I'm out of the office today working in a small country ER. Fortunately the beautiful weather outside has made the level of traffic quite reasonable (I'm blogging, aren't I?)
But I find something quite fascinating. We have a new electronic tracking board in the department, the big screen that shows us all the patients we have and where they are. This board also allows me to look at the ER traffic in the larger ER about 15 minutes down the road in the next town.
As I type this, there is one patient in my waiting room, a kid with a bug bite, and no patients in the department. In the bigger ER all the beds are full and there's 13 people in the waiting room. All this only 15 minutes down the road!
One might wonder why such an unequal situation exists. Well, it's because if the triage nurse at the other ER were to look at an obviously stable patient and say "Look, it's a 3 hour wait here but my computer tells me the other place down the road is empty, why don't you go there?" she'd get fired. And even if she didn't, if the patient were to get into an accident or otherwise hurt themselves during the trip, the hospital would be blamed. "He was in yuour ER and you sent him away?!" You can already hear the press howling.
It would make sense for the other ER to look at all their lower level patients and send them over here. But it won't happen because the system won't allow it.
Not that I'm complaining. Might even get a nap later...
Thursday 11 July 2013
Thursday 29 October 2009
Flu Information
Provided as a public service
"The flu" is caused by a specific type of virus, the influenza virus. Other viruses can produce respiratory illnesses with similar symptoms but they are not "the flu".
Influenza presents as follows: rapid onset of fever, muscle aches, fatigue, dry cough, headache. Sometimes vomiting and diarrhea can accompany the illness. The rapid onset is an important part of the illness. A respiratory infection that comes on gradually and slowly gets worse is not "the flu".
Influenza viruses are labelled by looking at two proteins in them, hemagglutinase and neuraminidase. This is where the H and N in the name comes from. For example, swine flu has hemagglutinase type 1 and neuraminidase type 1 proteins in it, hence H1N1.
People with chronic medical conditions that affect their constitutional strength or immune system, along with very young children and the very old elderly are at the most risk of complications from the flu. However, due to the unpredictable nature of the virus, anyone could potentially develop serious complications such as myocarditis (inflammation of the heart) or bacterial pneumonia.
There are two vaccines this season. One has 3 strains in it to cover the usual seasonal influenza strains. The other is specific to H1N1. Despite rumours to the contrary, it is a safe vaccine with no significant toxic components and is expected to be 90-95% effective in preventing the flu.
Remember that scrupulous hand washing, getting plenty of sleep and a diet rich in fruits and vegetables is a good way to prevent transmission of the flu or to minimize its effects if caught.
"The flu" is caused by a specific type of virus, the influenza virus. Other viruses can produce respiratory illnesses with similar symptoms but they are not "the flu".
Influenza presents as follows: rapid onset of fever, muscle aches, fatigue, dry cough, headache. Sometimes vomiting and diarrhea can accompany the illness. The rapid onset is an important part of the illness. A respiratory infection that comes on gradually and slowly gets worse is not "the flu".
Influenza viruses are labelled by looking at two proteins in them, hemagglutinase and neuraminidase. This is where the H and N in the name comes from. For example, swine flu has hemagglutinase type 1 and neuraminidase type 1 proteins in it, hence H1N1.
People with chronic medical conditions that affect their constitutional strength or immune system, along with very young children and the very old elderly are at the most risk of complications from the flu. However, due to the unpredictable nature of the virus, anyone could potentially develop serious complications such as myocarditis (inflammation of the heart) or bacterial pneumonia.
There are two vaccines this season. One has 3 strains in it to cover the usual seasonal influenza strains. The other is specific to H1N1. Despite rumours to the contrary, it is a safe vaccine with no significant toxic components and is expected to be 90-95% effective in preventing the flu.
Remember that scrupulous hand washing, getting plenty of sleep and a diet rich in fruits and vegetables is a good way to prevent transmission of the flu or to minimize its effects if caught.
Wednesday 11 March 2009
What I Need
First, what I don't need: I don't need a nurse practitioner who thinks she knows as much as I do about medicine, who thinks she's equal to me in skill and experience.
What I do need: A physician assistance who will see the 15-20 people who call me every day needing to be seen RIGHT AWAY because they've had that sore throat or cough for - gasp! - more than 24 hours!
What I do need: A physician assistance who will see the 15-20 people who call me every day needing to be seen RIGHT AWAY because they've had that sore throat or cough for - gasp! - more than 24 hours!
Tuesday 27 January 2009
Is Single Tier Health Care a Reality?
Many countries have various religious or national beliefs. Often these beliefs are part of the core view of that country's national identity. The British believe they brought civilization to the world by colonizing as much of it as they could. The French believe that hairy armpits are sexy.
As for Canada? Well we apparently believe that srictly socialized medicine with no room for private care is the only moral form of medicine there is and that anyone who disagrees is a horrible person who wants the poor and elderly to die in the street while the rich are pampered in private hospitals.
Of course, a close look at the systems these zealots defend shows their hypocrisy. In Ontario, for example, there is a claim by the government that we have single tier health care but that really isn't true. There are multiple tiers:
1) Basic - OHIP (Ontario Health Insurance Plan) covers visits to doctors, hospitals and most procedures. But that's it. Drugs and physiotherapy are not covered and msut be paid for out of pocket. Pretty hard if you're one of the "working poor" whose salary barely covers the necessities of life on a monthly basis.
2) OHIP with ODB (Ontario Drug Benefits) - if you're lucky enough to be on social assistance or over 65, you get ODB to go with your OHIP. A good number of prescription drugs are covered (although some, like straight penicillin, aren't) as well as some limited physiotherapy and optometry coverage. But that's more than the schlub with Basic OHIP gets.
3) WSIB (Workplace Safety Insurance Board) - if you're really lucky, you get injured at work. WSIB covers lots more physiotherapy and a wider range of drugs than ODB plus other paramed specialities like occupational therapy, retraining around an injury and much quicker access to important tests like CT and MRI scans for which those on OHIP wait, and wait, and wait...
4) Private plans - for the successfully employed with comprehensive drug plans, life is much easier. Coverage for injuries like the WSIB does but also non-injury related coverage so that you get access to drugs and paramedical specialities. This is a huge thing for people with multiple chronic conditions on 20 drugs or so.
5) Politicians - you really think the prime minister or the provincial premier wait in line at their family doctor's office? Get real.
6) Doctors - you really think I'm gonna wait in line when I get sick? Get real.
7) The United States - for those who want the best quality medicine in the world and who can afford it, the U.S. is only a border away.
So in the end there are 7 tiers I can list all off the top of my head even as our provincial premier (who has spent much of the last few years cutting away what OHIP will cover) styles himself as the fearless defender of single tier health care.
You don't believe in private medicine? Well I don't believe in hypocrites.
As for Canada? Well we apparently believe that srictly socialized medicine with no room for private care is the only moral form of medicine there is and that anyone who disagrees is a horrible person who wants the poor and elderly to die in the street while the rich are pampered in private hospitals.
Of course, a close look at the systems these zealots defend shows their hypocrisy. In Ontario, for example, there is a claim by the government that we have single tier health care but that really isn't true. There are multiple tiers:
1) Basic - OHIP (Ontario Health Insurance Plan) covers visits to doctors, hospitals and most procedures. But that's it. Drugs and physiotherapy are not covered and msut be paid for out of pocket. Pretty hard if you're one of the "working poor" whose salary barely covers the necessities of life on a monthly basis.
2) OHIP with ODB (Ontario Drug Benefits) - if you're lucky enough to be on social assistance or over 65, you get ODB to go with your OHIP. A good number of prescription drugs are covered (although some, like straight penicillin, aren't) as well as some limited physiotherapy and optometry coverage. But that's more than the schlub with Basic OHIP gets.
3) WSIB (Workplace Safety Insurance Board) - if you're really lucky, you get injured at work. WSIB covers lots more physiotherapy and a wider range of drugs than ODB plus other paramed specialities like occupational therapy, retraining around an injury and much quicker access to important tests like CT and MRI scans for which those on OHIP wait, and wait, and wait...
4) Private plans - for the successfully employed with comprehensive drug plans, life is much easier. Coverage for injuries like the WSIB does but also non-injury related coverage so that you get access to drugs and paramedical specialities. This is a huge thing for people with multiple chronic conditions on 20 drugs or so.
5) Politicians - you really think the prime minister or the provincial premier wait in line at their family doctor's office? Get real.
6) Doctors - you really think I'm gonna wait in line when I get sick? Get real.
7) The United States - for those who want the best quality medicine in the world and who can afford it, the U.S. is only a border away.
So in the end there are 7 tiers I can list all off the top of my head even as our provincial premier (who has spent much of the last few years cutting away what OHIP will cover) styles himself as the fearless defender of single tier health care.
You don't believe in private medicine? Well I don't believe in hypocrites.
Wednesday 31 December 2008
The Holiday Rush
One of the difficult features of medicine is that a good chunk of it is not connected to a regular working schedule. Yes, you could wait to have that sore throat checked until 9:30 am on Monday morning but no one picks when to have a stroke or heart attack. It could be at a convenient time in the middle of the week or it could be the early Sunday morning of a 3 day holiday weekend.
As a result, there really is a differential of care when it comes to how some critical illness are handled in the health care system. Come in with leg swelling and pain on Monday morning and by Monday afternoon you will have had your doppler ultrasound to determine whether or not you have a deep vein thrombosis (blood clot in the leg). Come in on the aforementioned Sunday morning and if you're in a rural area with no weekend ultrasound technologist, you will be anti-coagulated for 2-3 days before you actually find out if you needed to be in the first place.
This also becomes an issue during the holiday break at the end of December. Just like the rest of society, medical professional want to take this time off for a well-earned vacation. Most consultants and family doctors, except for those who get stuck with call, disappear for two weeks or slightly longer. Operating rooms close down except for real can't-wait emergencies. Need a non-urgent referral to a specialist? I tried to arrange one the other day only to discover the specialist in question had turned her answering machine and fax off for the holidays to avoid having to come back to a huge backlog!
And where does this backlog therefore wind up? Well, the emergency room of course. We're open 24/7 after all so for those people who can't wait a week to see their family doctor or who think they have something urgently wrong, they wind up in the ER where they wait, and wait, and wait...
And even once they get seen, the joke is still on them. Unless they need emergent care or surgery, it's either a prolonged admission to hospital until the holiday break ends or a reassuring pat on the back that the lump they found in their breast or testicle will have to wait 2-3 weeks until the appropriate testing can be booked.
It's no way to run the system. Any solutions out there?
As a result, there really is a differential of care when it comes to how some critical illness are handled in the health care system. Come in with leg swelling and pain on Monday morning and by Monday afternoon you will have had your doppler ultrasound to determine whether or not you have a deep vein thrombosis (blood clot in the leg). Come in on the aforementioned Sunday morning and if you're in a rural area with no weekend ultrasound technologist, you will be anti-coagulated for 2-3 days before you actually find out if you needed to be in the first place.
This also becomes an issue during the holiday break at the end of December. Just like the rest of society, medical professional want to take this time off for a well-earned vacation. Most consultants and family doctors, except for those who get stuck with call, disappear for two weeks or slightly longer. Operating rooms close down except for real can't-wait emergencies. Need a non-urgent referral to a specialist? I tried to arrange one the other day only to discover the specialist in question had turned her answering machine and fax off for the holidays to avoid having to come back to a huge backlog!
And where does this backlog therefore wind up? Well, the emergency room of course. We're open 24/7 after all so for those people who can't wait a week to see their family doctor or who think they have something urgently wrong, they wind up in the ER where they wait, and wait, and wait...
And even once they get seen, the joke is still on them. Unless they need emergent care or surgery, it's either a prolonged admission to hospital until the holiday break ends or a reassuring pat on the back that the lump they found in their breast or testicle will have to wait 2-3 weeks until the appropriate testing can be booked.
It's no way to run the system. Any solutions out there?
Intro Post
Hello and welcome to my blog.
I'm a simple family and emergency physician from Southwestern Ontario and I want to use this forum to share my thoughts on medicine and medical politics.
Unlike my friend, Garnel Ironheart, I won't be pushing a religious agenda or trying to antagonize people I disagree with, unless they're naturopaths, homeopaths or leftwing bastards who think that single tier health care is a sacred trust that can't be constuctively challenged. I probably won't be advertising this blog much either so it'll be interesting to see how much attention it attracts.
Welcome and enjoy the content.
I'm a simple family and emergency physician from Southwestern Ontario and I want to use this forum to share my thoughts on medicine and medical politics.
Unlike my friend, Garnel Ironheart, I won't be pushing a religious agenda or trying to antagonize people I disagree with, unless they're naturopaths, homeopaths or leftwing bastards who think that single tier health care is a sacred trust that can't be constuctively challenged. I probably won't be advertising this blog much either so it'll be interesting to see how much attention it attracts.
Welcome and enjoy the content.
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