MEDICARE?

I should mention that I started to practice in 1950, and at that time there was no Medicare, only a few Medical insurance companies.

Today we are feeling the result of the planners:

1. That 10+ years ago decided there were too many doctors, as they cost too much money.

2. That there were too many hospitals, and the patients did not need to stay as long in the hospital.

3. That there were too many beds in the hospital and if there were fewer, then the bill for patients staying in the hospital would be less.

4. That the patients were not patients, but rather clients &/or consumers. This was a figment of the imagination of MBA trained people, who seemed to have the idea they could plan things.

5. All doctors must have computer facility to get their lab and X-ray reports from whatever source exists.

6. All doctors should, apparently, look on Medline every time a "client" needs a diagnosis, as this would help s/he to make the correct diagnosis, and give the correct "approved standard treatment". I don't think there is time for the doctor to do this in his/her office ever, as it takes a long time to get on the net, put in some weird password, and get a garbled answer from some committee that thinks it knows everything about "standard treatment".

Have none of the planners and the committee members ever learned anything about DNA, and the fact that each persons' DNA is different from anyone else? This makes "standard treatment" wrong, as it will not treat every person correctly.

When I started practice in 1950, it was said that General Practitioners were correct in their diagnosis and treatment 60% of the time and Specialists were correct 80% of the time. Is seems that the planners think that with the computer, and Medline, that all doctors must be correct 100% of the time. I regard this as impossible in view of the differences in DNA, and the fact that many of my patients were not sensitive to whatever "standard treatment" that existed, and I have to change their drugs or their dosages to suit their drug sensitivity.

As a result of my talking to the representative of the Health and Welfare of Canada at a meeting of the Ont. Medical Association in 1981, where his trained seals were presenting papers on the fact that no one should give sleeping pills in anything but low dosages, and never more than for 2 weeks duration, and the patient should learn to go to sleep without pills. I told him that this did not work, and that one of my patients needed 375mg per day of Dexedrine to stay alert and awake in the day. He said nothing, but sent his spies to examine all my prescriptions and then asked me to copy all my files and the files from my hospital on 16 patients, and answer 4 questions. My answers and the copies consisted of 10" of paper, which I sent to Ottawa as of Dec 13/82. The following Jun 13/83 I got a letter canceling my prescribing rights for Schedule G drugs.The letter also stated that I had treated patients for Narcolepsy who had Schizophrenia, Manic Depressive Disorder, Low back pain, Alcoholism, and Arthritis, as if this were a crime. How niave could they be? Apparently they never heard of cormorbidism.

This result may have satisfied his rules of standard treatment, but then there are certain other effects.

It means that I am for the future years completely unable to properly prescribe for my patients. These bureaucrats seem to think they own the world and can control all the doctors forever, and that this is wonderful for them.

It ends up being useless for the patients, and certainly for the doctors, as the local provincial Colleges of Physicians & Surgeons believe that whatever the Health and Welfare in Ottawa does is written in stone like the Gospels.

It has taken many years, and still doctors are not able to prescribe sedatives, and Ritalin without the foolish interference by both the above groups with the necessary prescribing of sedation for non-malignant sedation, as well as the prescribing sedation for the patients with proven malignancy, as they apparently think that the patients with malignancy just might become addicted to the pills. My God! What difference does it make if you are going to live only 3-6 months if you are addicted to the sedative? This opinion is what I hear from my patients who have had cancer. I always have thought that the patient knows what s/he needs in most cases.

This opinion is anathema to the regulators of course, as they have never brought it up in their officious committee meetings, or if they did, they shot it down. The regulators apparently have never learned that the antidote for narcotics is pain, and that very few patients with severe pain ever get addicted to narcotics as a result.

Which means that the regulators, suffer from a lack of being able to think logically, and also of lack of ethics, and have little or no empathy or sympathy for people with chronic pain, no matter what it is due to. Just look at the literature for chronic pain, and you can see how many talk of the necessity of "learning how to live with the pain", and that pain clinics must be seen by all the pain patients, as they are the only ones who can be allowed to prescribe "bad pills", and that the patient must be counselled, and seen by psychologists, who know just how to get their thinking changed so that the pain does not bother the patient, because this is the cheapest thing the regulators can think of. I wonder just how much is spent on the consultations, and so-called psychotherapy of painful patients. I'm sure it is much more than the cost of the pills that work. I note that one pain clinic using Botox for pain is being criticized for not having proper research on the use of this, by randomization and placebo comparison. Look at my 2SD on my web site for my opinion of these types of research.

For instance, Calcium pills have been removed from the free supply for seniors, and for others on Disability and welfare. I would think that in my personal case it would be much cheaper for them to pay for my Calcium pills than for them to pay for my operation to replace my hip joints, and send me for physiotherapy in a rehab centre for 1-2 months. Of course lately the allowance for the rehab centres has been reduced in time as well, so it is almost useless to go there for 1-2 weeks, to learn to walk again.

Home care has been reduced recently in some patients I know of from 5 hours per week to 3 hours. Now, how in the world can an elderly lady or man look after their spouse under these minuscule helping conditions?

My cousin had a recent eye operation, and was sent home 2 days later and had to go to the local hospital 3 times a day for treatment of her eye, and changing the dressing, etc. Finally the hospital or someone decided that the VON should go to her house. instead. The lady is 81 yrs of age. This is more bureaucracy!

I note in the newspaper recently that there are 3 patients who are appealing to the Ministry of Health of Ont. to have their disability not canceled. Interesting isn't it. How did they suddenly become non-disabled. It must be some miracle, or else it is some more bureaucratic stupidity, fearful of helping patients, that it might not save money.

Are we so afraid that Medicare is going to cost more than the GNP? Maybe the governments, could pay some of the legislatures less, and raise the welfare patients from the 21% less payments, so some of them could buy food the last 2 weeks of each month, that they have been unable to do.

It is interesting that the Ont. legislature recently raised its pay 32%, and raised the doctor's pay 1.5% per year for 3 years, and never raised the welfare payments at all!

The new plans:

1. We must be more efficient, and engage in "evidence-based medicine". This means that no pills or treatments should be used or given to a "client" without some test done to prove that there is pathology in the "client".

2. We must have doctors in groups, with helpers–Nurse Practitioners, Psychologists, Counsellors, Secretaries, and there must be at least 7 doctors, all to take care of "clients" 24 hours a day 7 days a week.

3. There must be computer readiness, and codes to access information re the "clients" from the testing labs, or hospital if they went there. This supposes that each of the medical groups has the proper passwords, and the meetings to set all this nonsense up. This takes up the doctors' time and prevents s/he to be able to see the "clients", and is part of the burgeoning bureaucracy insisted on by the planners, who know that there should be reports of all the ongoing items, so these planners can approve of whatever treatments the "clients" get.

4. If the treatments, or prescriptions are not approved, then the doctors, or nurse practitioners will lose their privileges to prescribe, because this is absolutely necessary, as no one should be able to give pills or treatments that are not approved.

5. The "clients" who go to the group facility, must see whatever doctor, Nurse, Psychologist, Counsellor, Secretary or perhaps the janitor of the day before they see someone relating to their complaint. Of course if the complaint is not serious enough the "Triage" setting of the receptionist will not allow the "client" to see anyone, as it will cost the Payer (government) too much money.

6. Money spent on "client's" treatments should be as little as possible, and the pills to be prescribed should always be generic, as they are cheaper.

1. When I go to my doctor's office, I want to see the doctor each and every time, and to see the same doctor every time, and talk to s/he about my complaints re my health. I do not want to see different doctors each time, going the gamut of the 7 available ones. I do not believe that the electronic records which are supposed to be kept will contain the information that I give my doctor, and that the other 6 doctors, will not have that information, and will see me for the usual short time, (10-15 minutes) and therefore will not be able to treat me properly.

2. I have discussed this with many of my patients, and friends, and they agree that :

a: They wish to see the one doctor who knows them and their history, and hope he remembers the history.

b: They do not wish to listen to the virus nonsense, every time they have a cold or cough, but rather think they should be examined, and sputum samples taken, and given something appropriate to the colour of their sputum than just stating it is virus and given nothing.

This has happened to me twice. In 1975, I coughed from mid November till awakening one night in mid-February coughed twice, and could not breathe. I had stridor, and I went to the washroom nearby and tried to get a drink of water, but could not do it, so I went back and laid down in bed so I might last more than 4 minutes. I finally got some air in and out of my lungs, and could whisper to my wife to call my ENT doctor. He said bring me to the emergency, where we went through red lights. The doctor was in the emergency waiting for me and sprayed my throat and possibly my larynx with cocaine. This stopped the irritation, and the cough, and felt as if there were a tennis ball in my throat, but I could breathe again. This was a great relief. I stayed in hospital for 1 week with the humidifier running in the room, and on medication-Erythomycin which was no help. I went home and the next week I showed some slides to friends on evening, and during the night the cough returned, and the spasm, and I went back to the hospital for another week, with the humidifier and Tetracycline. This time the drug worked and the irritation stopped, and I spent 2 months at home trying not to talk. My wife stopped talking to me as I kept answering. The latter part of the 2 months were very quiet.

The cough recurred every year or so and when I took Tetracycline for 2 weeks at tab i qid it would stop, but at lower doses, or less time it would recur.

Two years ago I was coughing from mid-October to the week before Xmas, when I had coughed up a 1/4" x`1" dark greyish green sputum. I went to my doctor Dec 17, and he said he heard nothing and that it was virus, and gave me no pills. The cough continued and I went back on Dec 24, and he had me have a chest X-ray This showed a shadow at the right apex, and I was immediately given an appointment to see a chest surgeon. He did a bronchoscopic, under anaesthesia. He took samples, and no malignant cells showed, but the material grew Aspergillus T. He gave me some antibiotic for 1 week, and then changed it to Cipro for 2 weeks at about tab i tid or i qid. And after 2 weeks he stated that the shadow had cleared up. I never saw that X-ray report.

I again started to cough Jan 5/02 without sputum, and frequently developed slight stridor after each bout of coughing. I have wondered if this is not Pertussis. I have had no tests for this as yet. I saw a Respirologist in mid-March, and he said I had a virus and COPD, possible chronic Bronchitis, and Asthma, and gave me a steroid puffer to use to help my breathing. This did no good so I stopped using it. Finally I got some sputum samples which I finally got to see the result as I had asked them to examine it for fungus, and it grew Aspergillus, and Yeast.

As a result of this I finally got my doctor to give me some Cipro tab i bid for 2 weeks. After 1 week the cough lessened and disappeared. After stopping the Cipro the next week a lesser cough returned and it was productive of brownish sputum in small amounts, and this lasted for 10 days or so, and then decreased.

It is my opinion that I do not have much asthma or chronic bronchitis, but rather an infection in my larynx which causes this cough.

I am also very annoyed that every time I cough, I am told that it is virus, and think this is due to the mechanisms of the planners, who do not want anyone to get any pills at all. This makes me think these planners would like us to return to the conditions of treatment which existed before antibiotics, because no treatment is cheaper.

If we look at the above problem with the planning in the past, how must we think of the possible plans of the present planners to do anything that we would like to happen. The past story is so terrible, that one would expect the present plans to be equally bad!

September 10, 2002 Medicare2

I note that in the Toronto Star paper yesterday that they are congratulating themselves on the use of group, ICONS ( Improving Cardiovascular Outcomes in Nova Scotia) which has listed the treatments for post cardiovascular accident patients in Nova Scotia, resulting the 16% fewer readmissions to hospital in the year following their vascular incident."Cross-disciplinary clinical teams collaborated to make sure that patients received appropriate medication, as well as advice about how to maintain their health. Researchers monitored the results of treatment and fed this information back to the clinicians to further improve care. A patient stated that he is tested regularly and receives a lot of information about his medication and possible side effects. What has the most impact is the newsletter he gets from the project informing him about the results of patient surveys and offering tips about diet and healthy living. The paper stated that Mr. Romanow liked it, as it made substantial savings through fewer or shorter hospital stays."

More Control!!

Some of the ideas posed for the change of medical practise are:

1. 7 general practitioners, to be available 24 hrs 7 days a week.

2. 3-4 (likely more) nurse practitioners, likely also available 24/7.

3. At least.2 psychologists for 24/7.

4. At least 3-4 counsellors for 24/7. I note that these latter when used to help kids to grieve after accidents, make the emotional upsets worse, so we can check them off the list).

5. 3 receptionists to handle the incoming multitude of patients, for 7 doctors, some 24/7 as well.

6. 9 computers, as well as a server to keep all the histories, etc.

7. All above to be trained in the use of the above computers.

8. Of course these all must be housed in an appropriate location, with enough offices for all, enough parking for all and for the patients. A large enough waiting room for all the patients. In addition to sleeping accommodation for the male & female staff who have to be there 24/7. Are the regulators having to be present to see that the men & women stay in different beds all night and all day?

9. My question is: Who will have the money to build these monstrosities? Will OHIP build them and supply the computer equipment for free? I doubt it. The doctors will have no money, as they keep having the services they have to do, keep getting delisted and are not paid for, and the doctors have to spend more of their time to see patients to keep records of what was said, prescribed, and the side effects (not the benefits) of the medications, so they won't be sued, of if they are, the examiners will only believe the paper writing, not what the doctor says. It is most interesting to me that recent publicity on the ability of people to recognize lying amounts to only 50% of any group of people investigated, from parents, to children to lawyers, to judges, and psychiatrists and psychologists. However when the investigators use the PET scan they can apparently find that some people have differing areas of the brain light up when they either speak the truth or lie. I am waiting for this to be used on the doctors who are not credible at disciplinary hearings of the Colleges of Physicians & Surgeons, as well as their accusing women patients.

10. My answer is: The facile MBA's who think up these plans never asked a patient what he wanted about seeing his/her doctor at any time, and seem never to think what they would like to happen to themselves when they will have to go to these wonderful new installations, and be treated by a different doctor each time. (In the future the patient will only be allowed to attend once a month or less). He/she will likely see the janitor first, who will look at a flow chart and tell the patient (client) who will see him/her next or send the client home: The nurse partitioner, as is supposed to be cheaper, and only if this next flow chart is bad will the patient ever see a doctor.

11. There is going to be a lot of life style advice, and complementary medicine (read diet, Gingko Biloba, St. John's Wort, Tiger Balm, or whatever is the latest thing that is popular in the media and one the Internet groups who think up something from the ground, the trees, the fishworm, leeches, along with all the past things like rhinoceros horn, bear gall bladder bile, shark fins, raw fish, and many new things I have not heard of yet.

12. I am of the opinion, that doctors should be more independent and not have to kowtow to every regulator who seems to think that he/she can tell what is wrong with every patient from flow charts, and DSM IV. I particularly dislike DSM II. III &IV. I have read them.
This also means that the hospitals should not have all the doctors renting space in them, (it is likely that hospitals will demand that all general practitioners must rent space in their buildings) as these doctors will be picked on to behave like the hospital governing body wants. This tendency, is the result of power corrupting. And this is the history of present day medicine. Look at the number of guidelines at the present.

It seems to me that the MBA's who are making all these plans, have little empathy for patients, which is why they have begun to call them clients or customers. This means that the person who thinks like this will have less sympathy for the client's symptoms that if they thought of them as patients. As an example: When I was at the Montreal Neurological Institute int 1947, Dr. Wilder Penfield found that Dr. Herbert Jasper looked with some aspersion toward the doctors on the staff, and Dr. W. Penfield then asked Dr. H. Jasper to attend the McGill Medical School and take his M.D. degree. After this Dr. Jasper had a different attitude to the patients and the doctors on the staff. Therefore patients are never to be called clients or customers, or Medicare will suffer.

22Oct02

There have been recent articles and columns in the Globe & Mail and the Toronto Star about Medicare, and what the writers' advice consisted of. In addition there have alao been articles on the dearth of doctors in general practice in various areas on Canada.

Not one of these articles contain any opinions from the mass of patients concerned.

About 2 years after I graduated from Medicine at the University of Toronto, I thought one day that I regetted that I had not had enough money to spend each year in a different medical school in different countries, so I would have a more varied education, and understand different ways of thinking about disease.

From the present attitude of the Colleges of Physicians & Surgeons of all the provinces of Canada, it is obvious I would never have been able to get my license of practise, as I would have, as has been my wont to answer the questions on examinations according to my knowledge, and not that of the examiners!!

The present articles object to the number of foreign trained doctors in Canada at the present time who cannot get a license to practice.Looking back at my above statement, it is obvious that I would not have been able to practise medicine in Canada, without all the bureaucratic objections for many years after I had graduated.

The attitudes of the regulating bodies would not have known that I would think just like them.

The regulating bodies have the idea that anyone who has a thought that they do not approve of must not practise medicine.

A mind is like a parachute, useless unless it it open!

Where do the regulators get the idea that all the other countries doctors, do not think politically correctly, and that their education is not suitable or practice in this country?

I think that the reason is really restriction of the numbers of doctors available.

This is the reason that now there is all the movement for midwives, nurse practitioners, ujpgrading registered nursing assistants, and university trained nurses. I note that the nurse practitioners will be paid $75.000to $85000. per year. I do not see how the GP will be able to do this from his present reduced intake of money. I might just add that I never made that amount in any of my years of practice, and one year I paid no income tax. I also note that midwives get $1725.00 per confinment, while Obstetricians get $275.00 per confinement. This must be a cheaper way to pay for treatment?

If all these will be cheaper like the pay for the midwives, then the regulators will be at fault for bankrupting the country.

We need the doctors from other countries, to get their varied thinking, so we can learn from them.

Apr 21.04

I talked to one of the officials of the Ont. College of Physicians & Surgeons the other night. I mentioned that the MBA who were planning the Remake of Medicare did not ever ask doctors what they needed or thought necessary. His reply was that they asked the MBAs about this, and the MBAs replied that if they knew anything about medicine, they might be emotionally involved, and therefore could not make uninvolved decisions.

I wonder if the MBAs get married, can they plan their lives with their wives. Do they have to have a girl friend, so they (when with her) plan their lives with their wives, and visa versa?

This is so obviously illogical that I wonder where they MBAs got this idea pounded into their heads as if it was Gospel.This means that their teachers have shoved this idea into the heads of the MBA's, and are unethical teachers.

May 28, 2004

The OCP&S Dialogue arrived yesterday. I contains a large article on getting foreign doctors living in Ontario to be able to practise medicine in Ontario. Isn't that wonderful!

If they could recall a little history of the past, they would be able to realize That numerous professors of medicine and/or surgery came to Canada, perhaps on invitation, and these doctors did no have to go through the numerous beaucratic nonsensical paths to take a 2 or 3 year internship (after practicing medicine in their own countries, apparently without trouble), so that then they can take and exam in English (they might be better able to talk to their own countrymen than we can), and pass examinations. The requirement to pass examinations is to assure the regulating committees (who need to have something to do to justify their existence) that the new doctor will think like the Canadian doctors, and prescribe the same way.

This is another example of cookbook medicine. No doctor must prescribe anything that is not approved.

However, did the regulators ever learn that if everyone thinks alike, then nothing new is able to be attempted or accomplished. Therefore there will be no progress. Increasing regulations, are not progress, but are increasingly restrictive of progress. e.g. see the above comments on MBAs, and their illogical thinking.

The latest thing I saw on TV last night was that some father is being brought up in court because his son got sunburned, and he did not use a big enough number on the lotion given the boy to prevent sunburn. This seems to me to be very inventive legal posturing, as if the lawyers needed a job, and wanted to get paid for going to court.