Well, I think we all knew this a long time ago...

Dr Oz is NOT a good information source.....article written by a reluctant former colleague.....

Adapting to Canadian Life: my husband visits Dr Johnny Depp

Our health system in British Columbia covers any resident in B.C. (BCMSP)  The catch is, you have to be enrolled.    Yet, believe it or not, some people don't bother do it. 

It seems that BCMSP isn't too sticky about when you pay because my work *forgot* to pay my premiums for three months - and everything was still covered, retroactively.   As long as you are a resident, you will be covered.  They seem to be quite nice on the phone and willing to work with a person to get any errors straightened out.

If  you make less than $22K per year, you do not pay anything for your Medical coverage. There is 100% premium assistance.  The more you make, the more you pay (see chart mid-page).  The working poor can afford monthly payments.

The maximum you would ever pay as a single would be $60.50 per month, a family of two would pay $109.00 per month and a family of three or more  would pay $121.00 per month. No co-pays (a Canadian doesn't know what co-pay means) and it doesn't matter what pre-existing illness you have.

When I lived in the USA, I knew all kinds of people who would love the benefits of our plans above.  When my husband  quit his job in Washington State to move up here, he was offered COBRA coverage at $600 per month plus a high co-pay.  His co-pays were fairly substantial ($5K deductible per year for single, $10K per year for a couple ) when he did have his insurance. 

You would never hear a Canadian pay *that* without complaining. Canadians complain when they have to pay an extra $8 if they happen to go to a certain drugstore that charges an extra dispensing fee (there are some that would include it with the medication - for those that get their medications covered by the government )

I mention all this because my American-born husband just came back from the MD (Dr Johnny Depp) and asked me why they didn't want to see his extended medical card - only his BCMSP card?  I had to explain to him that there were no such thing as co-pays and that BCMSP covered the entire visit - that our other cards from our employer (paid for entirely by the employer at no cost to us)  coveres our Dental, medication, Travel Medical and excess medical plus ambulance, chiropractor, naturopath, massage therapy, physiotherapy, private room, eyeglasses etc.  Our employers also pay our BCMSP premiums for us.

My husband is still trying to acclimatize himself to the system here.

Johnny Depp is my MD

So I went to see the doc that will be my new MD yesterday.

I knew when I went to my appointment,  he was going to be young.   He has been an MD for 5 years. Got his education at McGill University. ( alumni include 9 Nobel Laureates, 161 Rhodes scholars, 3 astronauts, 2 Canadian Prime Ministers, 4 Justices of the Supreme Court, 3 foreign leaders,9 Academy Award winners, 3 Pulitzer Prize winners, and 28 Olympic medalists...and ya, I realize there are people who graduate at the bottom of their classes - but allow me to be optimistic here....)

He hails from Saskatchewan - just like my father.  Good stuff.

What does he look like?

No lie.

The spitting image.  (without the moustache and beard-thing)

Very disconcerting.
 
Especially since he is one of the only "stars" I enjoy seeing in a movie. ( ....so much for my future pap tests)

We had a discussion about his rating on rating MDs dot com.  We both laughed when I told him what I thought of the opinions published on the website (2 thumbs down).  Apparently he thinks the same thing. 

He stated that his partner in the office (who has only been practicing for only one year) made the big mistake of looking at his own ratings on the website and he was devastated by the critiques expressed on there about himself.

 I had looked in advance at both docs on that website, so was quite aware of the published opinions.

"What???" I exclaimed in disbelief.  "How can he be upset with the critiques about him on that site ? He has all smiley-faces and only *one* report that was mediocre and even then was mostly positive."

"Ya, I know.....he was pretty upset - almost immobilized by the report"

Which goes to show, MDs are people too, are sensitive and are subject to the same feelings we are.

More to come.

Upper Respiratory Infections

My first year of University found me living with a room mate diagnosed with TB part way through our second semester.

Luckily, I didn't get TB - but I was diagnosed with pleurisy and ended up having to take antibiotics....but since then, I have experienced restriction in my lungs.   When I sneeze or breathe really deep, the chest pain is excruciating.  When I get an URI - it seems to be worse than your average joe experiences.  I have puffers that I use, just so I can get air.

When I was an LPN just starting out - it was routine to have X-Rays done yearly because they did not do the standard yearly Mantoux testing.   Without fail, the hospital's health nurse  would always call me over to her office for post X-Ray counselling.....

"They found extensive scarring on your lungs on your last CXRay....did you know....?"

And I would always reply, "Yes,  I had pleurisy when I was 18 and my lungs always show the scarring"

A few years ago, an Xray for my MVA injury showed up incidental "nodules" on my lungs.  Subsequently, I had to have a follow-up CT scan.   The "nodules" were benign, so they said. 

My last trip to the walk in clinic - the MD said to me - "Your asthma seems to be in fairly good control".

I had to tell him that I don't have asthma. 

I don't know what gave him that idea unless the fact that I had had an inhaler prescribed for me for a reactive lung problem a while ago might have made him think that.

I was working L&D in a busy unit and the spray cleaner that was used on a nearby stretcher caused my respiratory system to spasm so badly - I couldn't breathe.  Talk about scarey.  An anesthetist coming down the hallway towards me asked if I was ok. If it wasn't for one of the OB's standing nearby loaning me his salbutamol inhaler, I would have ended up in ER.  Or dropped to the floor.  It was good to know help was so close, just in case.

It reminded me of the pregnant RN I worked with in L&D in California - dx with a placenta previa but still working.... even after she was ordered on bedrest.  She also figured it was safest to be at work. Help would be always close by.

I went to see the Occupation RN for the hospital.  Her take? I would require allergy testing to see if I was "actually" allergic to the cleaning solution (I had reacted the same way with every other hospital using the same cleaning agent - all whom switched to squeeze bottles rather than aerosol - or switched cleaning solutions entirely) but "even then" she stated, "if you test positive for an allergy to that agent, the hospital would change nothing"

I was fortunate that the cleaning staff were very particular and considerate of my plight and would always check ahead of time to see if I was on shift and make sure I was nowhere around when they used their cleaners.

I'ts been two weeks since I have been sick and I am still coughing up "gunk".   It always feels like mucus hangs out on top of my palate in that space.  When I cough there is that harsh spasmy sound.

At least I am breathing and feel like I am getting enough oxygen.  I don't have a fever, either.

The good news?

I found an ad in the local newspaper for an MD within 2 blocks that is now taking patients so I won't have to drive 100kms to see my MD.  I looked him up under Rate MDs dot com  and found out that people are making the exact same complaints of this doc as my former doc (esp complaints such as #2,#6 and #8 - oh and complaints about the laptop use and the decor is "too casual"). 

That shows me he must be pretty good.

Stay tuned.

Meeting Someone Famous in L&D

Occasionally we would have residents come through that had other interesting occupations.   This is a story from 2002:

I happened to be chatting with one of the residents in my course of arranging care for one of my laboring moms, and I could see that she was excited.  She mentioned she had just come from  Los Angeles this past weekend. She explained she had attended the Oscars.

"Wow. That must have been a spectacle" I offered, only minimally impressed but not wanting to dampen her enthusiasm.  My old roommate in California had turned down an invite to go to the Oscars as a date with one of the Big Kahunas at Fox Studios, and had heard of some of the shenanigans that goes on with all the activity around the function.

 "Well, I didn't get to see the whole thing.  I was one of the performers". Matter of factly, as if she was discussing a case presentation.

 I looked at her in surprise.

She seemed to be an ordinary, slightly-built, petite young woman who seemed average in every sense of the word.  And - a darn good resident to boot.

She handed me a photo of herself standing arm in arm with a fairly tall man all dressed in black.  She was flushed with excitement.

I looked closely at the photo.  "What is it exactly that you do?" I enquired.

"I was performing with my troupe - 'Cirque du Soleil'  as one of their aerial gymnasts.  At the end of the performance we got to hang out backstage.   I was hoping to meet any celebrity....but when I ran into Sting  backstage  - he wanted to stop and talk with me.  He was so friendly - just an ordinary guy, and nice enough to let me have a picture taken with him." She points to the guy in the photo standing next to the grinning resident dressed in a costume.

"He is my absolute favorite. So excited to meet him!  I would have been happy meeting anyone - but it was Sting - can you believe it??"

I suppose some might be impressed with meeting Sting, however I was too busy what with being in awe of her as one of the troupe members for The Cirque.

  Pretty cool.


The Cirque's Performance at the 74th Oscar in 2002:


Sting's Performance at the same Oscar's:

"There but for the Grace of God..."

I used to live right downtown in the heart of Vancouver - the West End actually.  Right in  the heart of the Gay district - two blocks from English Bay... Sunset Beach.

 I lived in a 100 year old building with floors so sloped -  that if you put a marble on the old hardwood floor in the living room - you could watch it travel  past the kitchen and into the bathroom.

 I was allowed to paint the apartment as I wished.  There was no regulating the radiator heat - and sometimes we had to open the windows to cool the place off,  or turn on the gas stove and open the oven door to warm the place up.   Members of the "Swollen Members" Band lived across the street from me, and when I vacated my apartment,  a band member of Bif Naked (saw her in a Lilith Fair Concert with Sarah McLachlan )moved in.

I put an ad on the bulletin board at the local Internet cafe and thus got myself a really nice roommate - a young gal from Australia - she happened to be a psychologist, but couldn't practice in Canada...and ended up working instead as a tour guide on the gondolas up Grouse Mountain.

 I loved the movement of kids in and out of the apartment - there was a never ending assortment of interesting people...Kiwis, displaced Montrealers.....you name it.  My roomie would bring them home.  I worked nights at that point and since I slept like a rock during the day and was never home at night...it was a great arrangement.

Living downtown Vancouver was just a different atmosphere than any I have known.  It feels less like a city and more like a small village.  You can sit outside at any number of local coffee shops and restaurants year round.  The weather is that moderate.   People are friendly.  They smile and say "hi" as they go by.  You often see the same people over and over again.

 Even the street people were like family.  People living downtown would make sure the local street people were taken care of.   One of the  "givens" was that you would save your refundable bottles and put them out once a week for the local street people so they could come by with their carts and collect them and turn them in for cash.

I remember one young aboriginal guy that could be found on the same street corner every morning as I walked home.  He always had a cheery "Good morning" and a big smile as I would pass by.  Very friendly. Happy-go-lucky type.  Once in a while I would stop and talk.

 He never asked for money, but if it was something you wanted to do, he was open to offers. Always said "Thank-you! Have a nice day!" whether you gave or not. I never gave money - it's just my policy - but always food or items he might need.   Curious, I asked him how much he could collect in a day. 

"Oh - some days it's better than others.   I sometimes am lucky and can get $50 by noon.  If that happens I run to the store and buy myself a nice big steak to eat."  Life, to him, was pretty simple.

One morning, when passing by his usual spot on my way home from work,  I could see he was in rough shape.  He looked like crap. I stopped and asked if he was OK.   "My friends beat me up - we got into it" .   He had a deep gash on his elbow and  bruises to his face. Ripped clothes.  By the odor still wafting about him, I assumed perhaps they got into a fight while intoxicated.

"Can't you go to the clinic and get that looked after?" We were standing 10 feet from a Walk in clinic.   "There's also an emergency just around the corner" pointing in the direction of the hospital I was just leaving.

"No - I don't want to go to Emergency.....and the Clinic already told me they wouldn't take me."

I was thinking they probably would, more than likely he just felt uncomfortable going to either place.   I couldn't imagine that the clinic would refuse him.  First Nations are a part of the federally funded health care  - and definitely, he would be covered.  I could understand, though, why he would be reluctant to show up at either place looking like he did.  Gary** was usually fairly meticulous about his clothes.

I went into the drugstore next to the Walk In Clinic and bought some first aid supplies.  I showed him how he should clean the wound and how to put the bandages on.   I helped him apply the steristrips and  and then handed him the bag of supplies.   He promised me that he would take care of it every day.   "Don't let me catch you with an infected elbow" I warned him.

Then,  he just - disappeared.   I watched for him every day.   Then, as suddenly as he disappeared - a year later - he showed up in the same spot on his street corner just as if he had never left. 

"Gary! I missed you! Where did you go?? I was worried - where were you all this time?!"

"Oh...well....I had to go up to Bella Coola for a court appearance and they put me in lockup for a year."

"Geez, Gary.....stay out of trouble will ya?"

He smiled his usual big smile.  " I sure will. Thanks! Have a nice day!"

Quite the contrast from the MD that I worked with that was also First Nations.  Articulate and talented, not only was this MD was just finishing his Family Practice Specialty......but he was also a well known actor.   He was telling me that patients would recognise him all the time...which could be a little bit difficult at times.  He was on the shy side and quite reserved. 


My husband is part Native American - Apache/Comanche - and part Hispanic.  If anyone understands the struggles facing the Indigenous of America - he does.   Having struggled growing up in poverty and then facing prejudice throughout his life,  my husband is my hero.  Not only has he overcome the tribulations of his former life, but he has in fact achieved more than what he ever dreamed of.... surpassed it.

There was a feature on a TV program here in Canada of this young lady.....First Nations and a foster child for the first part of her childhood until a family took her in at age 6.  She has now graduated from Lakehead University -a first Nations University - and has her Bachelor of Education degree/Royal Conservatory Teacher Certification and presently teaches music and Ojibaway between gigs.

I often wonder at the paths people choose to get them to their particular destination in life. Or is it entirely their choice.....?





**Gary: not his real name

Rating MDs: Round 2

I was thinking about the previous posting and hoping that people think that I don't believe patients shouldn't express their health needs and goals. I do believe that patients should take charge of their bodies and take more responsibility for their health. I have always advocated for my patient, often in the face of an angry MD.

I just believe that a site like Rating MDs dot com doesn't really help doing what it says it does - finding a good MD. The opinions expressed by the commentators are totally subjective. For one thing - I don't know how a patient could possibly rate an MD's "Knowledge"- which is one of the categories, by the way.

 They could give an opinion based on what knowledge they have gleaned elsewhere (suspect if taken from a source that is questionable) or from what another professional has stated. But, sometimes one MD's opinion will differ with another....not that either are wrong - it is just that medicine is not an exact science.

For example - on what basis of knowledge can patients judge whether a test should or shouldn't be done? And, how many times have comments by an MD or RN are either not heard, taken out of context or even interpreted and passed on incorrectly.

Here is more food for thought. I quote one article about the site:
"Doctors say that the Internet has forced them to manage their images instead of spending time, say, reading medical journals. The review process could affect how doctors interact with patients--putting more emphasis on making sure patients like them than on assessing medical problems and how to fix them."

I am thinking that the first sentence of the quote is a little exaggerated - I can't see an MD abandoning all learning due to a website. But I can see an MD doing the latter - sprucing up the image and making all efforts to be personable - while spending less time on the all-important things.

Certainly a patient can make a comment on their experience, how they were treated, how long they had to wait or what they have observed as behaviors in staff....but even then, that observation may be open to interpretation. What one patient observes as "rudeness" may be "friendliness" to another. I can see that in the comments on my own MD's site. Opinions are strong on both sides -attack and defense.

All I know, is that if someone starts up a site rating RNs - I know that there will be patients who will spill their guts on the site. Statistics, my friend! And - I am not so sure I would like my name on there.

Not everyone will have a good experience in the hospital. Not everyone has a great outlook on life. Not every druggie will get their fix on the hour like they want. Sometimes it is so busy, I can't get to the next patient in a timely manner like I should. Sometimes I will forget that medication that I promised to get for you because of that code in the next room. Not every day is going to be a good day for me either - and hopefully I don't take it out on anyone else - but we are all only human. Poop happens.

And, I certainly would take offence at comments made about my knowledge base. Remember that RN that abandoned her patient in my post previously? Mostly, her patients loved her. I know some RNs that are very good nurses but because they aren't social butterflies - the patient doesn't warm up to them. What kind of rating would they get?

It's only my opinion but I would prefer that patients give feedback -- both positive and negative -- to me personally. That way, I can try to correct something I have done or explain a little better to the patient to ensure they understand.

In the end, though, sometimes, you just can't please everyone - and I just wouldn't want that reflected on the internet where the world can see.

Rating MDs dot com

There is a site on the internet where laypersons can go and rate their MDs. The site actually allows people to do this anonymously.

Looking for Dr Death

At first glance it sounds like a good idea. One would hope their MD is the best in their field and we all do our best to figure this out. But what happens when patients who don't really have a reason to - start to complain? What if people start submitting comments that are not true? Or for whatever reason they feel slighted or they don't like the way their MD does something so they start to make comments, and you as an MD (or as an RN if they start up a site like that!) cannot debate the points made because of our confidentiality laws? It is a one way street.

I just looked up my own MD and to my surprise: her rating is BAD. In fact - "frowny-blue-face-bad".....which is the worst.

My MD is a female age approximately 40. She is very fit and looks great. She is a very positive person. Her physiotherapist husband shares office desk duties with another gal receptionist. When I come in for my appointment, my MD has her laptop in front of her and she takes copious notes (hey this is the 21st century people!) as she asks questions. She examines me thoroughly in whatever area is in question at the time. She is punctual, I never have to wait more than 10 minutes - but mostly she is on time. She jokes a bit and laughs easily, she is no nonsense and comes right out and says what she thinks.

Besides her family practice ( and by the way, no - she doesn't do deliveries) she also does certain "beauty treatments" on the side, which women pay cash for....such as botox or filling in lines - which is not covered under our medical system. Some of her "patients" apparently look at that as a bad thing. Personally, I hate needles so wouldn't even consider it - but that is my choice - just the same as it is another woman's choice to have these procedures done. My MD does not push it - only displays pamphlets that it is available as a procedure in her office.

Some of the comments people are posting are totally off base and very personal attacks. I would actually venture to say: Defamation of Character and libellous. If these patients have a concern about an MD, instead of posting it in a public forum, why not take it to their professional governing body rather than Cybershred an MD in a public medium where the MD cannot defend themselves at all.

Here are some of the complaints posted on this site about my MD:

(my comments in blue)


1. "this MD has a 'personality disorder' ". Hmm. I thought you have to have a degree of some sort to diagnose this. I worked in psychiatry and I certainly do not detect any comparable "personality disorder" in my MD. I did note that the "patient" did rant in a way that one could suspect transference on the part of the patient. I would say that this is a Libel-worthy lawsuit and would hold up in the B.C. courts of law if the MD decided to go forward with it.

2. "this MD has a one complaint/one visit policy, and I don't like that" Since the MDs only get paid per visit...I would be inclined to side with the doc on this one. Fact is, all MDs have this policy. Otherwise docs would have patients coming in for an hour or more with millions of little complaints in their allotted time slot. I don't know of any MD that allows unrestrained complaints. I know that I have been reasonable with my "complaints" and organize them - even going as far as writing down in point form prior to my appointment. I often find that my MD will then extend the "one complaint" policy to more than one. The MD doesn't have time to hold everyone's hand and listen indefinitely. There are other patients waiting....and... there is only so much time in a day, and time is money, as much as a patient doesn't like to think of that. Which brings me to the next complaint -

3. "this MD is in the 'business to make money' "....um...like no one else works for money? I really don't understand this complaint at all. I would like to see that patient work for free. I wouldn't do nursing if I had to do it for free - unless I could afford it - and then it would be nursing to those who are in desperate need - ie: third world countries. It costs money to live, never mind the cost to get there - education is expensive.

4. " the doc didn't give her a referral to a specialist when she asked and complained when the doc told her she didn't give "knee-jerk referrals". This MD is only telling this patient what she should. There are a lot of GPs that have excellent diagnostic skills....THEN - if they need to - get a referral to a specialist. That's the way the system works here in Canada. Most minor complaints can be dealt with in a GPs office. There is a time and a place for a specialist, but most of the GPs I have known can cope with routine complaints. Your little tiny complaint usually isn't that *special*.

5. " the doc made many references to the Government not wanting to pay for tests every year, such as yearly pap tests." I think this is called-making the pt aware of what is/isn't covered and how frequently you can have them. Last I heard it wasn't an offense to let the patient know what the government allows under it's medical plan.

6. "I don't feel "cared" for as much as my previous physician. Not anything I can put my finger on, but I don't feel like I can confide in her, and I don't feel very comfortable with the manner she has." OK. If you have a personality conflict - go elsewhere. Easy. You really don't have to post this complaint in a public place. The MD is not responsible for your incompatibility. Also, in my experience, patients feel they aren't getting adequate care unless an RX is given or test is done. I can't tell you how many times I have heard complaints about the MD that saw a patient who "*only* took a BP,Temperature, listened to my chest and then told me I was ok" . What is the complaint here? Were they looking for a voo-doo magical experience? Xrays in the office?

7. " I saw her often for a few year for a chronic disease and she only remembered me for a prescribed BOTOX procedure (unrelated to my disease). She runs her practice like a business and makes no qualms about it. I do agree with those who are in support of "XXX", that she does know her stuff and is very efficient, that is a good quality in a doctor." Personally, I can't remember a patient from one delivery to the next. That doesn't make me a bad nurse - it only means I am not good at remembering the millions of faces that pass by every day. I don't see the need for an MD to memorize absolutely everything on your chart verbatim either. I don't see how they can. There are lots of more interesting things to put in a brain. That's why my MD is typing on her computer....so she is noting everything about you so she won't have to remember. Besides, if you feel your MD is doing her job, is efficient and "knows her stuff" - why complain at all? I would like to see some of these patients try to remember as much as an MD has to remember.

8. "She was rude, insensitive, had an extremely poor bedside manner and just typed on her laptop the entire time without really paying attention to me. " Thank goodness the MD was taking notes. Or maybe the patient would feel better if the MD went back to the good ol' pen and paper? This is the 21st century and computers make lives easier - never mind that no one has to try and decipher bad handwriting. As far as rudeness or insensitivity goes.... see point 6 above. Our government is pushing completely electronic medical files. Get used to it.

9. " She was always firing her staff which is not a good sign." Actually, one office gal changed jobs due to an offer closer to her home. That is the only change in staff I saw the entire time, and I have been with this MD since the beginning of her practice in that city.

I was curious as to how other MDs I knew and worked with rated, so I looked them up.

I remember an MD I worked with that was downright dangerous, yet his patients loved him and would swear by him because he held their hand and went along with everything the patient would say. He would give abx whenever a patient requested whether it was needed or not. Most of his patients were on tons of medications - even ones that conflicted. That MD has all sorts of yellow smiley faces by his name.

My sis in law actually went to an MD that had been suspended by the government to practice when he billed for a dead patient - on more than one occasion - then skipped the country and, when the publicity died down, returned to his practice. I don't see any blue frowny-faces after his name.

I worked with another one that ran out of the country without paying his bills...yet he was in good stead with his patients. Lots of smiley faces there.

I worked with an OB that was terrifying to work with. He was abusive to staff, he freaked at any emergency and did some very questionable things that were caught by the nurses. It could have been bad for the patient. Yet - yellow smiley faces.

If the patient is going to complain, there are processes and procedures - so why not do it in the forum that allows an MD to defend themselves rather than an anonymous posting? I would hate it if there were a website that allowed patients to post bad things about me and because of HIPPA or FOIPAA laws, I could not defend myself. I can just visualize in my mind what could be printed by whomever. Yet, this is being done all the time on this site under actual Md's names.

There is such a thing as free speech, but when it comes to the infringements of personal rights and when it can have an impact on their means of support......there needs to be a line drawn.

Our Court system is a little fuzzy when it comes to Laws of the Internet, but this does need to be addressed. For now....it is a very grey line.....