Did doctor warnings reduce car crashes?

By Julia Belluz - Wednesday, September 26, 2012 at 5:54 PM - 0 Comments

Getty Images

To this day, Dr. John Crosby, a family physician in Cambridge, Ont., remembers the scene perfectly: “She chased me around my waiting room with a walker, screaming and yelling.” The doctor dodged in and out of chairs to avoid getting beaten. “She” was one of his patients. Months later, when she was admitted to hospital and Dr. Crosby went to visit her, she greeted him with: “Oh! If it isn’t Big John Crosby.” She’d never forgive him, she said, not even on her deathbed.

The offense? Dr. Crosby had reported her to the Registrar of Motor Vehicles because she had dementia, and by his calculation, was a potential hazard behind the wheel. In Ontario, according to the Highway Traffic Act, physicians are legally required to report patients who are suffering from a condition that may impair their ability to drive. This is part of their role as guardians in our society, alongside other unpleasant duties like filing reports about gunshot wounds or suspected child abuse. But just because it’s a legal and professional obligation doesn’t make the task any less painful. “It’s one of the hardest things,” said Dr. Crosby. “Patients are always furious with you, no matter what.”

This is why doctors dread telling patients they may be unfit to drive, and it’s why, in 2006, Ontario introduced a financial incentive—$36.25 that doctors could bill the province—for each time they tell on a patient.

Six years later, a New England Journal of Medicine study released today, finds that the rate of reporting by doctors has increased since 2006 and patients who’d received a formal RMV warning were 40 to 45 per cent less likely to be involved in a serious car crash. “In our study, the baseline risk in this cohort of patients was 4.7 serious crashes per 1,000 drivers per year,” said Dr. Donald Redelmeier, a senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and lead author of the report. After the warning, the risk came down to 2.7 serious crashes per 1,000 drivers per year.

Continue…

When your doctor is an addict

By Julia McKinnell - Wednesday, September 26, 2012 at 11:30 AM - 0 Comments

Showtime Network/Everett Collection

The pill-popping habits of TV’s Nurse Jackie may amuse audiences, but picture the real-life paramedic who pockets the morphine and shoots you up with saline as you lie there writhing in pain. He doesn’t care about your bone-crushing accident. His mind is focused on his next fix.

As implausible as it sounds, health care workers routinely steal patients’ drugs, says New York anesthesiologist Dr. Ethan Bryson. The horrifying case studies in Bryson’s new book, Addicted Healers: 5 Key Signs Your Healthcare Professional May be Drug Impaired, are designed to help patients, colleagues and family members identify addicts and get them to rehab.

“There is a myth in our society that the people who choose to become doctors, nurses and other health care workers are somehow different from everyone else,” Bryson said in a phone interview from the Mount Sinai School of Medicine where he is an associate professor in anesthesiology and psychiatry. “We come to our profession with the same propensity for addiction as the general population.” In fact, he estimates 12 to 15 per cent are addicts. “Because they have access—and because there’s this false thought that because they’re medicines, they’re somehow safer—they are more likely to become addicted to prescription drugs, and when they do, the consequences are severe.”

Continue…

The shouting continues

By Aaron Wherry - Friday, July 13, 2012 at 2:46 PM - 0 Comments

Bal Gosal was interrupted again this morning.

See previously: Another news conference crashed, Bal Gosal gets interrupted, The Conservatives vs. the doctors and ‘Members of the Conservative government will be disrupted from this point on’

Bal Gosal gets interrupted

By Aaron Wherry - Tuesday, July 10, 2012 at 5:53 PM - 0 Comments

Doctors opposed to the government’s cuts to health care for refugee claimants confront a third cabinet minister.

Amateur Sport Minister Bal Gosal was speaking at a promotional event for the 2015 Pan Am Games in Toronto when he was interrupted by four doctors wearing their white coats who approached the stage yelling. ”What about health care for refugees? What about medications for our patients?” yelled the protesters. ”How can you look your cabinet colleagues in the face?” added Gary Bloch, who identified himself to reporters later in a scrum as a family physician at St. Michael’s Hospital in Toronto. ”Ask Minister Kenney why diabetics can’t get insulin,” another doctor added as Gosal stopped his remarks.

See previously: The Conservatives vs. the doctors and ‘Members of the Conservative government will be disrupted from this point on’

Lessons from a year of ‘Science-ish’

By Julia Belluz - Thursday, May 31, 2012 at 6:28 PM - 0 Comments

Left: Erik K Veland/Flickr Right: ShironekoEuro/Flickr

It’s been a year since Science-ish launched with the aim of scrutinizing the news coverage of health topics, and holding politicians, opinion leaders and journalists to account for misusing or misrepresenting science. The modest goal of the blog was, and remains, to help readers wade through the evidence on a given subject and get a sense of what the science actually shows.

So what has Science-ish learned in 12 months of fact-checking the reporting on everything from the health effects of asbestos, to whether the benefits of urban cycling outweigh its harms, how and if cancer screening will save your life, the “cures” for autism, dubious mental health statistics, and just about every health story in between? Here are five key lessons for telling science from science-ish:

Continue…

Do doctor bonuses actually improve health care?

By Julia Belluz - Thursday, April 5, 2012 at 1:18 PM - 0 Comments

Erik K Veland/Flickr

You get what you pay for, right? It’s taken for granted that this holds true when it comes to using financial incentives to improve the quality of physician care. For example, if a GP gets a smoker to quit or a doctor at the hospital treats a heart-attack patient with the best medicine, they’ll be paid extra.

Intuitively, this makes sense: rewarding physicians for providing better care should, theoretically, boost quality and lead to improved health outcomes. That may be why “pay-for-performance” schemes have been touted by policymakers around the world. The Affordable Care Act in the U.S. advocates the use of pay-for-performance programs at hospitals. Britain and Australia have already ushered in these compensation models at the primary-care level. And here in Canada, health-care observers have long argued that rewarding and incenting quality among doctors is the way forward.

But what about the evidence?

Continue…

Hacking health care–in a good way

By Julia Belluz - Monday, March 5, 2012 at 2:33 PM - 0 Comments

Toca Boca/Flickr

Dr. Shaheed Merani had barely finished his morning coffee last Saturday, when the solution to a tech challenge that’s plagued his work as an Edmonton hospital resident was almost at the prototype stage.

It was day one of HackingHealth, Canada’s first health-focused hackathon. Nearly 70 health professionals like Dr. Merani had flown in to Montreal from across the country for one purpose: to connect with some 160 designers and developers, and tackle the tech issues that bog down their professional lives.

The event was inspired by the programming jam-sessions run by giants like Facebook, where computer geeks get together for a day or so and, in Red Bull-fuelled bursts, design new website features, games or apps. HackingHealth, though, was devoted to solving problems in that most sluggish sector: health care.

Sitting at a lunch table on the McGill University campus, three coders quietly but furiously clicked away on their laptops, working on the solution to the conundrum that’s been frustrating Dr. Merani and many of his colleagues: the anachronistic domination of pagers and fax machines in hospital communication. Right now, Dr. Merani said, physicians often use instant messages to discuss a patient’s case and its developments, but those texts aren’t captured in patient files. Also, docs are required to file orders for prescriptions and medical tests via fax—which is more complicated and slower than sending them via text. Continue…

Are Canadians bribing their doctors? Tell us your story.

By Richard Warnica - Tuesday, February 28, 2012 at 12:09 PM - 0 Comments

Truthout.org/Flickr

Any good thriller needs great characters to succeed. And the cast in Quebec’s still unfolding pay-for-play medical scandal are certainly that. On the one hand, you have the accuser, Valery Fabrikant, a notorious murderer enjoying a second life in prison as a litigious scourge. On the other, you have Andre Pasternac and Mark Eisenberg, respected cardiologists accused of committing a very un-Canadian sin: taking kickbacks to influence Fabrikant’s care.

The details of the plot are so juicy they may obscure the real story here. In the days after the Montreal Gazette broke the news that Pasternac and Eisenberg face disciplinary hearings over their conduct, the paper says it was flooded with other tales of patients paying off doctors. It isn’t the first time, either. The Gazette‘s Charlie Fidelman first reported on this story in 2010. Then too, he she received tips from numerous patients who say they were asked to or did pay to move up waiting lists. At least one “prominent” doctor told Fidelman the practice was “systemic” in Quebec and “an open secret.” Continue…

The Layton intrigue

By Aaron Wherry - Tuesday, March 22, 2011 at 10:50 AM - 33 Comments

A month ago, Stephen Harper invited Jack Layton over for a chat. Afterward, the NDP leader listed five “proposals” for the federal budget:

1. Remove the federal sales tax on home heating bills.
2. Restore the EcoEnergy program.
3. Increase the Guaranteed Income Supplement to aid vulnerable seniors.
4. Strengthen the Canada Pension Plan
5. Improve access to family doctors.

According to various leaks and hints, it seems the EcoEnergy program will be renewed, some kind of assist for vulnerable seniors will be provided and student loan forgiveness will be offered to new doctors who choose to practice in rural areas. Depending on what else is included, that’s three (two and a half?) out of five and so whether or not the budget passes would seem now to depend on whether that’s enough for the NDP.

There is some question now as to whether Mr. Layton will announce a position today or tomorrow. I’m told no decision on timing has yet been made.

In the meantime, Rob Silver considers the long, meaningful history of the EcoEnergy retrofit program.

TV: Besides Cops, Lawyers and Doctors, What Else Is There?

By Jaime Weinman - Wednesday, January 26, 2011 at 12:08 PM - 24 Comments

I don’t comment too much on pilot pickups because most of them will never see the light of day. (I want the networks to bring back those summer shows where they burned off the pilots they rejected for the upcoming season.) But on a comment thread on another site, I noticed some understandable frustration that most of the drama pilots fall into the usual categories: Doctor show, lawyer show, cop show. CBS in particular has almost completely given up pretending they care about anything else; no more Jerichos or Viva Laughlins, just more cops, more lawyers, and their highest priority is finding a successful medical show. But most networks are heavily oriented towards crime and doctor shows, with the occasional science fiction or period pilot to leaven the mix. NBC may have ordered a “complex, sprawling” epic ambitious pilot from the creator of Syriana, but it’s still a crime show with cops and criminals when you come right down to it.

So, yes, this can be very tiresome. You look for variety on TV, and what you get is mostly a limited range of shows about a limited range of jobs. But I’m a little more sympathetic to the broadcast networks once I try to think out the obvious follow-up question: what kind of jobs are appropriate for a network TV drama? As I’ve said in the past, most TV dramas are really melodramas — it’s very tough, no matter how ambitious you are, to make a continuing series about ordinary life, because the stakes are too low for 13 episodes a season. Bump it up to 22 episodes or more, as on broadcast TV, and it’s even more imperative to have really high stakes. Meaning that slice-of-life dramas are more or less ruled out. They usually can’t sustain a full season.

That being the case, network dramas need melodramatic situations that can spin off a lot of episodes. But here’s where the choices narrow even farther, because there are other things a network drama needs besides melodrama. There needs to be a setup that can bring in new “cases” every week, not only because the network needs something to promote, but because it provides a self-contained element that new viewers can grab onto — and regular viewers can follow as a diversion in case they’re getting bored with the relationships. (Not every successful show is a serial, but most of them offer something new or interesting in that particular week, which often comes from an outside character wandering in with a case.) And they need to be cases that have some kind of high-stakes, even life-or-death component to them.

Which is why doctors, lawyers and cops are such reliable subjects for a TV series. They have jobs that are about life-and-death issues — mostly death — and allow guest characters and new stories to walk in any time. They spin off stories with clear goals: save a life, win the case, catch the crook. And they are about people who deal with outsiders every day (patients, clients, victims), meaning that guest characters can come in and carry some of the emotional load. All of that makes it much easier to write 22 episodes a year and not run out of big, effective story ideas.

One format that used to be on a level with doctor/lawyer/cop, and was actually more popular than those types of shows when weekly TV drama started, is the Western. Same thing applies there — actually, since so many Continue…

Baby, Can I have a drink?

By Cathy Gulli - Monday, September 27, 2010 at 12:57 PM - 0 Comments

Getty Images

Until now, a doctor wouldn’t usually ask a woman having a routine pap smear how many drinks she enjoyed that week. But new national guidelines recommend that alcohol consumption become a regular topic of conversation between female patients of child-bearing age and their physicians. “We’re not here to moralize or be pejorative,” says Dr. Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, and a co-author of the report. “This is a question of awareness and harm reduction.”

The guidelines, published in the August edition of the Journal of Obstetrics and Gynaecology of Canada, recommend that doctors ask women who are or could become pregnant about their drinking habits, and record that information in their charts. Previous guidelines focused on diagnosing cases of fetal alcohol spectrum disorder, which affects as many as three in every 1,000 births, and results in neurological and behavioural problems.

Continue…

Do you trust your doctor?

By Charlie Gillis, Julia Belluz, and Josh Dehaas - Monday, August 16, 2010 at 10:37 AM - 37 Comments

Getty Images

After five miscarriages, and with the odds of ever having children stacked against her, Lee Dix was glad to get a second opinion. It was the summer of 2000, and the Toronto woman had been referred to a gynecologist based at Scarborough Hospital, Dr. Richard Austin, whom she hoped would eventually deliver her first baby. But far from feeding her optimism, Austin told Dix she had a benign tumor called a fibroid in her uterus, and made a provisional diagnosis of endometriosis, a painful disorder where cells on the uterine wall grow out of control. Between 2002 and 2005, the greying physician performed two operations on Dix—one a total abdominal hysterectomy, the other to remove her remaining ovary (she’d had one taken out in a previous operation). “I just went with what he said,” Dix now recalls. “I trusted doctors, and I thought that if anyone is going to work on me, they must have the proper schooling and knowledge.”

Continue…

Killer Apps that save lives

By Katie Engelhart - Thursday, March 18, 2010 at 1:00 PM - 6 Comments

Photograph by Andrew Tolson

Dr. Phillip Yoon loves—nay, needs—his iPhone. Yoon, district chief of emergency medicine for Halifax’s Capital District Health Authority, refers to his phone as his “peripheral brain.” “It’s part of my body now,” he trills. “If I lost it, that would be trouble.” Yoon’s love affair should be a familiar one to his colleagues. The smartphone—and in particular, the iPhone—has left the realm of electronic plaything, and become an almost required medical tool. According to Manhattan Research, a health care consulting firm, the percentage of U.S. physicians using smartphones stands around 64 per cent and is projected to hit 81 per cent by 2012. In Canada, the trend is the same. Smartphone use in hospitals “is almost ubiquitous,” says Dr. Dante Morra of Toronto’s University Health Network.

Today, doctors with a few dollars to spare and a smidgen of electronic know-how can download applications at the iTunes store that can transform their iPhones into drug-dose calculators, fetal monitors, or remote receivers for patient records. Yoon could purchase the Anatomical Diagrams app for 3-D illustrations of the human body. He could use Medical Spanish so he can advise Spanish-speaking patients—or check Medscape to review alternatives to the lab test he wants to order.

Rural docs are especially quick to jump on the iPhone bandwagon. In India, the iPhone is being used to mount a campaign against a retinal disease that afflicts premature babies. The effort takes place mostly at remote outposts, where lab assistants use iPhones to take pictures of preemies’ eyes. They then send the pictures to pediatric eye surgeons in Bangalore for diagnosis. Some press reports refer to India’s “EyePhone.”

Continue…

Depressed girls gone wild?

By Colby Cosh - Wednesday, November 25, 2009 at 2:39 AM - 38 Comments

I realize nobody has all that much interest in being strictly fair to insurance companies, but I’m sort of horrified by the way the Nathalie Blanchard story is being handled in the press and electronic media. The evidence for the notion that Ms. Blanchard lost her long-term disability benefits “over Facebook photos” appears to amount entirely to “She says she was told that’s what happened.” Now, she could be quite right. Manulife admits it does use Facebook to investigate disability claims, as anyone would expect them to do. Here’s a news flash for particularly naïve children and desert-dwelling stylites: an insurance company following up a suspicion of a false claim uses every kind of evidence it can scrape up. Its hirelings will quiz your neighbours, co-workers, and friends! They will rummage through your garbage! They will engage in photo and video surveillance! They’ll Google you until the cows come home!

In short, this is, like this spring’s “Craigslist killer” news story, a narrative to which the supposed cynosure of attention really has no special relevance. At all. It would be nice if news organizations could get together, run one last banner headline announcing that THE INTERNET EXISTS, and be done with these trumped-up technology angles for all time.

Anyway, since we don’t know what other evidence Manulife’s investigation turned up, and they are bound not to tell us, it seems inappropriate for the headlines and the secondary commentary on the story to take Blanchard’s version as the gospel. Which is exactly what everybody is doing, even though Manulife may have had a dozen other reasons for cancelling the claim.

I’m not suggesting, mind you, that they necessarily do. An insurer makes decisions like this with hypothetical litigation in mind. That’s not necessarily conducive to clear thinking: it’s conducive to thinking like a juror, which may well be the diametrical opposite. It would not be surprising if some excitable junior associate had been shown Blanchard’s Facebook pictures of fun in the sun and thought “Well, well, well. These will be awfully hard to for her to explain to a jury.” You would have to be an idiot to think that such pictures are, in themselves, good evidence that Blanchard is not depressed. And, unfortunately, the world is full of idiots.

The key question for an insurer, however, is not whether Blanchard has depression, but whether she is making bona fide efforts to return to her job. Her duty isn’t to stop being ill, but to do what she can to get as well as she can and start earning her paycheques again. There are plenty of seriously depressed people who still manage to drag their butts out of bed and punch the clock most days. Blanchard’s statements to the CBC leave me wondering a little about her self-understanding, and since thousands of bloggers and editors apparently have no trouble questioning Manulife’s credibility, I feel quite licensed to wonder.

She says, for instance, “that on her doctor’s advice, she tried to have fun, including nights out at her local bar with friends and short getaways to sun destinations, as a way to forget her problems.” I suppose that a physician treating depression would recommend, in a general way, that his patient should try to get exercise, seek pleasant new experiences, maintain strong social networks, etc., etc. On the other hand, I can’t see any doctor having a display of travel brochures on the wall of his office, or publishing a guide to Eastern Townships nightlife. Again, pictures of Blanchard at a bar cannot possibly demonstrate that she is not depressed. But they could show that she was defying a doctor’s advice concerning the safe use of psychiatric medication, or the consumption of alcohol itself, if she were at risk of co-morbidity from substance-abuse problems.

Blanchard also says, by the way, that she “doesn’t understand how Manulife accessed her photos because her Facebook profile is locked and only people she approves can look at what she posts.” I hope that since this interview, someone has taken her aside and gently explained the Sherlockian maxim that “when you have eliminated the impossible, whatever remains, however improbable, must be the truth.” In this case, the compelling conclusion is that somebody Blanchard trusted snitched on her to the insurer, perhaps in a spasm of dudgeon over her insurance-subsidized lifestyle. It happens. In fact, it was known to happen before there was such a thing as Facebook.

Where will P.E.I. Muslims go to pray?

By Katie Engelhart - Thursday, November 12, 2009 at 12:40 PM - 50 Comments

Call it Little Mosque on the Island. Last week, the CBC ran a news story about a Muslim doctor whose efforts to build the first mosque in P.E.I. have thus far come to naught. The “disappointed” doctor asked the province for financial assistance, only to be “turned down.”

The CBC story also suggested that there was reason to believe the city might step in. It quoted Charlottetown Coun. David MacDonald as saying he would be willing to meet with Muslims and “see if the city can assist in building a mosque.” But when Maclean’s spoke to MacDonald, he said, “We wouldn’t give any assistance to a religious group any more than we would to anybody else. We don’t provide financial assistance to any kind of developer.” The meeting, MacDonald says, will be little more than an “information session.” Continue…

Best Cigarette Advertising Campaign Evah

By Jaime Weinman - Friday, June 12, 2009 at 11:20 AM - 9 Comments

This was just e-mailed to me, and I can’t believe I didn’t think to look for it online: my favourite cigarette ad campaign ever, Camel’s “More Doctors Smoke Camels!” campaign. I first heard this on an old tape of Abbott and Costello radio shows from the ’40s, and this is the TV version. It is essentially the same as the radio version — same slogan, probably even the same announcer — except that it ends with a shot of a woman who is either not a doctor or the most elegantly-dressed medical professional in the world. Because one of the early rules of TV advertising was to get a hot woman into the commercial, no matter what the product was.

You have to admire the incredible jiu-jitsu technique involved: promoting a product whose biggest flaw is being bad for your health (even before the smoking-cancer link was discovered, it was accepted that cigarettes, like alcohol, were not particularly good for you) by claiming that health professionals love it.

Doctors need medical attention too

By Cathy Gulli - Friday, December 5, 2008 at 6:30 PM - 4 Comments

Last spring we put together the popular “How healthy are you?” package. One of the most stunning trends we reported on showed that people under 25 have, by far, the highest rates of psychological problems compared to any other age group, according to data gathered by Scienta Health.

A new study in BMC Medical Education shows that med students are no exception. Researchers at ABC Regional Medical School in Brazil have found that 38 per cent of the 481 students they examined had at least 10 depressive symptoms. It was most dire among females.

Last week at the Canadian Family Physicians Forum in Toronto, experts from the College of Family Physicians of Canada spoke about the stress many medical residents face before they even start working. A report showed that more than a third of med students say their debt load after school will be over $80,000. Family docs, as it happens, earn 33 per cent less than other medical specialists. 

And then there are all the stresses of actually working in our overstretched medical system, which we wrote about last January.

So who’s taking care of our doctors?

Nursing Saskatchewan back to health

By Cathy Gulli - Wednesday, October 1, 2008 at 4:29 PM - 10 Comments

The premier of Saskatchewan, Brad Wall, was in to talk with Maclean’s this week. (The entire interview will be posted on our website tomorrow.) 

I asked him about a recent study that ranked Saskatchewan second last out of 10 provinces for the quality of its health care—Newfoundland faired the worst. He said the number one obstacle facing the medical system is . . . a shortage of doctors and nurses!  

The interesting remedy: poach nurses from the Philippines. Because English is a first language there and nurses are educated in a similar style as the ones in North America. The province is hoping to attract hundreds of Filipino nurses to its hospitals. Already 300 have been signed and some of them have even arrived and begun work. That, says Wall, will help alleviate all the other problems facing Saskatchewan’s health care system, like long wait times. Other places such as this New Brunswick community are doing this as well.

With all the red tape over accrediting foreign-trained doctors let’s hope this strategy works. Another option: let’s also invest significantly in our medical schools and start turning out more health care workers here. The Canadian Nurses Association says that “Canada has consistently graduated fewer nursing students than it did 30 years ago, despite a 39 per cent increase in the Canadian population over that same time period.”

Public respect for doctors up, journalists down: poll

By Kate Lunau - Tuesday, May 6, 2008 at 3:49 PM - 0 Comments

Here’s a new Angus Reid poll that shows a majority of Canadians have a “great deal or fair amout of respect” for doctors (95 per cent of respondents). And of all the provinces, BC residents respect their medical practitioners the most (96 per cent). Interestingly, respect for every single profession has dropped over 14 years, with the notable exception of doctors, who are getting more respect than ever before (in 1994, 91 per cent of respondents respected them).

Journalists, meanwhile, are at the bottom end (harrumph). We get respect from a mere 49 per cent of Canadians, compared to 73 per cent in 1994, the biggest slump that any profession has seen. Politicians (who are in last place) are keeping us company: a mere one-quarter of respondents said they respected them.

So, how does the public feel about medical journalists?

THE NUMBERS:

Percentage of respondents in an online poll who say they have “a great deal or a fair amount of respect” for the following professions:

doctors – 94 per cent

police officers – 83 per cent

teachers – 83 per cent

journalists – 49 per cent

lawyers – 44 per cent

politicians – 25 per cent