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Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Old Apr 20th 2017, 3:39 am
  #541  
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I don't know whether I dreamt it or not but did you mention that your partner had the RCGP diploma in substance misuse? I also acquired this prior to leaving the UK having worked in a very large drug and alcohol rehab centre located near to our GP practice. I won't elaborate in case I did indeed dream it! If you just edited your post and want more information then I can give you my comments.

I would certainly agree with RICH and Snoop's comments with regard to both gardening/growing vegetables as well as outdoor activities. In this area, both are readily available. We keep our kayaks about 3 feet from the water of Kalamalka Lake at one of our kind neighbors docks to use whenever we like.(she also happens to be a patient in our office which helps! )- As the others have said, hiking, biking and huge opportunities are available for outdoor activities during the summer as well as obviously winter sports during the colder months.

As Snoop suggested, I do like my gardening although as RICH says, irrigation is important in our area but this gives us ample opportunity to grow within reason, most produce that you might wish for. A load of my patients grow huge amounts of vegetables and obviously fruit. My main problem is keeping the wildlife from eating my garden! The trouble is, I don't want to fence them out we are very keen on wildlife and so the rampaging deer/raccoons/marmots/black bear eventually take their toll towards the end of the season! If you really do want lush verdant greenery then probably coastal BC/Vancouver island is your best bet as winters are warmer and you certainly don't need to be reliant on irrigation! I however love our little patch of heaven.

The first one is entitled "You might feel safe but my bloody plants don't! "
2nd- a view down toward the lake
3rd- Cheeky little black bear scoffing our grapes (yes, they come in black to pale browny red (and indeed white..though sadly not here - no Spirit / Kermode bears round here but further East and North )
Attached Thumbnails Chat for and with Canadian Family Practitioners/ex UK General Practitioners-20160922_180327-02_resized.jpeg   Chat for and with Canadian Family Practitioners/ex UK General Practitioners-20160420_144321_resized.jpg   Chat for and with Canadian Family Practitioners/ex UK General Practitioners-pesky-critter-1.jpg  

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Old Apr 20th 2017, 3:48 am
  #542  
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Just a few more views of our arid desert
Attached Thumbnails Chat for and with Canadian Family Practitioners/ex UK General Practitioners-20160621_192136_resized.jpg   Chat for and with Canadian Family Practitioners/ex UK General Practitioners-20160621_192611-01_resized.jpeg   Chat for and with Canadian Family Practitioners/ex UK General Practitioners-20160507_165952-01_resized.jpeg  
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Old Apr 20th 2017, 5:33 am
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Originally Posted by JonboyE
If you have aspirations for his'n'hers Porches you might have to put this on hold for a few years until you have your own practices, but most GPs scrape by.
Hehe, no we're not really into flashy things. Our only luxuries are probably visiting the city to go to the theatre/art house cinema - something I'm going to miss but that's an exchange for the smorgasbord of outdoor options that BC offers. 2-bed house but with a couple of acres would suit us fine.

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Old Apr 20th 2017, 6:02 am
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

Originally Posted by Stinkypup
I don't know whether I dreamt it or not but did you mention that your partner had the RCGP diploma in substance misuse? I also acquired this prior to leaving the UK having worked in a very large drug and alcohol rehab centre located near to our GP practice. I won't elaborate in case I did indeed dream it! If you just edited your post and want more information then I can give you my comments.

The first one is entitled "You might feel safe but my bloody plants don't! "
2nd- a view down toward the lake
3rd- Cheeky little black bear scoffing our grapes (yes, they come in black to pale browny red (and indeed white..though sadly not here - no Spirit / Kermode bears round here but further East and North )
You're not mistaken - he does two sessions fortnightly in a substance misuse clinic as a specialist. He enjoys it a lot (some patients are obviously difficult, but you can really have a positive impact and help someone drastically improve for the better as I'm sure you know) but the diploma isn't really recognised in Canada and he'd have to apply to prescribe stuff like methadone. Also, from this thread it appears you don't want too many patients with substance misuse problems (well benzo addicts at least). Don't they count addictions as a chronic illness in billing? Or is it the level of risk/difficulty/demand that these patients sometimes have that make them less attractive?

Those pictures are adorable - your garden looks so lovely. Did you put in the terraces yourself? I heard that deer are difficult in most of BC, but I'm also very much into protecting wildlife and unlikely to fence them out too - can you plant companion plants that are ahem more attractive to deer? I'm really the one into gardening - would love 3 to 4 acres to get myself some permaculture veg beds/crop rotation going. If we're lucky to get more space then i'd also love some fruit trees and maybe an apiary? Oh and of course lots of bee and butterfly friendly flowers. We have a small garden here, so that's one thing i'm looking forward to changing eventually!

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Old Apr 20th 2017, 6:29 am
  #545  
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Re deer, not too bright. They don't know that they aren't supposed to like certain plants so have a nibble anyway, as does the next one, and the next. They probably do it again the next day!!!
I love them, their gentle faces, beautiful big eyes. They drive Stinky mad, but he wouldn't hurt them.
Re the Okanagan, just out of the valley, rainfall increases and prices fall. A lot of people live off the grid but within easy driving distances of towns.
Addictions are classed as chronic disease from a CDM payment point of view, it counts towards the Mental Health Planning fee. But that is poorly paid and takes a lot of time, so I rarely bother with it unless I think the patient would benefit.I think they have made methadone prescribing easier though. There is a billing code for it I think, not sure if it's worth the extra work, not many seem to bother.

Last edited by snoopdawg; Apr 20th 2017 at 6:37 am. Reason: I was wrong re the CDM
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Old Apr 20th 2017, 6:40 am
  #546  
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With regard to substance misuse, I certainly found it rewarding when I was working in the UK but I have to say that I have enough on my plate changing continents and coming to a new medical system that I had no inclination to go back into this and also, it has to be said that unless he manages to find a separate clinic that he could do that kind of work from, he may well have the prospect of methadone users coming to his normal family practice office which may well not prove popular, particularly with his colleagues and certainly not with his other patients. I'm not saying that they cause trouble but they as well he knows can certainly cause a few "issues." There is a lot of street drugs which have been diverted from prescription pads here to be honest, the biggest problem here is at the moment, fentanyl and it's superstrong derivatives causing a significant number of overdoses both within the province and elsewhere. Not much one can do about this unfortunately aside from prescribed reversal agents for them to hopefully try and save the lines. Unfortunately often this is not fast enough or accessible enough and death rates are high.

He could always settle in first and see how things go and then if necessary he can reactivate his interest. If he wished to get back into the methadone prescribing, he just needs to do a short course I would've thought. I think they certainly would, once he was known within the health authority have a look at his diploma and certainly take this into consideration. The training is minimal compared to what he learned from the diploma course.

With regard to the garden, it was messy at the time, I just wanted to show you that it can be quite lush. We moved from an acre and a half of very hard work garden in rural North Norfolk which had raised beds, a beautiful greenhouse, wildlife ponds long rose tunnels and massive oak trees whose leaves which had to be cleared up in the autumn! We now have a third of an acre of as you say terraced garden leading down to the lake. It is a lot less hard work for me and this enables us to spend more time out and about in the park photographing, getting the boat out of storage probably next week to get back onto Lake in the very near future.
Interesting to see your comments with regard to, permaculture, this seems a reasonable and certainly feasible way of cultivation. If you buy a fairly flat patch of ground, you can do what you like with it, use machinery to cultivate this very nicely but just need to keep the critters off it with fencing. High fencing where deer are concerned-10 feet!
We don't get many rabbits here which is certainly a bonus as I had that is a huge problem when I was in Norfolk. Xeriscaping seems to be a reasonable way forward in our area although we already had a complex if a little fragile irrigation system in supplying around seven different regions of the terracing within the garden and the trees and shrubs and plants that we have aside from the one that I have later put in were not so drought tolerant and therefore to rely on water so unless we just killed these off, it isn't an option to fully go into xeriscaping. I have been planting a lot of drought resistant plants-as you can see, lavender do very well, deer certainly hate this and many other aromatic plants which is a good thing
maybe we need to sta
I am sure that's there are several gardeners on this forum that could advise, there have been threads on here which we may need to resurrect, maybe have a search on these. There are some certain very talented gardeners who shared their information and advice on this forum but probably not in the current thread we are in!

Anyhow, I hope that helps-bees are certainly welcome around here, we do have beekeepers, these are certainly crucial for the pollination of all the fruits trees within all the orchards and gardens as well as of the plants and vegetables-one of my patients makes beautiful handmade beehives. As for butterflies, we have a lot of them, we get a huge number of Pacific swallowtails here -incredibly fast flying and often difficult to photograph but beautiful-I'll dig out photo if I can ensure got one-there are others as well. One couldn't really keep chickens where we are unless they were totally enclosed as we have a very healthy population of bald eagles, ospreys a good number of raccoons and I have to say I wouldn't trust some of the big fat hairy marmots around us, they would probably mind having a go! We also have the northern Pacific rattlesnake but thankfully I haven't seen one in the garden yet, just in the park next door. It makes gardening interesting, I make sure I wear very thick gloves and do not have those in buds in my ears when gardening using my iPod

Anyhow, I seem to have swerved this thread a little bit, something that's we often do here but with best intentions-good luck
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Old Apr 21st 2017, 7:01 am
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Originally Posted by Stinkypup
With regard to substance misuse, I certainly found it rewarding when I was working in the UK but I have to say that I have enough on my plate changing continents and coming to a new medical system that I had no inclination to go back into this and also, it has to be said that unless he manages to find a separate clinic that he could do that kind of work from, he may well have the prospect of methadone users coming to his normal family practice office which may well not prove popular, particularly with his colleagues and certainly not with his other patients. I'm not saying that they cause trouble but they as well he knows can certainly cause a few "issues." There is a lot of street drugs which have been diverted from prescription pads here, to be honest, the biggest problem here is at the moment, fentanyl and it's super strong derivatives causing a significant number of overdoses both within the province and elsewhere. Not much one can do about this unfortunately aside from prescribed reversal agents for them to hopefully try and save the lines. Unfortunately often this is not fast enough or accessible enough and death rates are high.

He could always settle in first and see how things go and then if necessary he can reactivate his interest. If he wished to get back into the methadone prescribing, he just needs to do a short course I would've thought. I think they certainly would, once he was known within the health authority have a look at his diploma and certainly take this into consideration. The training is minimal compared to what he learned from the diploma course.

good luck
Thank you for such a detailed post. So many useful nuggets of information -we really appreciate it.

I've persuaded him to sign up to here and he should post at some point to say hi. I'll try and stick to GP relevant stuff as I'll completely go further off piste if i focus on gardening anymore. Suffice to say it sounds like a lot of the plants we have in the garden here (echinacea, verbena and echinops and of course lavender!) would probably do pretty well in BC, which makes me very happy.

We also had a similar discussion regarding how his specialist interest might be perceived when looking for jobs or how it might impact his work when he decided to do the diploma during training here in the UK. Part of the reasoning for doing it was in case we wanted to try and move to Vancouver -
shout out to East Hastings street! (but that doesn't interest us anymore). As long as we can get to Va once in a blue moon then we're happy. Speaking of which as I think snoopy commented way back that Okanagan's roads out become pretty impassable for a few weeks each year - are the small regional airports still open or do they also shut down due to heavy snowfall as well? I agree, he'll focus just on getting established before even deciding whether to tackle that area. He was just worried about deskilling - but a lot of his D&A experience has been helpful with his ordinary mental health patients in practice anyway and there are always high functioning/ higher social economic background alcohol dependents found in smaller communities. It's sad to hear about the increase in fenantyl usage in the area though.

Random question: how are the internet speeds in Okanagan or on the island? Is there broadband,fibre or the dreaded dial-up?

We have 4 house valuations booked for next week - dreading the process as it's our first home that we're selling. Fingers crossed that it goes quickly.

Last edited by Verdant; Apr 21st 2017 at 7:43 am. Reason: For clarity.
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Old Apr 21st 2017, 10:27 am
  #548  
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Hi here I am - ecokid's other half!

Thanks to everyone who has posted on this forums - stinkypup and snoopdawg in particular. I've been thinking along similar lines, really - focus on getting established and integrated in general Family Medicine first, worry about specialist interests later. If it's anything like the UK there'll be a large chunk of mental health anyway, I'm sure.

Anyway, I'm just posting this quickly between phonecalls and coffee, so it can't be a long post, but once again thanks for all the info you've provided, and I'm sure to be asking some more questions soon!
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Old Apr 21st 2017, 12:43 pm
  #549  
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Funny things about family doctors.

Here in QC, it is almost impossible to get one (we'd been trying since 2004!).

A few weeks ago, my wife got wind of a new surgery in Ottawa. The guy takes patients from QC. You have to pay up front but you can claim back from the QC government. We signed up with him instantly and he is a gem. The perfect family doctor.

The odd thing is, he wanted to set up his practice on the QC side (in Gatineau). The government wouldn't let him because his French isn't good enough.

Gatineau is highly bilingual FFS! He'd fill his patient list in ten minutes if he came over here.

Seriously nice guy. Didn't seem too upset about accidentally spraying his face with contaminated anaesthetic.
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Old Apr 21st 2017, 2:12 pm
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Originally Posted by ecokid
Speaking of which as I think snoopy commented way back that Okanagan's roads out become pretty impassable for a few weeks each year - are the small regional airports still open or do they also shut down due to heavy snowfall as well?

The roads close for a day or so, but several times a winter ( spring, summer, autumn!) This year was bad. But they open again quickly- the issue is as someone who works, I could never guarantee being able to drive to Vancouver and back on any given day in the winter. If I didn't work and could delay a day or so I would be ok.
The airports- I can only really comment on Kelowna which is a great airport. Very rarely closes- maybe slight delays with very heavy snow- Has great connections and increasingly more direct flights. I think they really want European flights- should happen at some point I think.


Random question: how are the internet speeds in Okanagan or on the island? Is there broadband,fibre or the dreaded dial-up?

[Much faster than the UK! We have Shaw at 100Mbps- although seems slower since we refused to sign up on a contract!
Just about to get Telus fibreoptic @ 250Mbps

We have 4 house valuations booked for next week - dreading the process as it's our first home that we're selling. Fingers crossed that it goes quickly.

Good luck!
See above!
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Old Apr 21st 2017, 3:21 pm
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Originally Posted by Souvy
Funny things about family doctors.

Here in QC, it is almost impossible to get one (we'd been trying since 2004!).

A few weeks ago, my wife got wind of a new surgery in Ottawa. The guy takes patients from QC. You have to pay up front but you can claim back from the QC government. We signed up with him instantly and he is a gem. The perfect family doctor.

The odd thing is, he wanted to set up his practice on the QC side (in Gatineau). The government wouldn't let him because his French isn't good enough.

Gatineau is highly bilingual FFS! He'd fill his patient list in ten minutes if he came over here.

Seriously nice guy. Didn't seem too upset about accidentally spraying his face with contaminated anaesthetic.
Glad you finally got a GP - Sounds like you got a good one.
I don't mind the odd spray although when I get a face full of sebaceous cyst contents when removing one, my stomach turns a little bit
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Old Apr 21st 2017, 5:19 pm
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Originally Posted by Stinkypup
Glad you finally got a GP - Sounds like you got a good one.
I don't mind the odd spray although when I get a face full of sebaceous cyst contents when removing one, my stomach turns a little bit
It was a pure fluke. He decided to whip out an old, dormant, one while I was there seeing him about something else. It was simple bad luck to stick the needle into the "pipe". The anaesthetic went in, through and then straight out!

Finding him came at a very opportune time. I had another of those things. It appeared very quickly and was in the last place any bloke would want it. He wasn't keen on cutting it (or, rather, he said I wouldn't enjoy it much). Thus, two weeks on 450mg Clindamycin, and some heavy duty probiotics.
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Old May 13th 2017, 3:16 pm
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Default re: Chat for and with Canadian Family Practitioners/ex UK General Practitioners

I need some advice, I find the idea of online reviews quite daunting. In UK, it was never part of the culture to post negative reviews online but patient seem to be quite rude and derogatory in canadian websites. I havent been rated yet but sometimes I feel pressure to do things just to avoid a negative review.
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Old May 13th 2017, 3:53 pm
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Originally Posted by Brainwave
I need some advice, I find the idea of online reviews quite daunting. In UK, it was never part of the culture to post negative reviews online but patient seem to be quite rude and derogatory in canadian websites. I havent been rated yet but sometimes I feel pressure to do things just to avoid a negative review.
Quite simple- never look or read them! I never have. I know the ones who will post negatively are those who have clashed with me for some reason- e.g. I won't give the drugs they want- they were billed for a no show.
These web sites shouldn't impact your decisions. Complaining constantly seemed much more prevalent in the UK, in Canada it's done in a more anonymous way via web sites.
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Old May 13th 2017, 4:28 pm
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Originally Posted by snoopdawg
Quite simple- never look or read them! I never have. I know the ones who will post negatively are those who have clashed with me for some reason- e.g. I won't give the drugs they want- they were billed for a no show.
These web sites shouldn't impact your decisions. Complaining constantly seemed much more prevalent in the UK, in Canada it's done in a more anonymous way via web sites.
I do look sporadically but don't worry about them, as Snoop says they are the ones who are often drug seeking or who have been fired for unreasonable/unacceptable behaviour. There is a doc in our office who obsesses about comments - I think it depends on your personality- if you see yourself as the best doctor on the planet who never makes mistakes then you will no doubt feel devastated to receive a bit of criticism.

In the UK, they don't use the websites, they send in complaints to the GMC for even trivial complaints- the GMC attitude seems to be guilty until proven innocent however ridiculous the complaint. I would much rather some ranting pillock on RateMd than having to appear in front of some complaints panel for some spurious and totally unfounded complaint.
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