Malpractice prosecutor John Edwards has dropped out of the race for the Democratic nomination for president.
Photo: AP
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Wednesday, January 30, 2008
American doctors rejoice!
Monday, January 28, 2008
Death threat forces Morgentaler to leave 20th-anniversary celebration early
Some disturbing and sad -- though not altogether surprising -- news has come out of Saturday's symposium on the 20th anniversary of the 1988 Morgentaler decision that decriminalized abortion across Canada.
Dr Henry Morgentaler, the man behind the '88 case, and Dr Garson Romalis, who was shot by a sniper in his home in 1994, were both forced to depart early from the University of Toronto-hosted conference after a death threat was phoned in. Here's a link to The Star's report.
This incident serves as a reminder to those who believe the debate over abortion rights has ended.
To read NRM's recent, in-depth Q&A with Dr Morgentaler (including his comments on his experience with punk rock and his ping-pong wizardry), click here.
After reading The Star's news report, I did a quick search online. Nobody else has bothered to mention the death threat.
*Update, Tuesday, January 29:
A couple of people have mentioned the death threat online now, besides The Star. There was a discussion last night on the Free Dominion ("the voice of principled conservatism") internet forum about the veracity of the threat. Below an ad for an assault weapons discussion website, one user commented, "Its a theatrical play to denegrade the opposition...staged by all the usual suspects in the malthusian death cult that is the foundation of trudeaupian political culture." Said another: "It's a cooked up tale by the pro-abort crowd to feed the tale of the frothing anti-abortion extremists seeking to take away women's rights, yadda, yadda ... Of course, the media dutifully report it all as fact." One user joked about one of the forum's members making the death threat -- "Somebody check Hailey's long distance phone bill" -- and another still yearned for the courage to make a similar death threat: "I could actually dream up such things but never have the nerve to pull it off."
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Thursday, January 24, 2008
Health Wonk Review: January 24, 2008
The latest issue of Health Wonk Review -- a regular collection of the best recent entries from health policy-related blogs -- is online today at the e-Care Management blog, hosted by Vince Kuraitis.
Canadian Medicine makes a brief appearance:In the category of beware of what you ask for because you might just get it, Sam Solomon at Canadian Medicine points to an unintended consequence of universal healthcare. Is universal healthcare an illegal, dangerous monopoly? One Ontario lawsuit argues ‘yes’. Concluding that this is relatively uncharted territory in Canadian jurisprudence, he explains that the plaintiff’s
The mention of "unintended consequence" is an interesting one.…lawyers insist Ontario’s universal healthcare system is putting citizens’ lives in danger. (OHIP provides universal healthcare insurance; OHIP has a monopoly over healthcare insurance; monopolies are detrimental to the public good; ergo OHIP is detrimental to the public good.)
Is healthcare rationing, as in the Flora v OHIP case, in fact an intentional method by which Canadian provinces' healthcare system limits spending? Some would allege that's the case. In Canadian jurisprudence, violations of people's rights under Section 7 of the Charter of Rights and Freedoms may be judged in court to be justifiable if those violations are necessary in order to accomplish a goal that benefits society as a whole, and if that goal cannot be achieved any other way.
I suspect we're unlikely to ever see that argument used by the Crown in a case like Flora or any of the other Chaoulli-citing suits (it didn't work out well for Quebec in Chaoulli in 1995, as Dr Jacques Chaoulli himself explained to me last year), but it's nevertheless an interesting note to keep in mind when we're talking about rationing and rights.
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Wednesday, January 23, 2008
Health Promotion ministries get no respect
The news that Nova Scotia has the lowest rate of teen smokers of all Canadian provinces makes you wonder: why?
There are a number of possible explanations for Nova Scotia's success at combating youth smoking: anti-smoking legislation, increased social stigmatization, the rising price of cigarettes, the accumulating evidence that warns of the dangers of not only smoking but also of second-hand smoke exposure.
But all of those reasons, it seems, point to one major difference between Nova Scotia as well as Ontario, where teen smoking rates only just barely exceed those of Nova Scotia, compared to the rest of the provinces: Nova Scotia and Ontario are the only provinces with entire government ministries devoted to Health Promotion.
Quantifying the effect of establishing a new ministry on smoking prevalence is probably an impossible task; there are too many variables. But, based on limited evidence like the rate of teen smoking, the country's two Health Promotion ministries appear so far to have been successful, just three years now after the ministry was established in Ontario's case, and less than two in Nova Scotia's.
Why don't other provinces have Health Promotion ministries? In a time when preventive medicine is an increasingly popular buzz word, one would think the provincial governments would be eager to add a Health Promotion Minister to their cabinets.
The federal government's recent proposal to can the Canadian Health Network website -- the flagship publication of the Public Health Agency of Canada's Centre for Health Promotion -- means that the feds probably aren't about to push the provinces too hard to get moving on their own Health Promotion ministries.
The absence of dedicated departments of the government for health promotion initiatives in the majority of Canadian provinces is somewhat ironic given the fact that the World Health Organization's 1986 agreement on health promotion is called The Ottawa Charter for Health Promotion, after its host city.Click here to read about Ontario's Ministry of Health Promotion, headed up by lawyer Margarett Best.
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Click here to read about Nova Scotia's Ministry of Health Promotion and Protection, led by former real estate agent Barry Barnet.
Tuesday, January 22, 2008
Is universal healthcare an illegal, dangerous monopoly? One Ontario lawsuit argues 'yes'
Adolfo Flora, whose first legal appeal in his case against the government-operated Ontario Health Insurance Plan (OHIP) was dismissed last year, is back at it again. His lawyers insist that Ontario's universal healthcare system is putting citizens' lives in danger. (OHIP provides universal healthcare insurance; OHIP has a monopoly over healthcare insurance; monopolies are detrimental to the public good; ergo OHIP is detrimental to the public good -- so goes Mr Flora's argument.)
Mr Flora is now appealing the earlier case's dismissal in the Ontario Court of Appeal. (To read about yesterday's events at the courthouse, check out coverage from the Star and the National Post.)
In 1999, Mr Flora, a retired science teacher, was diagnosed with liver cancer. "He was told he had two weeks to live, to get his affairs in order," Rick Baker, the president of Vancouver private medical access firm Timely Medical Alternatives told me last year about the case. Mr Flora needed a partial liver transplant, but his doctors told him he was unlikely to survive and a deceased-donor liver was near-impossible to procure. He travelled to England and received the partial transplant from his brother — at a cost of $447,000. OHIP refuses to reimburse him.
Mr Flora's lawyer, Mark Freiman, argued yesterday in court, "When the government monopolizes health care and effectively seals off the exits so that access to private care is illusory to all but the wealthiest... the government is responsible for the impairment of the right to life and security of the person."
"The appellant obtained the treatment he wanted..." retorted government counsel Janet Minor. "Clearly there is nothing the government did to deprive Mr. Flora of his ability to obtain treatment... What the appellant seeks in this case is an economic benefit for himself."
Mr Flora's case is relatively uncharted territory in Canadian jurisprudence.
The famous Chaoulli v Québec decision of 2005, which overturned that province's ban on private insurance based on the rights to life and security of the person enumerated in Section 7 of the Canadian Charter of Rights and Freedoms, is the only precedent for this type of claim and it remains to be seen whether the Chaoulli decision will be extended to other provinces beyond Quebec. If that were to happen, the five basic tenets of the Canada Health Act -- public administration, comprehensiveness, universality, portability, and accessibility -- would seem to be due for a rewrite.
But not all Canadian legal experts worry, however, that the Canada Health Act is at risk of being ruined. I wrote last year: "In a lecture given in late November [2006], Patrick Monahan, the dean of York University's Osgoode Hall Law School, argued that Chaoulli need not lead to an 'American-style, two-tier' system but instead effectively enshrines a new requirement in the Canada Health Act: what he calls 'patient accountability.'
"'Far from heralding the destruction of Canada's publicly funded healthcare system,' wrote Dr Monahan, 'I believe that Chaoulli may provide the key to its reform and long-term sustainability... Patient accountability means that those responsible for funding the healthcare system and providing care are ultimately answerable to patients for the timeliness of service provided and, further, that this accountability can be enforced through the legal system.'"
OTHER CASES
Here's a short list of some of the other cases that have arisen across Canada after Dr Jacques Chaoulli's 2005 victory:
The case: Murray v Alberta
The details: Bill Murray (not the actor) was denied government funding for hip resurfacing, in a case that harkens back almost identically to the Chaoulli case. John Carpay, executive director of the Canadian Constitution Foundation, which is funding Mr Murray's lawsuit, told me, "It's often said that anyone who tries to make a prediction on a court outcome is a fool. It's not a slam dunk, but the Chaoulli decision is a strong precedent."
Where it stands now: At last update, he was still trying to obtain permission from the court to file his suit as a class action.
The case: McCreith-Holmes v Ontario
The details: Lindsay McCreith and Shona Holmes were both diagnosed with brain tumours and then left Canada for the US to obtain treatment. They're filing a constitutional challenge based on Section 7, like Adolfo Flora. "I think it's a very important court case," Dr Chaoulli told me a few months back when I wrote about McCreith-Holmes. "I think it has a very good chance to succeed."
Where it stands now: The case was filed September 5, 2007 in Ontario Superior Court.
The case: Shirley Healey, still considering filing a case against the province of British Columbia
The details: Ms Healey was diagnosed with mesenteric ischemia in 2006. Her physician, Robert Ellett, of Kelowna, BC, told her, "Anyone with blocked arteries is not meant to wait six months to a year... with the way things are in Canada, I would go to the States as well." She was treated promptly in Bellingham, Washington.
Where it stands now: Ms Healey still hasn't filed her oft-threatened lawsuit. Rick Baker told me he thought Ms Healey would win reimbursement for her medical costs from the province because the kind of treatment she received in Washington wasn't available in BC. No word yet on the province's decision.
BUILDING PRECEDENT
A quick search reveals that this is just "the tip of the iceberg," as Patrick Monahan put it. The Chaoulli decision has already set in motion a series of legal consequences that may turn out to change the landscape of the whole of Canadian healthcare delivery. There have been 44 decisions in Canadian courts or tribunals since 2005 that cite the Chaoulli decision, some of which have themselves been cited multiple times.
Here's the full list, from my Canadian Legal Information Institute search (for links to the full text of each decision, click here):
1.
Sfetkopoulos v. Canada (Attorney General), 2008 FC 33 (CanLII) — 2008-01-10
Canada — Federal Court of Canada
marihuana — designated producer — holder — users — principles of fundamental justice
2.
E.K. (Succession) c. Régie de l'assurance maladie du Québec, 2007 QCTAQ 11480 (CanLII) — 2007-12-04
Quebec — Administrative Tribunal of Québec
chimiothérapie — non myéloablative — thérapeutique — non apparenté — transplantation
3.
Canadian Council for Refugees v. Canada, 2007 FC 1262 (CanLII) — 2007-11-29
Canada — Federal Court of Canada
refugee — country — asylum — refoulement — torture
4.
Rivet c. Canada (Procureur général), 2007 CF 1175 (CanLII) — 2007-11-15
Canada — Federal Court of Canada
obligation d'équité procédurale — consultatif — risque pour la sécurité aérienne — portées — méfait
5.
Amnesty International Canada v. Canada (National Defence), 2007 FC 1147 (CanLII) — 2007-11-05
Canada — Federal Court of Canada
detainees — application for judicial review — bereft of any chance — motion to strike — extraterritorial
6.
Cheskes v. Ontario (Attorney General), 2007 CanLII 38387 (ON S.C.) — 2007-09-19
Ontario — Superior Court of Justice
adoptees — birth parents — privacy — principle of fundamental justice — information
7.
Haj Khalil v. Canada, 2007 FC 923 (CanLII) — 2007-09-18
Canada — Federal Court of Canada
permanent residence — ministerial relief — refugee — inadmissible — application
cited by 1 case
8.
R. v. Dryseth, 2007 ONCJ 446 (CanLII) — 2007-09-11
Ontario — Ontario Court of Justice
police — breath tests — hospital — pain — provide a breath sample
9.
Chevalier v. The Queen, 2008 TCC 11 (CanLII) — 2007-08-24
Canada — Tax Court of Canada
medical expense tax credit — chronic fatigue syndrome — patient — individual — multiple chemical sensitivities
10.
H.N. c. Québec (Ministre de l'Éducation), 2007 QCCA 1111 (CanLII) — 2007-08-22
Quebec — Court of Appeal
école — minorité — anglais — langue — subventionnée
11.
C.B. c. Société de l'assurance automobile du Québec, 2007 QCTAQ 7603 (CanLII) — 2007-08-16
Quebec — Administrative Tribunal of Québec
secret professionnel — témoin — notaire — déconsidère l'administration — québécoise des droits et libertés
12.
Trang v. Alberta (Edmonton Remand Centre), 2007 ABCA 263 (CanLII) — 2007-08-16
Alberta — Court of Appeal
principle of fundamental justice — vans — arbitrary — prisoners — security of the person
13.
Peavine Métis Settlement v. Alberta (Minister of Aboriginal Affairs and Northern Development), 2007 ABQB 517 (CanLII) — 2007-08-14
Alberta — Court of Queen's Bench
membership — settlement — individual — freedom — registered
14.
Veffer v. Canada (Foreign Affairs and International Trade Canada), 2007 FCA 247 (CanLII) — 2007-06-25
Canada — Federal Court of Appeal
passport — place of birth — freedom of religion — policy — country
15.
Health Services and Support - Facilities Subsector Bargaining Assn. v. British Columbia, 2007 SCC 27 (CanLII) — 2007-06-08
Canada — Supreme Court of Canada
collective bargaining — health care — freedom of association — health sector employer — union
cited by 14 cases
16.
Sagharian v. Ontario (Education), 2007 CanLII 6933 (ON S.C.) — 2007-03-12
Ontario — Superior Court of Justice
autistic children — pleaded — educational programs — allegations — duty
17.
Melanson et al. v. New Brunswick (Attorney General) et al., 2007 NBCA 12 (CanLII) — 2007-02-26
New Brunswick — Court of Appeal of New Brunswick
paiements par l'intermédiaire — members — pension plans — commuted value — priority scheme
cited by 1 case
18.
Flora v. Ontario Health Insurance Plan, 2007 CanLII 339 (ON S.C.D.C.) — 2007-01-15
Ontario — Divisional Court
treatment — liver transplant — medical — cadaveric — health care
19.
Club Pro Adult Entertainment Inc. v. Ontario (Attorney General), 2006 CanLII 42254 (ON S.C.) — 2006-12-18
Ontario — Superior Court of Justice
smoking — legislation — municipality — bad faith — tenable
20.
Covarrubias v. Canada (Minister of Citizenship and Immigration) (F.C.A.), 2006 FCA 365 (CanLII) — 2006-11-10
Canada — Federal Court of Appeal
country — medical care — risk to life — refugee — inability
cited by 5 cases
21.
CanWest Media Works Inc. v. Canada (Attorney General), 2006 CanLII 37258 (ON S.C.) — 2006-11-03
Ontario — Superior Court of Justice
coalition — pharmaceutical products — intervenor — drug — impact
22.
Québec (Commission des droits de la personne et des droits de la jeunesse) v. Laval (Ville), 2006 CanLII 33156 (QC T.D.P.) — 2006-09-22
Quebec — Human Rights Tribunal
recitation of the prayer — freedom of religion — human — conscience — religious
cited by 1 case
23.
The Canadian Bar Association v. HMTQ et al, 2006 BCSC 1342 (CanLII) — 2006-09-05
British Columbia — Supreme Court of British Columbia
public interest standing — challenge — legal aid — constitutional — legislation
cited by 1 case
24.
Association pour l'accès à l'avortement c. Québec (Procureur général), 2006 QCCS 4694 (CanLII) — 2006-08-17
Quebec — Superior Court
ivg — santé — assurés — médecins — établissement
cited by 1 case
25.
Wynberg v. Ontario, 2006 CanLII 22919 (ON C.A.) — 2006-07-07
Ontario — Court of Appeal for Ontario
intensive behavioural intervention — special education programs — autistic children age — group — pupils
26.
Wynberg v. Ontario, 2006 CanLII 22920 (ON C.A.) — 2006-07-07
Ontario — Court of Appeal for Ontario
intensive behavioural intervention — special education programs — autistic children age — group — pupils
cited by 5 cases
27.
D.M.M. v. Ontario, 2006 CanLII 19946 (ON S.C.) — 2006-06-07
Ontario — Superior Court of Justice
birth parents — adopted persons — information — disclosure — legislation
cited by 1 case
28.
Ali v. The Queen, 2006 TCC 287 (CanLII) — 2006-05-18
Canada — Tax Court of Canada
patient — medical practitioner — drugs — dietary supplements — individual
cited by 1 case
29.
Baier v. Alberta, 2006 ABCA 137 (CanLII) — 2006-05-01
Alberta — Court of Appeal
platform — fundamental freedom — seeking election to a school — infringe — expression
cited by 3 cases
30.
Placements Sergakis inc. c. Québec (Procureur général), 2006 QCCS 2026 (CanLII) — 2006-04-10
Quebec — Superior Court
intérêt — irrecevabilité — soulevées — liberté — tranchée
31.
R. v. Barnhill, 2006 BCSC 485 (CanLII) — 2006-03-24
British Columbia — Supreme Court of British Columbia
marihuana — barn — warrant — police — search
32.
Newton-Juliard v. Canada (Minister of Citizenship and Immigration), 2006 FC 177 (CanLII) — 2006-02-10
Canada — Federal Court of Canada
santé — visa officer — foreign national's health — étranger — expected to cause excessive demand
cited by 2 cases
33.
Gray v. Ontario, 2006 CanLII 1764 (ON S.C.D.C.) — 2006-01-26
Ontario — Divisional Court
residents — substitute decision maker — guardian — parens patriae jurisdiction — institutions
34.
Doe v. Canada (Attorney General), 2006 CanLII 1185 (ON S.C.) — 2006-01-19
Ontario — Superior Court of Justice
semen — donor — sexual partner — women — insemination
35.
Raywalt Construction Co. Ltd. v. J.R.B., 2005 ABQB 989 (CanLII) — 2005-12-29
Alberta — Court of Queen's Bench
fire — diesel fuel — damage — contributory negligence — lighter
cited by 1 case
36.
Kubby v. H.M.T.Q., 2005 BCCA 640 (CanLII) — 2005-12-22
British Columbia — Court of Appeal
constitutional — possession of marihuana — cultivation — invalid — medical
cited by 2 cases
37.
Doe v. Alberta, 2005 ABQB 885 (CanLII) — 2005-12-06
Alberta — Court of Queen's Bench
principles of fundamental justice — parent — person — guardianship — best interests of the child
38.
Prentice v. Canada (F.C.A.), 2005 FCA 395 (CanLII) — 2005-11-28
Canada — Federal Court of Appeal
principle of fundamental justice — violation — immunity — translation — peacekeeping missions
cited by 16 cases
39.
Électrique Glaswerk inc. c. Axa Boréal Assurances inc., 2005 QCCA 942 (CanLII) — 2005-10-14
Quebec — Court of Appeal
intimées — intérêt — nullité absolue — faillite et l'insolvabilité — intentée
cited by 3 cases
40.
Jane Doe et al. v. Manitoba, 2005 MBCA 109 (CanLII) — 2005-09-30
Manitoba — Court of Appeal
government's motion — therapeutic abortions — summary judgment in favour — dismissed — hospital
cited by 6 cases
41.
Human Rights Commission v. Workplace Health, Safety and Compensation Commission, 2005 NLCA 61 (CanLII) — 2005-09-23
Newfoundland and Labrador — Supreme Court of Newfoundland and Labrador, Court of Appeal
legislation — board of inquiry — inoperative — adjudicator — enacted
cited by 5 cases
42.
Covarrubias v. Canada (Minister of Citizenship and Immigration), 2005 FC 1193 (CanLII) — 2005-09-01
Canada — Federal Court of Canada
country — risk — medical care — adequate — treatment
cited by 8 cases
43.
Alberta v. Kingsway General Insurance Company, 2005 ABQB 662 (CanLII) — 2005-09-01
Alberta — Court of Queen's Bench
legislation — bill of attainder — insurance — reform — ultra vires
cited by 1 case
44.
Fédération Franco-Ténoise c. Procureure Générale du Canada, 2005 NWTSC 62 (CanLII) — 2005-07-15
Northwest Territories — Supreme Court of the Northwest Territories
territoriaux — déclaration modifiée — résumés — témoins — précisions
cited by 1 case
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Wednesday, January 16, 2008
Flea speaks out about his fall from grace
"No wonder when doctors write, they write namby-pamby noncommittal crap -- it might get you in trouble someday,” Dr Robert Lindeman told me recently.
Dr Lindeman (pictured right) is the Ivy League-educated, Boston-area pediatric pulmonologist and erstwhile blogger (under the alias “Flea”) whose electronic exploits led to a large settlement in a malpractice suit brought against him last year in the case of a 12-year-old who died of diabetic ketoacidosis. The prosecutors discovered Dr Lindeman's blog, where he had been chronicling his not-so-polite thoughts on the trial, and Dr Lindeman’s attorneys decided to settle the next day for an undisclosed sum of money. (For more about the case, read the Boston Globe’s coverage from last May.)
Dr Lindeman’s ”namby-pamby noncommittal crap” comment has set off a small flurry of excitement among medical bloggers -- a group that tends to revere Dr Lindeman as a martyr for physicians’ freedom of speech. First, Dr Kevin Pho, a New Hampshire-based physician and the author of the popular KevinMD blog, mentioned Dr Lindeman’s comment on his site. Not long after, another doctor-blogger, Dr Mary Johnson of North Carolina, blasted Dr Pho for refusing to publish a comment she had written in which she accused him of writing “namby-pamby noncommittal crap” himself, in deference to his “corporate sponsors.” Dr Johnson wrote:“[...] it is my opinion that Kevin M.D.'s brand of white-washed, fence-sitting, corporately-sponsored, sell-out, NAMBY-PAMBY medical blogging should NOT define the genre for the rest of us. It should not be rewarded. We doctors have to be braver and bolder than that. We owe that to bloggers like Flea.
I spoke to Dr Lindeman as part of my research for an article that appeared January 15 in the National Review of Medicine, entitled “Check my blog and call me in the morning.”
“We owe that to ourselves.”
The following is an abbreviated transcript of our conversation.
Sam Solomon: If your blog hadn’t been discovered by the prosecution in your malpractice trial, do you think you would have won the case?
Dr Robert Lindeman: Yes. I didn’t lose, by the way -- I settled. I think its pretty clear the reason for the settlement was that there were too many of what are kindly referred to as ‘prior inconsistent statements,’ which is legalese for statements making the defendant look like a schmuck. They tried to make me look like a schmuck and we tried to make their witnesses look like schmucks. That’s how this game is played. One of the purposes of blogging about this was to tell the story that some doctors know, but most folks don’t know this story. Most have misconceptions about what malpractice is. The process of adjudicating malpractice is basically an exercise in trying to make the doc look like a schmuck. Anytime you write something in print, you need to expect someday it is going to be read to you in court. The most innocuous thing I ever wrote -- it was a description of the immunization schedule, on my official website -- was read to me by the attorney to make me look like a schmuck. How much more so something incendiary, then? No wonder when doctors write they write namby-pamby noncommittal crap -- it might get you in trouble someday. Another reason I blog is because medical writing is a horror show -- it’s embarrassing.
SS: Do you regret blogging?
RL: If I had the opportunity to do it again I wouldn’t blog anonymously. I think certainly the tone and some of the content would be different, but nothing I wrote was fiction. Enough details were changed so patients were not identifiable. One thing that surprised me was I wrote an article on my website and in a magazine about ear infections, and one on Flea [his blog] and when I compare them side by side, I actually pulled some punches for the blog.
SS: You say you wouldn't blog anonymously if you could do it again, but it seems to me, especially with your situation in mind, that there may not even be such a thing as true anonymity online in the first place.
RL: In principle it’s possible, but it’s difficult. I might suggest that my experience has made it more difficult for a doctor to remain anonymous. I think the lawyers are sitting at their desktops trolling, to use a blogging term -- looking for stuff. The way I was discovered was a most circuitous route. Some guy called somebody else who called somebody else. A guy in Louisiana caught me.
SS: You sound concerned that you’re still at risk because of your blogging.
RL: I try not to think about it. Three hundred and fifty-eight days a year I take care of patients for a living so I cant really think about the 300-pound gorilla in the corner. If I do, I’m not going to be able to do this job. Conscious or unconscious, the thought of malpractice is in our minds the whole time. The reason I blogged about it was to bring the id out into the public, to explain that this is something we are consumed with. To pretend this is not going on is foolish and possibly dangerous and possibly harmful to your health. One of the really awful ironies about this whole episode is now the story won’t be told. The world will still never know what the experience of being sued is like for a doctor. If more folks did know about this, maybe the landscape would change. Maybe people would think differently about doctors, or maybe that’s naïve. If we maintain our silence the opportunity to change hearts and minds is zero. Malpractice is shameful -- we’re ashamed of it. We don’t even talk about it amongst ourselves.
SS: How much did you settle for in your malpractice case last year?
RL: I’m not allowed to say. I can tell you the plaintiffs would very much like me to slip or tell someone like this [a journalist] because the lawyers would like to publish the amount to advertise their services. They’re not allowed to unless I divulge the amount. They’ve been out there combing to see if I am going to slip. This is not paranoid fantasy, Sam. This is about money. This is not about making whole a family who lost a child. This is about getting paid, alright? The issue is that as long as I’m alive and can still take interviews from newspapers, these guys will be out there looking to see if I am going to slip.
SS: Do you think your story has had a chilling effect on doctors’ willingness to express themselves online?
RL: The scuttlebutt I have been hearing is that it has had a chilling effect, and that makes me feel terrible. I try not to think about it, it makes me feel so bad that I am responsible. I’m inclined to think it is true, but I desperately hope it’s not true. Kevin Pho immediately pulled down some posts from his blog and he’s the über-blogger. Kevin was a real mensch -- he emailed me a few times. I thought, “My god -- if Kevin, who is not anonymous, took stuff down, I wonder what everybody else is doing.” I am afraid it may be true.
SS: Any words of advice for other doctors who blog, or who want to start blogging?
RL: Don’t blog anonymously. The reason not to do that is because you probably will be more restrained in the things you say [if you write under your real name] and aware things you say can and will be used against you in court. One of the reasons I blogged anonymously, as odd as this sounds, is that I knew that, and this was a protest. It turned out it was a really stupid protest. Who knows how the trial really would have turned out? Probably we would have prevailed. I recommend -- if at all possible -- that my colleagues avoid going to trial if they can.
SS: This is all pretty gloomy talk about doctors blogging...
RL: I suppose doctors could blog to advertise for themselves or to provide information for their patients, but I think blogs like Flea are a bad idea and there probably won’t be any more like those, for the sake of the blogger. I think the content was interesting -- “thought-stimulating,” in words of the plaintiffs’ lawyer -- and I think my readers thought so too, but there has been a certain amount of blunting of messages that are difficult for a doctor to say. For a pediatrician to say most visits to a pediatrician office is unnecessary. It’s a stupid thing for a person practising medicine to say, but Flea could say it and explain why and make an argument. I think the blog is a great thing. I hope it doesn’t go away.
SS: You’re saying it’s dangerous, legally speaking, for doctors to blog about their opinions at all?
RL: It’s dangerous, period. Anything a doctor writes is potentially going to be read back to him or her in court, from the most innocuous to the most inflammatory. One solution is not to write at all. I’m not sure if it’s possible to be careful -- that’s the reason why I told you about the immunization schedule. I bristle at the suggestion that there’s a way to do this that is right, if by right you mean safe. Writing as a physician is a dangerous activity, and that’s a shame. That’s a message I’d like the folks to know. For physicians, writing is dangerous and there is something really messed up about that.
SS: Do you have any plans to start blogging ever again?
RL: No. It’s been a real sudden about-face. I have turned away from it and don’t have plans to return to it. I don’t read the blogs anymore. It was fun. I had a really good time. I love to write and I don’t have an opportunity now to write like I did. I think a physician has to make a decision as to whether he will write at all. That answer may be that it’s too risky to write, but I hope not.
Photo: Dr Robert Lindeman / Natick Pediatrics
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Tuesday, January 15, 2008
Israel recruiting Jewish Canadian doctors
Young Canadian, British and American Jewish physicians are the target of a new, $60,000 USD "absorption package" provided by the Israeli government, intended to attract physicians "in the Diaspora" to immigrate to Israel.
Haaretz reports today:Physicians under 40 who have completed their medical studies in either North America or Britain will receive $25,000 upon arrival in Israel. Over the next few years, they will be paid between $1,000 and $1,500 a month.
The effort was prompted by dire predictions of an Israeli doctor shortage. Compared to Canada, however, Israel's situation is hardly dire at all. Israel currently enjoys a ratio of 3.4 doctors per 1,000 people, compared to just 1.9 per 1,000 in Canada.
Applicants are promised shortened procedures to receive their medical and driver's licenses. In return, they must commit to work in Israel for at least nine months a year. Over the coming months, Nefesh B'Nefesh plans to launch a campaign among Jewish doctors in the Diaspora to promote the program.
The news story has generated some controversy among readers of Haaretz. (You can read their comments below the article.) Here are some of the most interesting responses:
"if you pay peanuts you get monkeys" - Specialist Doctor, from Netanya, IsraelCheck out our website: www.nationalreviewofmedicine.com
"Let me get this straight - the Israeli absorbtion and health ministries are trying to lure doctors to Israel - but only from the US, UK, and Canada? Whats so wrong with Jews from other areas - Russia, Poland, Germany, Greece, Algeria, Iran, Ethiopia?" - Steve Katz, Miami, USA
"While this plan may have good intentions will not result in a massive influx of Jewish doctors to the Holy Land. We all know that 60k is pocket change for most US doctors. This might recruit young doctors but they will still have a hell of a time paying back a 150k student loan even with this package. Not all but many doctors have lots of money, or assets like expensive houses that they can cash in on before they make Aliyah [immigration to Israel]. Why should they get a handout?" - Aaron, Florida, USA
"If Israel anticipates a future shortage of physicians it might as well offer incentives (however insignificant) across the board. In trying to lure physicians specifically from English speaking countries, Israel admits that the professional level of physicians who came from other countries (mostly the former Soviet Union and its satelites) is inferior. Israel should have invested in re-educating these physicians and bringing them up to the desired standard. Israel admits to have 2 classes of physicians- Western and non-Western. This is the perpetuation of the conditions which had prevailed in Palestine and the early years of the state- doctors who graduated from German or German speaking universities and those who were educated elsewhere. Never ends." - Michael N
"I am a GP in Canada..but the problem is that I am not Jewish!!! Can I still come? Or is it reserved for the one and only chosen ones?" - C'est moi, Canada
Monday, January 14, 2008
High demand for U of T health leadership course proves it: MDs make bad bosses
The enthusiastic response to a new course in Advanced Health Leadership geared towards physicians and healthcare executives offered at the University of Toronto reinforces an important lesson that many in the healthcare community have been slow to learn: doctors tend to make poor managers.
According to Brian Golden, a U of T professor of organizational behaviour, who recently spoke to the Toronto Star about this issue, the February session of the course received more than five times the number of applications than they had spots available for.
The problem is, as another one of the instructors in the Advanced Health Leadership course, Joseph D'Cruz, told NRM in November, doctors simply don't get any leadership training."Things like teamwork and empathy are not part of the natural toolkit of the physician, particularly empathy towards co-workers. We call this emotional intelligence."
Are you as bad a boss as the Toronto doctor who reportedly expected an office employee to walk the six hours from her home in Scarborough to his office in Parkdale during the August 2003 blackout in Ontario, when public transit was out of service? Take NRM's quiz to find out:
Mr D'Cruz says doctors score "quite low" in this area. "But the good news is that emotional intelligence is something that can be learned."
Doctors have immense potential as managers, he adds. "To be a good manager you need good native intelligence, and doctors have that in spades. They have the intellectual capability to be good managers — but they lack the emotional."
The first step, as with most things, is to acknowledge you have a problem. But doctors are often reluctant to admit it. "They think if they're smart as physicians, they must be smart as managers. That is a myth." says Mr D'Cruz. "Sometimes it's quite an epiphany when they're confronted with their ineptitude."What kind of boss are you?
For the answers, click here and scroll down.
1. A nurse at your clinic asks to take the next three days off work for personal reasons. You respond:
a) "Gosh, I hope it's nothing too serious. Let's try to find someone to cover for you."
b) "All leave requires one month's notice. That's the policy — or have you forgotten already?"
c) "Hm… I'll let you know tomorrow," you mumble as you hurry to your next appointment.
2. Your receptionist has overbooked your day — yet again. Patients are upset and, frankly, so are you.
a) "The only thing you're any good at is computer solitaire!" you yell in front of a shocked, full waiting room.
b) You ask to speak to the receptionist privately at the end of the day to sort out how the two of you can figure out a solution.
c) You say nothing and just try to clear through the backlog as fast as you can.
3. A young physician whom you supervise is being presented with an award for his work with underprivileged patients at a banquet on a Saturday night, but you've got hockey tickets. What do you do?
a) Pass the tickets along to a friend. Workplace solidarity takes precedence - after all, there are plenty more hockey games.
b) Make a brief appearance wearing your team's jersey beneath your suit and sneak out of the banquet hall after Dr Goody-goody has finished speaking.
c) You skip the banquet and ride the kid extra hard at the next M & M.
4. A departing staffer asks for a reference letter. You accept -- what else can you do? -- and then:
a) Dig out the forgettable, cliché-ridden letter you wrote for the last person who left, change the name and feel you fulfilled your obligation.
b) Mutter a quick prayer that he forgets he's asked you for a letter, and go on with your life.
c) Do what you promised: write a thorough and well thought-out letter.
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Gay rights advocate physician's death leaves legacy of forward-thinking leadership
An outspoken advocate of gay rights and an early promoter of specialized AIDS care, Canadian family physician Gary Gibson (pictured left) died early this month of a stroke in his home on Salt Spring Island, BC.
Dr Gibson, who came out when he was 40 in the early 1980s, served as a senior member of many disparate organizations, including the AIDS Committee of Cambridge, Kitchener, Waterloo and Area; the College of Family Physicians of Canada; the University of Western Ontario; the Ontario Medical Association; the College of Physicians and Surgeons of Ontario; and the University of British Columbia. He also made a brief foray into Ontario politics with the NDP.
The Kitchener Record ran a very thoughtful obit on Saturday:When he was about to do one of the bravest things he ever did, Cambridge family physician Gary Gibson was scared for his professional life.
As it turned out, his fears were assuaged; not long thereafter, he went on to a number of professional and personal successes, co-founding the AIDS Committee of Cambridge, Kitchener, Waterloo and Area with his partner at the time and helping to establish one of Canada's first group practices.
He told his close friend Paul Ottmann he was afraid he'd lose his practice, maybe be run out of town. He saved enough money to live on for a year.
Then, at the age of 40, in the early 1980s, he came out to the world as gay.
The Gulf Islands Driftwood also published a notice (PDF) of Dr Gibson's January 3 death.
Memorial services will be held January 20 on Salt Spring Island, BC and February 16 in Cambridge, Ontario.
Photo: The Gulf Islands Driftwood
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Friday, January 11, 2008
Rebick remembers the Morgentaler decision
Canadian journalist and activist Judy Rebick was delighted when she heard the verdict in the Morgentaler trial in 1988 that legalized abortion in Canada. "The day the news came out I watched people on the streetcars and I'd never seen it before — everyone was talking about it, saying 'Right on. Dr Morgentaler is a hero.' He's sort of a populist hero. He really inspired people. Truck drivers would give me money for him."
Ms Rebick's recollections about that fateful day in 1988 are collected alongside those of other Canadian writers, politicians and physicians in a special feature in NRM's January 15 issue, which also features Dr Morgentaler himself in a Q&A.
(Ms Rebick has published a longer version of her reflections on the Morgentaler decision on the Osgoode Hall Law School-operated website, TheCourt.ca.)
Image: CBC
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Call for nominees to the Canadian Medical Hall of Fame
Do you know somebody who deserves to be named to the Canadian Medical Hall of Fame? The Selection Committee wants to hear from you.
Nominations are being accepted until June 16, 2008. You can download the official nomination form and review the rules on the official website.
"There is no better feeling than to see a colleague, mentor, student or caregiver who has achieved greatness recognized with the honour of being inducted into the Hall of Fame. It speaks to the importance of their work, and gives tremendous value to the support system in which they flourish such as the people, institution and infrastructure," board chair Dr David Hawkins said in a release.
Voting will take place in September 2008, and the results won't be released until an April 2009 ceremony in Montreal.
So far there are 71 delegates to the London, Ontario-based Hall of Fame, the most recent of whom included Dr Wilbert Keon, (pictured right) a Progressive Conservative Senator and famed heart surgeon who was featured on the cover of NRM's October 15, 2007 issue. Read on to check out a full list of the laureates.
2007 Laureates
* Bagshaw, Dr. Elizabeth
* d’Hérelle, Dr. Félix
* Dussault, Dr. Jean
* Keon, Senator Dr. Wilbert
* Tulving, Dr. Endel
2006 Laureates
* Hubel, Dr. David
* McEachern, Dr. John S.
* McWhinney, Dr. Ian
* Pawson, Dr. Anthony
* Selye, Dr. Hans
2004 Laureates
* Avery, Dr. Oswald Theodore
* FitzGerald, Dr. John Gerald
* Lalonde, Honorable Marc
* LeClair, Dr. Maurice
* McCulloch, Dr. Ernest
* Till, Dr. James Edgar
2003 Laureates
* d'Youville, Saint Marguerite
* Feindel, Dr. William Howard
* Hebb, Dr. Donald O.
* Hollenberg, Dr. Charles H.
* Huggins, Dr. Charles B.
* Mustard, Dr. J. Fraser
2001 Laureates
* Bradley, Dr. John E.
* Friesen, Dr. Henry
* Gallie, Dr. William E.
* Lougheed, Honorable Peter
* Montizambert, Dr. Frederick
* Scriver, Dr. Charles
* Teasdale-Corti, Dr. Lucille
2000 Laureates
* Belleau, Dr. Bernard
* Brown, Dr. G. Malcolm
* Evans, Dr. John
* Hirsh, Dr. Jack
* King, Dr. Lenora
* Sackett, Dr. David
1998 Laureates
* Barr, Dr. Murray
* Bethune, Dr. Norman
* Bondar, Dr. Roberta
* Douglas, Honorable Thomas C.
* Farquharson, Dr. Ray
* Fisher, Dr. C. Miller
* Fortier, Dr. Claude
* Gingras, Dr. Gustave
* Johns, Dr. Harold
* Lehmann, Dr. Heinz
* Menten, Dr. Maud
1997 Laureates
* Beer, Dr. Charles Thomas
* Bigelow, Dr. Wilfred Gordon
* Breault, Dr. Henri J.
* Grenfell, Dr. Wilfred Thomason
* Masson, Dr. Pierre
* Milner, Dr. Brenda
* Noble, Dr. Robert Laing
* Siminovitch, Dr. Louis
1995 Laureates
* Barnett, Dr. Henry J.M.
* Chown, Dr. Bruce
* Jasper, Dr. Herbert
* Leblond, Dr. Charles P.
* Mustard, Dr. William Thorton
* Salter, Dr. Robert Bruce
* Smith, Dr. Michael
1994 Laureates
* Abbott, Dr. Maude Elizabeth Seymour
* Banting, Dr. Frederick Grant
* Best, Dr. Charles Herbert
* Browne, Dr. John Symonds Lyon
* Collip, Dr. James Bertram
* Copp, Dr. Douglas Harold
* Drake, Dr. Charles George
* Genest, Dr. Jacques
* Osler, Sir William
* Penfield, Dr. Wilder Graves
Photo: NRM
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Florida Congressional race pits internist against family physician
In a campaign that has been coloured by debate over the Canadian healthcare system, two physicians are competing for Florida's 15th District seat in the US House of Representatives. Doug Trapp, of the American Medical Association newspaper, AMNews, has the full story.
Dr Dave Weldon, an internist who trained in Buffalo, NY, is the two-term Republican incumbent (see here or here for more details). Dr Stephen Blythe, a family doctor who trained in Portland, Maine and spent the early part of his career in Lubec, Maine, is running for the Democrats in the November 2008 Congressional election (see here and here).
Dr Blythe not only practised near the Canadian border in Lubec, but actually treated patients on New Brunswick's Campobello Island nearby (famous for being the site of a Roosevelt summer home) and billed the Canadian government for his work there, reports AMNews. (NB: I suspect that Dr Blythe probably billed the government of New Brunswick for his work there, not the Canadian government. That's an immaterial point from the perspective of American readers, of course.)
Now, it seems, the unusual doctor versus doctor race may be decided by the two men's positions on Canadian-style universal healthcare, a model that Dr Blythe favours but Dr Weldon staunchly opposes. Florida's 15th is set to become a microcosm of the larger debate that's taking place across the United States as the 2008 elections draw nearer.
AMNews writes of Dr Blythe's opinion of Canada's healthcare system:Dr. Blythe said that [when he practised in New Brunswick] he didn't see Canadian people having the problems accessing health care that Americans sometimes do. The Canadian single-payer system provides all residents with at least basic care. "Health care is a right. It's a fundamental right that shouldn't be denied to American citizens," he said.
If a single-payer model cannot be achieved here, Dr. Blythe would like to see reform of the existing system so there's true competition and choice. For example, while he can shop around for lower-cost imaging, such as CT scans, patients don't know how to find the best values in health care. This keeps medical costs higher than they should be and also makes health insurance more expensive, he said.
And of Dr Weldon's opinion of Canada's system:Dr. Weldon... doesn't believe the government can provide care as well as the private sector. A single-payer system would lead to lower quality of care and waiting lists to see physicians, he said.
"We need to reinvigorate the health insurance market. We don't need more government running and intruding in health care delivery," Dr. Weldon said. Refundable tax credits, perhaps up to $5,000, for low-income individuals would help them buy private health insurance, he said.
Dr. Weldon, a member of a Republican political caucus that's writing a health reform plan, said it's very difficult to adopt major health system changes in Congress these days. "The potential in this political environment to institute radical reform is pretty remote," he said. It's more likely reform will happen incrementally.
Still, Dr. Weldon would like to end Medicaid and the State Children's Health Insurance Program and instead provide block grants to the states so they can create their own health programs.
Dr Weldon played a central role in the Terry Schiavo case of 2005, when the conservative members of the US government including Dr Weldon and Representative Bill Frist, also a physician, attempted unsuccessfully to prevent Ms Shiavo's husband from taking her off life support after years in a persistent vegetative state.
As of September 30, just before Dr Blythe's challenger for the Democratic nomination dropped out of the race, leaving him as the nominee, the race looked rather lopsided: Dr Weldon had raised $454,000 for his campaign, and Dr Blythe only $2,245.
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A lesson in medical poetry
In the current issue of the journal Chest, Dr Michael Zack waxes poetic about, well, poetry in the first article of the journal's new "Pectoriloquy" section.
(I've saved you the time and looked it up for you: "Transmission of the voice sound through the pulmonary structures so that it is unusually audible on auscultation of the chest, indicating either consolidation of the lung parenchyma or the presence of a large cavity." From The American Heritage® Medical Dictionary.)
Dr Zack, who practises in Medford, Massachusetts, writes about Dr William Carlos Williams, a pediatrician and renowned American poet, as well as his own feelings on poetry:What really matters in poetry (as is also true in medical interventions) is outcome. To continue the metaphor, specific materials and methods matter only as means to the end. Does the experience of reading the poem make a difference, reward the time spent, and create impact? If so, it is good poetry notwithstanding its form, rhythm, lyrical quality, and complexity.
His analysis is up for debate, but the real meat of the article is Dr Zack's delightfully bizarre "semiparody" of an entry to a poetry contest. I particularly like the bit about Paraguay.
Click "READ MORE" below to read his poem, or head over to the Chest website.Medical School
In med school first you listen,
then you imagine,
reducing yourself to scale.
Next you take a stab
at what’s wrong,
articulating a diagnosis.
And finally you treat.
After trying this on people
a few decades,
(successfully I might add),
I realized that in listening,
imagining, reducing scale,
diagnosing, treating,
I had been taught,
and had been practicing,
not just medicine,
but also poetry.
So I entered this contest
for the greatest poem.
My friend said be clever,
to win you must do a few things.
Never write about love,
at least don’t mention it as such,
change its identity to August corn
or herons in flight.
Use the words "shards" and "bone,"
avoid rhymes, use meter,
dialogue in taxi talk
and California speak.
I employed complex gerundives,
ornate adjectives, intricate adverbs.
My metaphors were gorgeous, poignant;
my conclusions profound.
But alas I lost.
Go back, he said,
you must try again.
Initial your first two names,
remove most vowels
from your last name,
tell them you’re from Paraguay.
Change the line endings and
tab the line starts to marginless
asymmetric anarchies.
Yet I lost again.
Perturbed, angry, rebuked,
I dashed off a note
to the committee
voicing my total frustration.
"What did they want?"
I implored. "Are there ever
successful poems?
How could one win?
It’s like trying to find a desert,"
I finished,
"by imagining an ocean and then taking away the water."
"Ah," their responding letter replied,
"That’s interesting."
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Friday, January 4, 2008
Canadian-led study named top medical breakthrough of 2007
In a seemingly unlikely turn of events, a Manitoba-based physician's work has been crowned the top medical breakthrough in the entire world in 2007.
Research led by Dr Stephen Moses, who teaches microbiology and internal medicine at the University of Manitoba, received the distinction last month from Time magazine.
The study singled out for the honour found circumcision reduced the incidence of HIV in Kenya. The Canadian Institutes of Health Research, which provided funding, is boasting today of its superb foresight.
NRM spoke to Dr Moses a year ago about his research and its critics. "I think that it would be in order for the Canadian Paediatric Society (CPS) to revisit the issue of routine male circumcision, not just in the light of the findings of reduced risk for HIV infection, but in relation to other health benefits which have come to light in recent years," he said at the time.
You can read a short profile of Dr Moses on the International Centre for Infectious Diseases website, and check out more of Dr Moses's research here. (Or you can read about Moses, the man who led the Jews out of Egypt in another kind of breakthrough altogether, here, if you prefer. Moses was himself presumably circumcised, as Jewish custom dictates. Coincidence? Probably.)
- 1. Circumcision can prevent HIV (research led by Dr Stephen Moses)
- 2. Test for metastatic breast cancer
- 3. First human vaccine against bird flu
- 4. Help for dieters: Alli
- 5. New diabetes genes
- 6. No more periods
- 7. Relief from fibromyalgia: Lyrica
- 8. Early-stage test for lung cancer
- 9. New source of stem cells
- 10. Benefits of vitamin D
Is Time's list accurate? I have my doubts. Is a controversial, diarrhea-inducing OTC diet drug like orlistat (Alli) really more important in the long run than advances in stem cell research or improved lung cancer testing?
That kind of question echoes one of the central problems of medical research and medical reporting: how to balance the time and money allotted to research with an immediate payoff against research that, although it probably doesn't make much of a difference right away, may lay the groundwork for true breakthroughs later on. (It's another matter entirely to consider the frequent use of the term 'breakthrough' in the pages of daily newspapers these days to describe relatively minor bits and pieces of research.)
Photo: International Centre for Infectious Diseases
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