health care, but on the quality of that care.
   Friends and colleagues have often asked me over the years why I decided to come to Canada.  particularly those who know of my close family relationships in the U.S.  The answer is relatively simple.  I  felt that Canadian medicine represented the best of the British and of the American system, while avoiding the worst of both.   Alas my opinion has changed over the years as I have seen the steady deterioration brought about by the politicization of health care.   We have gone from being one of the best systems in the developed world to becoming one of the most poorly rated.  The Canada Health Act has condemned Canadians to mediocre medicine at best, to shameful neglect at worst.  Furthermore the hubris of elected officials has assured that Canadians have been prohibited from seeking health care privately as is available in most of the developed countries in the world.  For the most part that has forced patients who are dissatisfied with the public system to go outside the country or to seek one of the low-profile sources that manage to exist because the prohibitions imposed by government are being challenged in the courts.  Unfortunately, the administridiots now control medical care and have turned it into a political game in which votes come first and patient care comes last.
   All of which is the introduction to one simple example I am  going to  share with you.  Because, even in this age of pseudo-respect for confidentiality, nothing is private, I will avoid identifying persons in this story that a friend of mine shared with me very recently.  The following account does not presume to record the actual clinical events in detail, but rather to give an overview of  my interpretation of what Rose told me took place.
   It was approaching midnight when Rose heard a loud clatter coming from the bedroom.   It was unusual  for Tom to still be clattering around at this time of night, so she went  into the bedroom to see what might be going on.  She was not a person who panicked easily, but when she saw her husband spasming on the bedroom floor, she panicked.  Even under those circumstances she reacted quickly and efficiently.  She called 911 and ran to his side to help in any way she could.  By then, he had stopped seizing.   The emergency response was timely and appropriate and Tom was taken to the nearest ER for management.  Rose was not allowed to accompany him  in the ambulance, so despite being thoroughly shaken up, prepared herself to drive to  Emergency to be at her husband's side.   
   Fortunately her neighhbour had been disturbed by the ambulance and came rushing over to help.
   "I think Tom has had a stroke  and they are taking him to  the Emergency Room.  They won't let me ride in  the ambulance so I  am going to drive right over there now." said Rose.
   "You can't  drive anywhere in the state you're in.  Let me grab my coat and I'll drive you to the emergency room."
   She dropped Rose off by the entrance.  Rose went in and introduced herself . The Doctor had seen Tom and had arranged an emergency CT scan as well as X-Rays and blood work.   Many hours later, when the tests had been completed and  interpreted, the doctor came over to talk to Rose.
   "Your husband has two tumours," he said, "one in the brain, the other in his lung."
   " Oh my God, what do we do now?" she asked, deeply distressed.
   "He needs to be evaluated by a neuro-surgeon and we are going to set up an appointment.  Meanwhile you can take him home now and we'll be in  touch with you regarding the appointment."
   "Will someone be seeing him tonight?" she asked.
   "Oh no," said the doctor.  "We will have to arrange an appointment.  You can take him home now and we'll be in touch with you."
    Rose felt a surge of panic welling up inside her."What if he has another seizure when I take him home?" 
   "We have started him on anti-convulsants and I will write you a prescription to keep him on, so that will probably keep things under control for the moment.  If he did have anything further in the meantime just bring him back here."
   Shaken badly Rose called a taxi and took her husband home so she could worry herself sick about him.
   A week went by and Rose had heard nothing. She had to phone the Emergency Department and her family doctor who knew nothing about the event.  
   When I talked to Rose a few days later she finally had a date for the appointment which had not yet taken place. Her stress level remained as high as one would expect.
  Now let me tell you how this would have been managed in the 'bad old days' when  I was a family doctor:
  The patient would have phoned the clinic her family doctor worked in, where a member of the group was on call on a twenty-four hour roster.  The patient would  have been patched through to the on- call doctor who would have met the patient in Emergency, examined him and prescribed what was necessary. This patient would undoubtedly have been ADMITTED to the hospital for observation and management and would have been seen as an emergency consultation by the neuro-surgeon in the morning,   Meanwhile, the family knew the patient (yes, I still call them patients!) was at least in a setting where immediate attention would be available if necessary.  Thus the patient was in a safe place where he would be appropriately monitored and the family/caregiver was relieved of some of the stress in a high stress situation.   
   These changes have come about because the administridiots that the Government put in charge of health care are more concerned with votes and appearances than with patients and they know it is easy to download the blame to the doctors and nurses and other health care workers on whose shoulders the whole system is carried.  

Many people share stories like this one with me. If you have one you'd like to share, contact me.  Obviously no identifying data would be published.



Tuesday 14 May 2019

Maybe a Funny Story! But who Nose?

   When I was a young physician,,  newly located in Regina, Saskatchewan, I was overwhelmed by the welcome that I received when I first arrived. People went out of their way to welcome us.  Some of the friends I made in those days remained my close friends until they passed on to the happier hunting grounds.  There are many stories about those days, some funny and some not  so  funny.  I write about them from time to  time.  I think is a funny one.
   When I walked into my examining room in the Department of Family Medicine at the new Plains Health Centre in Regina, Saskatchewan, I found a 'middle-aged' male looking at an article in Time magazine.  It so happened he was looking at a picture of a woman just one year older than me - Sophia Loren.  At that time, I thought that Sophia was the most beautiful woman in the world.  Enough said.
   "Ah," said I, "A beautiful woman."
   "Not so beautiful,"  he said sourly.
   I was immediately perturbed at my idol being thus dismissed.
   "What do you mean?" I asked.
   He spread out the "Time " Magazine in front of me.  "Look, she owes all of her success to her Jewish Producer," He pointed at the photograph of her, sitting next to Joseph E Levine.  It is true that Levine played a considerable part in Loren's success story.
   "Oh," said I taken aback. "And what makes you think he's Jewish?"
   "Just look at that Jewish nose?"
   Well, even in those halcyon days, a physician couldn't tell a patient just what he  thought of him.
   "Think that's a Jewish nose, eh!"   I raised my right fore-finger-tip to the tip of my own perfectly shaped nose. "You're wrong, THIS is a Jewish nose!  "
   The patient looked a little embarrassed and I was probably wrong to allow personal feelings to surface.  Too bad!   In retrospect, I think I reacted appropriately and would do the  same again, though probably with disastrous consequences.  I would still bet the bank that he didn't fill the prescription I handed him after I had dealt with  his medical problem.
   I'm glad I lived before the politically correct era !!
   By the way, I have enjoyed great mileage from relating this story at various celebrations!!

Tuesday 7 May 2019

Rules for Radicals. Pt.2.

"In the beginning, the organizer's first job is to  create the issues or problems"
Saul Alinsky, Rules for Radicals.

In other words, Alinsky is saying, that if there is no problem, there is a need  to create one.   Once created, if that problem catches the imagination of the public, it can destroy the status quo (i.e. go viral).    If the status quo can be destroyed, that leaves a vacuum for the 'New Society' that the LWLs (Left Wing Looneys) imagine they can impose on Canadians!

    In the previous century, to which I belong, liberalism meant fairness. My parents were liberal and most Jews were small  'l' liberals.   They needed a job, they wanted everyone to have a job.  They wanted to make a living.  They wanted to educate their children.  They were decent people who wanted to make a decent living for a fair days work.  They wanted to educate their children and they wanted their children to have a better standard of living than they themselves were able to attain.  That has all changed.
   Now, the "Liberal " leaders are multi billionaires.   The Left Wing Loonies, disguise themselves as 'Liberals' to protect themselves.  The most effective way that the 1% can protect themselves is by pretending that their mission is  to  improve the  lot of what used to be called 'the Working man'.   There is much less likelihood  of a rebellion if the 'elites' can convince the populace that they are working on their behalf.

   Alinsky's Rules (with my comments).
1. "Power is not only what you have, but what the enemy thinks you have."
This is a polite way of saying 'Bullshit beats brains.'. If you can intimidate the enemy sufficiently you are well on the way to winning. Much of the left's strategy is based on trying to intimidate their opponents, with considerable success. Their opponents are only just beginning to realize that defending themselves against baseless charges of racism and bigotry simply lends credibility to the charges. There is no reasoning with these people and the only rebuttal is to put their own behaviour and credibility under the microscope.

2. "Never go outside the expertise of your people.". Feeling secure adds to the backbone of anyone.
In other words don't let them catch you being in the wrong. Better to make no comment than to make an incorrect assertion that can come back to haunt you.

3. "Whenever possible, go outside the expertise of the enemy."
For the reason above - in reverse!

4. "Make the enemy live up to its own book of rules."
Study the enemy's book of rules and assertions. Catching them contravening their own codes damages their credibility.

5. "Ridicule is man's most potent weapon."
If one can effectively ridicule one's enemy and make him look silly you can undermine his ability to lead.

6. "A good tactic is one your people enjoy."
Puff them up, pump them up, make them feel important, no matter how unimportant the mission is.

7. "A tactic that drags on too long becomes a drag."
They have to feel they are achieving something important.

8. " Keep the pressure on. Never let up."
Make accusations, the more outrageous the better. If the lie is big enough it is likely to be believed.

9. "The threat is usually more terrifying than the thing itself."

10. "The major premise for tactics is the development of operations that will maintain a constant pressure upon the opposition." 

It is this unceasing pressure that results in the reactions from the opposition that are essential for success.
Relentless accusations tend to be believed, especially when a little salacious.

11. "If you push a negative hard enough, it will push through and become a positive."
Eventually you can aggravate your opponent into doing or saying something that is not in their best interests.

12. "The price of a successful attack is a constructive alternative".
Put forward any solution, even a weak or outlandish one - a lot of dopes will buy it anyway.

Enough of this for now.  Time to lighten up for a while.  A little light comedy next.