Having read this and the Pairodocs latest I conclude that we have in fact reached the point where medicine is no longer a profession. It retains some of the trappings, as does democracy in nations increasingly controlled by global elites, managerialists and lawyers, but it is now regulated and controlled, not self regulated, with no tolerance for dissent. Major changes such as MAiD are imposed with no proper consideration, debate or discussion within the profession. Calls for caution are regarded as obstruction of progress. Even if physicians wanted to stop this, and I fear most do not, it is too late
Sadly, that’s the conclusion I’ve reached as well. I’ll expand on it further in another post or two, but it’s been “deprofessionalized” (the knowledge base and skill set are no longer deemed unique to physicians), and it’s certainly no longer self-regulating (although the government is only too happy to have doctors pay licensing fees to the College to cover the costs of registration and discipline). It’s basically a job with shitty working conditions.
How soon will we have "bare-foot" doctors servicing the rural areas? A couple of years of at community college should be able to pump them out by the tens of thousands.
That’s about where it’s heading! As other professional groups convince government that they too have the ability to do what doctors do, the quality of the service slowly declines.
Back when I was in medical school, we weren’t tripping over pharmacists learning how to examine patients, and yet all of a sudden they’ve gained the ability to assess and treat “minor” illnesses, such as coughs, colds, shingles, vaginitis, etc. I’m assuming that people aren’t dropping their drawers in that tiny room next to the dispensary in my local drug store, so I’m guessing that a lot of those illnesses are being diagnosed based on symptoms alone.
Ditto for “chronic disease management”, something else the pharmacists and others now claim to have expertise in. As a doctor, when I see a patient and diagnose a chronic disease, I keep many things in mind as I undertake their treatment. Sometimes the diagnosis is based on what’s most likely, but I have to remain mindful that there might be another explanation. In treating, I’m trying to relieve symptoms with some drugs and avoid long-term complications with other drugs. I’m also on the lookout for the consequences of the disease, like renal failure or retinopathy in diabetics. All that while trying to keep track of other problems and overall health maintenance.
When a patient drops into a pharmacy for a prescription refill, and the pharmacist undertakes “chronic disease management”, do they know how the diagnosis was made, what the other possibilities are, why the various drugs were prescribed, what monitoring has been done to date, which symptoms are of concern, and how all of that aligns with everything else in the patient’s life? The short answer is that they don’t. They are being paid for a service they can’t adequately provide.
Have you heard of Dr. Bob McClure? He was a missionary surgeon in China from the 1920s until 1949. I have his biography "McClure: The China Years".
He was the one who designed a ring system for hospitals. The A hospitals were staffed by qualified western and Chinese doctors and nurses. They were surrounded by a ring of B hospitals. They were staffed by what McClure called quacks. Orbiting them were the smaller C clinics. Out in the periphery was the Grade D practitioners, the bare foot lads.
This was done due to need. Richer societies can do better. Yet we too have a form of his idea. I live in Sudbury. It has a regional hospital and a cancer clinic that supports the whole northeast Ontario. There is a helicopter pad on the roof to bring in patients from all over the north. Next to the hospital is a medical teaching university.
That was one of the major reasons we moved to Sudbury. We wanted to live in a city that had a teaching hospital.
Haven’t heard of him, but I agree we have a poorly planned version of the model you describe.
I grew up in Alberta, then moved to Nova Scotia. I worked as a hospital accreditation surveyor for a while, and for various reasons to do with health system bureaucracy, I got to see several of the hospitals in the more remote bits of Ontario.
As I see it, the provinces are mostly “large”, with small numbers of people spread across vast amounts of rural and remote terrain, and larger numbers of people jammed into a fairly small number of urban centres. It’s easier to organize a health care system when you have a critical mass of people within range of the right number of decent sized hospitals, and harder to provide health care in the rural and remote bits, particularly when you throw in winter weather and other complications, like some people’s expectations that they’ll still get equally great health care when they live miles from nowhere. That’s a story unto itself.
The Maritime Provinces (NS, NB, and PEI) are different from all the rest because they are “little”. The population is more evenly distributed. Even the rural and remote areas are within an hour of a population centre, for the most part. Sure, we get storms that shut down the roads, but not that often. That being the case, hospitals should be places in such a way that the maximum percentage of the population are within xxx minutes of a facility, by road, with the air ambulance there to facilitate emergency inter facility transfers.
Unfortunately, our system reflects the realities of the 1950’s. Facilities that were built then are still in use, or they’ve been replaced when they fail, without regard for the fact that the local population might have declined, or road linkages to bigger places might have improved. Sometimes, you get people leaving the larger population centres and driving to the little places with the newer facilities, because the emerg “in town” has too long a waiting time! Of course, if they need specialized care, they then get transported the other way.
On the other hand, you get communities that have grown enormously, and yet they have no local facilities, nor is there a plan to add any. The highway between Halifax and Truro, for example, is a growth corridor, with 10’s of thousands of new citizens, and yet it’s over half an hour to an emergency department, by ambulance, in either direction. One of those emergency departments is free-standing, with no attached hospital, so any patients seen there require referral on to a hospital with beds and specialists. Meanwhile, they are on a five year plan to expand the teaching hospital deep in the middle of Halifax, which is on a peninsula and hard to get to due to limit roads in and out and major traffic congestion.
The bottom line is that it’s a poorly designed system, unresponsive to shifting populations, with good care in a few places and mediocre care in many other places, when they are open. Not that different from China, as you’ve described it!
The care is better at teaching hospitals. My wife and I are in our 70s so that is important to us.
In Vietnam and In China, if foreigners get into serious accidents, the rural hospitals will stabilize them and then ship them to a teaching hospital in a bigger city.
A bus full of Korean tourists got into a serious accident along the Chinese-North Korean border. The wounded were stabilized and then shipped to Changchun, the provincial capital. To assist the medical staff at the hospital, students from the Changchun Foreign Languages School (a private high school a few blocks away) were sent to the hospital to translate between the patients and the medical staff.
Having read this and the Pairodocs latest I conclude that we have in fact reached the point where medicine is no longer a profession. It retains some of the trappings, as does democracy in nations increasingly controlled by global elites, managerialists and lawyers, but it is now regulated and controlled, not self regulated, with no tolerance for dissent. Major changes such as MAiD are imposed with no proper consideration, debate or discussion within the profession. Calls for caution are regarded as obstruction of progress. Even if physicians wanted to stop this, and I fear most do not, it is too late
Sadly, that’s the conclusion I’ve reached as well. I’ll expand on it further in another post or two, but it’s been “deprofessionalized” (the knowledge base and skill set are no longer deemed unique to physicians), and it’s certainly no longer self-regulating (although the government is only too happy to have doctors pay licensing fees to the College to cover the costs of registration and discipline). It’s basically a job with shitty working conditions.
How soon will we have "bare-foot" doctors servicing the rural areas? A couple of years of at community college should be able to pump them out by the tens of thousands.
That’s about where it’s heading! As other professional groups convince government that they too have the ability to do what doctors do, the quality of the service slowly declines.
Back when I was in medical school, we weren’t tripping over pharmacists learning how to examine patients, and yet all of a sudden they’ve gained the ability to assess and treat “minor” illnesses, such as coughs, colds, shingles, vaginitis, etc. I’m assuming that people aren’t dropping their drawers in that tiny room next to the dispensary in my local drug store, so I’m guessing that a lot of those illnesses are being diagnosed based on symptoms alone.
Ditto for “chronic disease management”, something else the pharmacists and others now claim to have expertise in. As a doctor, when I see a patient and diagnose a chronic disease, I keep many things in mind as I undertake their treatment. Sometimes the diagnosis is based on what’s most likely, but I have to remain mindful that there might be another explanation. In treating, I’m trying to relieve symptoms with some drugs and avoid long-term complications with other drugs. I’m also on the lookout for the consequences of the disease, like renal failure or retinopathy in diabetics. All that while trying to keep track of other problems and overall health maintenance.
When a patient drops into a pharmacy for a prescription refill, and the pharmacist undertakes “chronic disease management”, do they know how the diagnosis was made, what the other possibilities are, why the various drugs were prescribed, what monitoring has been done to date, which symptoms are of concern, and how all of that aligns with everything else in the patient’s life? The short answer is that they don’t. They are being paid for a service they can’t adequately provide.
Have you heard of Dr. Bob McClure? He was a missionary surgeon in China from the 1920s until 1949. I have his biography "McClure: The China Years".
He was the one who designed a ring system for hospitals. The A hospitals were staffed by qualified western and Chinese doctors and nurses. They were surrounded by a ring of B hospitals. They were staffed by what McClure called quacks. Orbiting them were the smaller C clinics. Out in the periphery was the Grade D practitioners, the bare foot lads.
This was done due to need. Richer societies can do better. Yet we too have a form of his idea. I live in Sudbury. It has a regional hospital and a cancer clinic that supports the whole northeast Ontario. There is a helicopter pad on the roof to bring in patients from all over the north. Next to the hospital is a medical teaching university.
That was one of the major reasons we moved to Sudbury. We wanted to live in a city that had a teaching hospital.
Haven’t heard of him, but I agree we have a poorly planned version of the model you describe.
I grew up in Alberta, then moved to Nova Scotia. I worked as a hospital accreditation surveyor for a while, and for various reasons to do with health system bureaucracy, I got to see several of the hospitals in the more remote bits of Ontario.
As I see it, the provinces are mostly “large”, with small numbers of people spread across vast amounts of rural and remote terrain, and larger numbers of people jammed into a fairly small number of urban centres. It’s easier to organize a health care system when you have a critical mass of people within range of the right number of decent sized hospitals, and harder to provide health care in the rural and remote bits, particularly when you throw in winter weather and other complications, like some people’s expectations that they’ll still get equally great health care when they live miles from nowhere. That’s a story unto itself.
The Maritime Provinces (NS, NB, and PEI) are different from all the rest because they are “little”. The population is more evenly distributed. Even the rural and remote areas are within an hour of a population centre, for the most part. Sure, we get storms that shut down the roads, but not that often. That being the case, hospitals should be places in such a way that the maximum percentage of the population are within xxx minutes of a facility, by road, with the air ambulance there to facilitate emergency inter facility transfers.
Unfortunately, our system reflects the realities of the 1950’s. Facilities that were built then are still in use, or they’ve been replaced when they fail, without regard for the fact that the local population might have declined, or road linkages to bigger places might have improved. Sometimes, you get people leaving the larger population centres and driving to the little places with the newer facilities, because the emerg “in town” has too long a waiting time! Of course, if they need specialized care, they then get transported the other way.
On the other hand, you get communities that have grown enormously, and yet they have no local facilities, nor is there a plan to add any. The highway between Halifax and Truro, for example, is a growth corridor, with 10’s of thousands of new citizens, and yet it’s over half an hour to an emergency department, by ambulance, in either direction. One of those emergency departments is free-standing, with no attached hospital, so any patients seen there require referral on to a hospital with beds and specialists. Meanwhile, they are on a five year plan to expand the teaching hospital deep in the middle of Halifax, which is on a peninsula and hard to get to due to limit roads in and out and major traffic congestion.
The bottom line is that it’s a poorly designed system, unresponsive to shifting populations, with good care in a few places and mediocre care in many other places, when they are open. Not that different from China, as you’ve described it!
The care is better at teaching hospitals. My wife and I are in our 70s so that is important to us.
In Vietnam and In China, if foreigners get into serious accidents, the rural hospitals will stabilize them and then ship them to a teaching hospital in a bigger city.
A bus full of Korean tourists got into a serious accident along the Chinese-North Korean border. The wounded were stabilized and then shipped to Changchun, the provincial capital. To assist the medical staff at the hospital, students from the Changchun Foreign Languages School (a private high school a few blocks away) were sent to the hospital to translate between the patients and the medical staff.
They have come a long way.