Wednesday 18 December 2019

Sleepless in London! Anesthesia Department Problems.

One of the worst nightmares of any university department head is to have his department lose its accreditation. After all, the whole justification for the existence of clinical departments is to teach the expertise of which the members are supposed to be the ultimate arbiters and teachers. The humiliation of having a group of carefully selected experts decide that your department doesn't cut the mustard is extreme and the prospect of the department members (and everyone else) working through and addressing the identified shortcomings is painful. I know, I was there once. Although it is rare for provisional accreditation to lead to total withdrawal of accreditation it can do and the re-assessment in two years time had better show that most if not all of the recommendations addressed have been carried out. Otherwise you may be out of business!
So I was more than a little surprised to read in my local newspaper that the accreditation team found that the anesthesia program at the esteemed (they told me so themselves) College of Medicine of the university of Western University not worthy of full registration.
There are numerous reasons why a department may fall short of meeting some of the requirements, many of them not related to the standard of medicine practiced though that of course is a prime concern.
The prestige of the teaching program as well as the performance of its students in national qualifying examinations is another. The excellence of the program as perceived by the participants is crucial. No resident wants to be in a program struggling to maintain its accreditation.
The contribution that the department makes to new scientific knowledge is reflected in numerous ways. Clinical research resulting in publications in prestigious medical and scientific journals, particularly those with an international reputation is the most desirable, but there are other acceptable if less envied ways of enhancing the departments stature. For instance the development of new teaching or evaluation methods, or advancement of practice techniques may make significant contributions and be recognized as such.
Administrative issues can play a major role in determining the success of a department. A well run department optimizes recruitment of quality faculty and residents which further enhances the department and makes it desirable to subsequent excellent candidates.

It will probably be a few weeks before the accreditation report is published. It will make an interesting read to an old has-been department head!

Monday 9 December 2019

Not the Canada I emigrated to!!

Canada has changed greatly since I emigrated to this country in 1963. I had the good fortune to move here at a time when the pioneer spirit was still alive and well in many Canadians. I moved to Regina, Saskatchewan and my family and I received a warm welcome in that cold climate. The people were tough but very friendly and helpful and there weren't many wimps around. Folks worked hard and a -40F (which is where Fahrenheit and Celsius meet) day was lightly referred to as 'a brisk day'!  People were caring and efficient.
Things have changed greatly!  

A few days ago I went to the Post Office to buy a few stamps. The man behind the counter said, "Sorry, we're out of stamps."
I gazed at him blankly, wondering if I had somehow misheard him or he had misunderstood what I wanted.
"Er, just ordinary local Canadian stamps!" I said.
"Yes, we are out of them!" he smiled blandly.
"I'm not looking for Collectors sets or anything," I reaffirmed," just ordinary stamps".
He smiled some more. "Yes, we are out of them," he repeated. 
"When will you have some in ?" I asked.
"I don't know," he said, shrugging his shoulders. 
I had a letter in my hand I wanted to mail. "How about one local stamp, I have an important letter I'd like to mail now?"
"I can let you have an international stamp," he said, "but it will cost more."
"No thanks," I said, and walked out.
No wonder the country is going down the drain!!

The very same day I needed to get my multiple medication prescriptions refilled.
I phoned the drug store. It was Saturday. One of my prescriptions, a rather vital blood thinner that I have been on for years had run out of repeats. Somehow it had gotten out of sync with my other meds.  
"Sorry, we can't refill this until we get a repeat prescription from the doctor."
"I have run right out of them. I have been getting them from you for years, can you give me a few until I get the doc to phone in a renewal?"
"Sorry, we can't do that, we'll fax the renewal over to the doctor and you can get them as soon as we hear from her."
"Yes, but it is only Saturday, by the time that will be ready it will be Tuesday. I can't wait that long." said I.
"We can get an Emergency Pharmacist Prescription in circumstances like this, but it will cost you $15."
I objected to that on a principle that I don't want to go into here.
"I'll phone the doctor," I said.
I phone the Western University Family Medicine Unit, the teaching clinic where my doctor practices.
"Hello, I urgently need a prescription to be refilled. Can i speak to the Resident on call ?" I know there is a resident on call - I used to run a Department of Family Medicine.
"I'll put you through to the Nurse on call."
"Are you a Nurse?" I ask.
"No, we are a call centre," she answers.
"And where are you located ?" I ask out of morbid curiosity.
"In Northern Ontario." she answers.
"So you can't put my call through to the resident on call ?"
"No, I can only have the nurse on call phone you back."
Okay, I say and give her my phone number.

  A while later the nurse calls me back. Pleasant, polite and helpful, but she has to go through the whole history algorithm which takes a considerable period of time. Although I had been on this medication a very long time, from this same pharmacy and was just requesting pills to tide me over for a few days, their failure to exercise a modicum of commonsense resulted in five people wasting time. To cut to the chase, the nurse informed me she would get through to the resident on call and ask her to call the pharmacy. She would call me back to let me know I could pick up the prescription right away or if there was any obstacle. This she did and I got my prescription.

This is Monday and I stopped by at the local Canada Post Office to pick up the stamps they were out of on Saturday. They were still out of local stamps, but were expecting them in any minute!!   I went to a local chain drug store. They had all the stamps I could use and would give me discount on seniors day, to boot.
I guess free enterprise really does work better.