The federal election seems to be focusing largely on issues such as the economy and security. If health is mentioned at all, it is in the context of health care.
But health care is a determinant of our health; it is not the main one. While our genetic inheritance also plays an important part, much of our health comes from the environmental, social, economic, cultural and political conditions we create as communities and as a society.
In our system, the federal government does not provide health care or manage a health-care system, aside from special situations such as for aboriginal people and the armed forces. But many other areas of policy for which the federal government does have full or at least partial jurisdiction do influence the health of Canadians. ...continue reading →
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
French general practitioners went on strike today. It’s part of an extended period of industrial action that includes refusing to process paperwork and a number of planned medical centre closures. Not every GP could participate today, however, due to a flu epidemic sweeping across France. Doctors had already closed their offices during December but there was little response from Marisol Touraine, the Minister for Health, and this was part of their planned efforts to maintain pressure.
The aim is to highlight the need to improve the effectiveness and accessibility of heath care worldwide. Why? As this (slightly UK-focused) video from the London School of Hygiene and Tropical Medicine elegantly illustrates ...continue reading →
If you look at an old map of Canadian healthcare policy, just near Privatization Island is a big warning: “Here be dragons.” So it proved for Alberta Health Services recently when a seemingly innocuous decision -- to swap the tender for laboratory services from a United States-based transnational corporation to an Australian one -- provoked a furore fueled by discontent.
Part of the problem is that ‘privatization’ has two meanings. One refers to an increase in the private funding of healthcare. In the Canadian context that is unequivocally bad. It breaks the compact between Canadians that they are all in the same boat in terms of access to healthcare and strikes at one of the key differences between the U.S. and Canada. On one side of the border, people can sleep easy knowing they are protected against the costs of healthcare if something goes wrong for them or their family. On the southern side, the spectre of bankruptcy or no care looms, even in the post-Obamacare world.
But Alberta’s controversy over lab contracts is about a different sort of privatization. It is about who delivers care within the publically funded system. ...continue reading →
Victor Montori is a physician specializing in diabetes care at the Mayo Clinic in Rochester, Minnesota. He conducts research in the Knowledge and Evaluation Research Unit at Mayo Clinic, and is a member of both the National Advisory Council for Healthcare Research and Quality to the U.S. Department of Health and Human Services and the steering committee of the International Patient Decision Aids Standards Collaboration. Dr Montori is a keynote speaker at the forthcoming NAPCRG Annual Meeting 2014
On Saturday November 22 2014, I will have the privilege to speak with the North American Primary Care Research Group plenary gathered in New York City, on Minimally Disruptive Medicine.
What will I try to accomplish? Beyond the stated objectives, I am hoping to promote among participants a new lens of looking at how we might organize and deliver care for patients with multiple chronic conditions. At the heart of my presentation will be the need to be careful and kind when caring for and about our patients, particularly those likely to be overwhelmed by multiple chronic conditions.
Careful care reminds us of our commitment to patients in terms of technically correct and safe care. For patients with multimorbidity, this means that we must understand how multimorbidity affects the efficacy and safety of routine interventions. Major uncertainty exists in this exercise, uncertainty that should lead us to only conditional recommendations, the kind that require us to engage patients in collaborative deliberation. This uncertainty gives clinicians permission to to care for each patient, rather than to attain targets.
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
The “Medical Innovation Bill” could radically change the way doctors make treatment decisions in the UK. Lord Saatchi, in response to the death of his wife from cancer, seeks to change the law to allow doctors to use experimental treatments, a concept that challenges evolved standards of practice. This Private Members Bill, which will be discussed at committee stage in the UK House of Lords on Friday, provoked ongoing discussions among leading doctors highlighting the tension between evidence based medicine and innovative clinical practice.
Medicine has made many mistakes in the past, some of which are listed in the website of the James Lind Library, the brainchild of Iain Chalmers, champion of the randomised controlled trial. While they recognise that doctors have always done their best, patients have been harmed because doctors didn’t have reliable knowledge on the effectiveness of treatment. As scientists, we recognise the need to make decisions based on the best evidence available and, equally important, to identify the harms. But, emotion is a powerful motivation ...continue reading →
The forum began with a talk by former deputy chief of staff for policy in the office of the Canadian PM, Dr. Peter Nicholson. Nicholson talked about innovation in Canada beyond the health care arena and pointed out that Canadian business has only been as innovative as it has needed to be – i.e. not very – which has resulted in a decades-long low innovation equilibrium. Why? Because we are too comfortable in Canada. Canada’s good fortune in having vast natural resources means that business innovation is just not as pressing a need as for some other countries. And our proximity to the US is no help – Canadian business is comfortably and profitably integrated with US business (“the ‘junior partner’ in North America?” asked Bill Tholl, Founding President and CEO of HealthCareCAN) making it particularly challenging for Canadian business to embrace global business models, keep pace with revolutionary technology, establish significant positions in sophisticated global value chains and develop clusters of skills and infrastructure that enhance innovation, Nicholson said.
It seems that dragging innovation in the health care space is not an anomaly but mirrors that of general Canadian industry. ...continue reading →
Dr Andrée Rochfort is Director of Quality Improvement at the Irish College of General Practitioners, Dublin
I frequently wonder how we can best prepare young doctors for their future medical roles and responsibilities, and how we can best support those already doing the doctor job.
We set out to care for others, to help others, to help others recognize their options and choices. We are set apart from patients during training. We learn to feel the expectations that “others” have of us; our peers, other health professionals, managers, professional bodies, medico-legal bodies, media, patients, patients’ relatives, our own relatives and non-medical friends. To this mix add in our self-expectations of ourselves. Combine these ‘perceived pressures’ then add our intrinsic sense of perfectionism and our pledges to others to do everything possible and we have a recipe for internal conflict! We feel guilt and failure when we cannot deliver perfect care with the selflessness we believe is expected of us. In reality we have to remember we are ‘human’ and we cannot work miracles. We do not have a magic wand. ...continue reading →
Declan Fox is a Family Doctor in Tignish PEI (that's Prince Edward Island, Canada, for international readers)
How did I get here?
With apologies to Talking Heads, I wonder sometimes, myself. How DID I get here? Resurrecting this family medicine practice in Tignish, PEI, is what I'll be doing for the next few years. At the ripe old age of 59 I'm taking on something I wouldn't even have attempted 25 years ago. And I'm doing it 2500 miles away from home in a health service that is very different from the UK NHS I once loved with a mighty passion.
So what's so great about moving to Tignish? A little history might help. 17 years ago this month I was mooching around home, three months after a suicidal breakdown due to my second bout of major depression. ...continue reading →
Dr. Ryan Herriot, Dr. Steven Persaud, Dr. Rannie Tao, and Dr. Stephanie Stacey are Resident Physicians in Family Medicine at St. Paul’s Hospital, UBC Faculty of Medicine
As family physicians in the first stage of our careers, we look forward to practicing medicine in a world that would be unrecognizable to our predecessors: a world where all patients have access to dedicated "primary care homes,” where multidisciplinary care is the norm, and where siloed, fee-for-service practice no longer predominates.
Therefore, we are very happy that Vancouver’s City Council has voted unanimously to support the continued and expanded provision of multidisciplinary primary care at Vancouver’s Community Health Centres (CHCs), which are vital to the future of frontline health care in this province. However, several of these Centres are facing funding cuts under a plan put forward by Vancouver Coastal Health (VCH). VHC is adamant that their plan is a rational one that will shift resources away from low-needs patients towards high-needs ones. We feel, however, that this a classic example of “robbing Peter to pay Paul.” Many patients will be forced into inferior care models and many “high needs” patients will be forced to travel great distances to a single “super clinic” being created at one CHC, Raven Song. ...continue reading →