scilly

??????


are you leaving soon?

scilly

BC will also send patients below the border or to another province, in urgent cases ............. for example, has been known for mothers with very premature babies have had to be sent to AB or to the US because Women's Hospital was so crowded with high-risk pregnancies and births

BUT the cost is much higher than if that patient is treated in BC, especially if they go south.

That means the patient sometimes has to find the funds to cover the difference between what BC would pay and the actual cost.


There was very recently a fund raising campaign in BC to raise $250,000 to send an 18 year old leukemia patient to Seattle for very new experimental treatment. All other options for his treatment here had been tried and failed over a period of 3 years. He was now in extremity. Almost $300,000 was raised by various fund raising efforts ......... the government would not cover it because the treatment is experimental.

Unfortunately, the young man's condition deteriorated and he died on March 19 before he could go to Seattle.

Tirytory

A blood test is an invasive unnecessary test just for the sake of it which carries risks. Every little test a doctor orders should come with a clinical reason why it was necessary. To do that to children for no good reason borders on assault..

And yes you are expected to just be well.. Unless symptoms present that you might not be... That's what the doctor is there for to examine, diagnose, order tests etc but not to waste valuable resources trying to find something which is rarely there once a year. I wish they had NICE over here...

scilly

As a patient .............. I beg to disagree with you


as it happens ............. my daughter was not sent for blood tests or x-rays at the child's annual check-up .......

....... he did measure her height and weight, and checked her lungs and heart

Things that were done regularly during the first year at the various doctor visits for vaccinations, etc ......... he wanted to continue doing that in succeeding years.


satisfied?


I'm not quite sure why you are so opposed to this type of care.

Tirytory

Because prior to moving here I was a nurse working in the NHS where resources are finite and care needed to be prioritized. I like medicine to be practiced from an evidence base and not just because a patient requests it. That's the efficient way care is provided in the UK. It's called NICE. Look it up..

Stinkypup

Home after a busy day screwing the Medical system for financial gain
Just a few comments in reply Bats. Maybe I misinterpreted your comments but I would still refute your suggestion of little accountability at local as well as higher/ college levels- if a patient has an issue then we have a robust complaints procedure in the office but more often than not, as Tirytory has unfortunately recounted with her hubby that patients frequently go for the throat and complain to the colleges. We most certainly have to respond to complaints at whatever level. The colleges do indeed have fitness to practice panels but before this, complaints are dealt with again, at college level concerning an assortment of complaints some justified and others often alas groundless but are given equal importance and are equally stressful.
With regard to audit, as you know, you have to have robust and reliable information gathering systems and until recently with the advent of EMRs - 20 years after the UK , there has been no way of getting this in GP land as well as hospitals- I would support audits 100% but again these are potentially expensive.

I'm puzzled by your experience with regards to unnecessary views partly as a result of patient demand- they don't write the XR requests, we do and I won't irradiate patients unnecessarily without clinical gain. Back XRs are I'm sure a prime example of unnecessary investigations which have minimal yield. CT scans in ER are repeated I feel to huge detriment of young patients.

Maybe I am affronted because I believe I am ethical, investigate my patients appropriately and your post I felt perhaps suggested that the majority of GPs were gaming hence my response. As I said previously, there are of course physicians who will always be chasing the dollars but I and the majority of my colleagues do not I feel fall into this (minority) category.

I have to say this has been a fascinating thread with all sorts of presumptions made, some reasonable and some not. I don't feel that the system is efficient on a fee per service basis but until they implement teams including widespread use of nurse practitioners , office nurses working with say family physicians in offices so that the system is not so doctor centred then there is no prospect of change.
I would love every patient to have their own family physician, unfortunately there aren't enough of them and tbh it is bloody hard work jumping though the hoops to work here just as it is if not worse, with nursing. I feel that it was worth the effort and my patients on the whole appreciate me. I see a reasonable number per day and yes so sometimes I keep them but I cannot plan what comes through the door beit a sore throat or someone who has to be told that they have breast cancer. I always apologise as I hate running over time and keeping people waiting. I'm no saint but I genuinely try my best to serve my patients to the best of my ability .
There... got that off my chest!

bats

Phew, and I'm glad you did! I understand your personal affront as I feel it too when people misunderstand what happens during an xray exam or particularly the skills that x ray technologists/radiographers have.

There are turf wars over who gets to do what, nurse practitioners, reporting radiographers, etc in both countries. Canada could do with more delegation of tasks that don't need several years of medical training and insight but it rarely happens unless forced. I haven't been impressed by the standards of nurse practiioners here but was in the UK. I'm fortunate to work in a small hospital where we can all work together and there is little oneupmanshio between disciplines. Though I have been told that my responsibility ends with taking the xray which is really not how it should work for the benefit of the patient.

I've been doing this job a long time and my tolerance levels are low these days.

Stinkypup

I would agree with you there, I have worked with some fantastic nurse practioners in the UK where they were seen as the norm unlike here. If acceptance of them by patients, increased by public education then standards would hopefully improve as there would be more of them. Everyone has their skills and should be respected for those skills, often, as you say acquired over many years. Teamwork is much better all round.

snoopdawg

Because she believes in evidenced based medical care- which should be the gold standard in all countries. Evidenced based care is not anecdotal, is not done just because it makes you feel all warm and fuzzy and loved by your GP!!! Canada has socialised healthcare that is paid for by the tax paying public who rightly want only medically necessary tests/investigations/treatments. If it made you feel good to have your serum rhubarb checked once a year, should your warm, "generous with tax payers money" GP order it???
There are good reasons why MSP do not pay for routine check ups, check ups for people with chronic diseases, young children and those we have concerns about are allowed. PSA is a very difficult investigation , urologists cannot agree at present about its usefulness as a screening tool so your GP should stick to the guidelines of the people who pay him.
I try to stick to ethical guidelines , I will only order X-rays I feel are appropriate- rather than the patient or their chiropractor, same with labs, same with other investigations. I've never had a "kick back" from anyone for anything- maybe I'm doing something wrong.
Personally I would welcome a radiographer contacting me to discuss something if they felt that a different X-ray/view or investigation would be more appropriate.

And finally- yes I believe strongly in teamwork- everyone should work together, respect each other and each others skills. In that regard, Canada lags hugely behind the UK, and IMHO Canadian trained doctors are partly behind this- at least the older ones. Maybe multidisciplinary care is being taught now but we teach medical students and are given no option/encouragement or time to get them to spend time with anyone other than ourselves unlike my own training in the UK many years ago.

scilly

I obviously bow to the combined knowledge of modern doctors who have no idea of the way doctors worked here in BC in the late 1960s, 1970s and 1980s.


I will point out that it was the DOCTORS who wanted, in the first case, annual checkups for all members of the family, and a second GP who believed that all men should be tested for prostate cancer from their 30s, using both the finger and the PSA test.

Neither I nor my husband asked for those tests, we were told to make appointments with the doctors to have them done. Both doctors and the requests seemed to me to be eminently sensible, especially after they discovered that OH had an enlarged prostate .......... it was necessary to check that it continued to be benign.


You seem to be wanting to crucify me for "asking" for tests unnecessarily.

We ourselves have NEVER asked to be given tests, sent for x-rays, or blood tests.

I have never asked to have my back x-rayed "again" even though I have a deteriorating spine .......... I trust that the doctor will say "it's about time that .......... "

I have never asked to have my knees or hips x-rayed "again", same reason, and same trust.

but by god am I glad that one doctor believed in women having a mammogram from the age of 50. That gave the base line for the cancer that was found 5 years later.

.......... and also glad that several other tests have been ordered that have found other problems not obvious by looking at either of us


and am I ever glad that I go to a Clinic where the new FP residents are being trained to take time to talk to their patients .............

Of course, I have no idea what happens when they get out into the big bad world, and start to work for real. They may well stop listening, and stick to their 10 minutes ....... but at least they are being taught what to look for


Oh yes ......... I was one who taught a young woman in her second month of residency how to tell someone that they had breast cancer


Talk about the patient consoling the doctor!

The resident was not left alone to do the job, one of the clinic supervisors came in to help ...... it was very instructive to watch him at work with me, with OH, and with the young resident. And, yes, there was no time limit placed on us.

BEVS

Karma

Stinkypup

Scilly, your posts all seem to have a recurring and somewhat monotonous message - with age comes experience and more years on this earth seemingly gives you knowledge in all fields. The whole point from what I can see of this thread is to look forward and evolve the health service in Canada not look back to what was being provided back in the 60s and 70s. No we weren't here in BC then- we weren't around when dinosaurs ruled the earth( seemingly you were) but we still know a hell of a lot about them, we didn't have to be there. Experiential learning is only one VERY small part of life... I'm sure however you might disagree with this last point as it seems to be your mantra. For god sake stop harping back to the good old days- move with the times like the rest of us.

scilly

Thank you for your vote of confidence in me ......... and your obvious dislike of what I post.



For what it is worth ..... I have posted that there are changes to be made

............... but all I see are you lot harping back to what happens in the UK and how that is better


If the NHS is so much better, why did you all leave? Some of you are obviously not happy with what you have found in Canada.



Not all my stories are from the dinosaur years, as you so charmingly put it ................


I taught the resident how to tell a patient about breast cancer just 3 years ago

Stinkypup

I taught I taught I taught

Dorothy

Those referrals were presumably triaged as being non-urgent or semi-urgent and therefore the waits.

I work in a very large teaching hospital's critical care department. We receive hundreds of referrals every week for patients and all of these must be triaged by doctors according to clinical urgency and clinical need before an appointment or procedure can be booked - sometimes the referral is rejected if the consultant feels the patient doesn't need specialist services. Appointments are usually within 3 months, but sometimes if something is just a follow up or not urgent it can go up to 120 days.

I can only comment on the heart thingie (actually it's called an echocardiogram) because I remember when you posted about it. An echo is an ultrasound of your heart that looks at the structure of the heart and the valves. If you were not exhibiting overt symptoms of structural heart disease or your doctor did not have reason to believe you had a life threatening illness then your referral would have been prioritised as either non urgent or semi urgent. I do know that in our hospital outpatient non urgent echoes are booked about 6 months away. Semi urgent within 3 months and urgent usually either go private (and are billed through Medicare as an arrangement exists between some of the private clinics and our department) or we can usually squeeze them in within a couple of weeks.

As for your other referrals, I can again only speak from experience working for ophthalmology practices in Ontario before moving to Australia. Too many patients wanting "routine" appointments for things either their optometrist or GP could handle and not enough time to see them all. New glasses, prescription for eye drops for dry eyes, routine pressure checks for people (like me) who have higher than normal intraocular pressures without any other signs of glaucoma, etc. These are things that the GP or optometrist should be taking care of, not the specialist whose job it is to treat more complex issues.

Anyway, I'm not trying to have a go at you and I apologise if it comes across that way.