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In the old days, no one can acquire antibiotics for sale if they do not have a doctor’s prescription for it.   Most people of those ages do think that it is rightly appropriate to first have a doctor’s prescription or at least his recommendation in order for one to be allowed to get some antibiotics for sale to treat their ailments, but today, due to modern advancements in science, health and technology, this way of thinking is now being overlooked.  The way most of us think about antibiotics today is also different, too.  When we get a bacterial infection, we would usually want to get it treated right away, and that’s what antibiotics for sale without a prescription is all about.

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What's in the news: May 20 -- Ontario docs have money on the mind

Ontario MDs anxious about financial matters
Recession aside, two recent events have some Ontario physicians concerned about financial matters.

The first matter of concern is the Ontario government's sudden decision last month to suspend new hiring in capitation-model practices such as Family Health Teams. (See the comments below this article for an update on this story.)

The news prompted the Coalition of Family Physicians of Ontario (COFP) to release an "urgent notice" to all doctors in the province. "With the present freeze by Government, new doctors poised to enter the medical work force are being forced to put their plans on hold and reconsider their options. Likewise, established doctors, who have made significant financial investments in setting up as a FHN/FHT/FHO/FHG, now face uncertainty and potentially devastating losses." [COFP notice]

Health ministry officials have said the suspension is temporary and should be lifted within several weeks.

The second issue is the amount of money the Ontario Medical Association owes in rent on a property it is no longer using.

The figure is a staggering $6.1 million per year in rent for the University Avenue office space the OMA was using before moving in early April to a new location on Bloor Street.

The COFP -- long a critic of the OMA -- has eagerly jumped at this opportunity to criticize the association. In the same notice referred to above, COFP president Dr Douglas Mark called the lease problem a "fiasco." "Although the OMA has laid the blame on the economy as the culprit, it should have been cautious precisely because of the poor economy rather than leasing new premises prior to securing a tenant for the old site."

Dr Mark's assessment of the OMA's likely next move is dire. "What are the implications for you in all this? It strikes us that the OMA seems to lack fiscal accountability to its members, and may simply pass on related additional costs to you directly, by means of an increase in OMA dues. It is empowered to do so by the OMA Dues Act of 1991, which is how it raises its revenue, without any mandated regard to its actual fiscal performance. Alternatively, it may choose to simply cut some programs to finance the shortfall. Both of these choices will have a negative impact on you."

Dr Mark encouraged physicians to write to their OMA reps and recently inaugurated OMA president Suzanne Strasberg.

Nuclear medicine worries as key nuclear plant shut down again
The Ottawa-area Chalk River nuclear power plant, which is responsible for producing more than half of the world's supply of a vital radioisotope used in as many as 90% of diagnostic imaging procedures, has been shut down for repairs for the second time in the last 18 months.

The plant was shut down after radioactive heavy water was discovered to be leaking out of the facility. [Ottawa Citizen] Similar leaks were discovered in December and necessitated a three-day shutdown for repairs. [Canadian Medicine]

There are now fears, once again, that too few radioisotopes will be available to physicians and radiological appointments could be canceled, as happened in late 2007 when the plant was last closed for an extended period of time.

"We'll be good for the next week, but the next three weeks will be really difficult after that," Dr Doug Abrams, the president of the Canadian Society of Nuclear Medicine, told the Canadian Press. "It's really going to depend on what other sources can be tapped from Europe." [Canadian Press]

The threat of a debilitating shortage grew so great in 2007 that the federal Parliament passed emergency legislation ordering the plant to reopen despite safety concerns. [Canadian Medicine] [National Review of Medicine] Not long after, then-Natural Resources Minister Gary Lunn fired Linda Keen, the head of the Canadian Nuclear Safety Commission, after she voiced concern about the wisdom of restarting the Chalk River plant without the required safeguards yet in place.

H1N1 flu news: a round-up
As of May 15, there were 496 confirmed cases of the H1N1 virus in Canada, with more than half in Ontario and BC. [Public Health Agency of Canada] One death has been attributed to the disease, that of a 39-year-old woman in northern Alberta who had not travelled to Mexico and whose flu-infected mother, whom she presumably caught the virus from, had not been to Mexico either. It was difficult, however, for doctors to determine to what extent the flu had been a factor in her death; she had preexisting medical problems. [Edmonton Journal]

Four hospital employees at University Health Network facilities in Toronto have been diagnosed with the H1N1 flu. [Toronto Star]

Remember the news earlier this month that Canada was the first country to decode the H1N1 virus's genes? [Canadian Medicine] It turns out that was somewhat less than true. Canadian scientists were the first to genetically sequence a Canadian sample of the virus and a Mexican sample, but CDC scientists in the United States were the first to decode the virus's genes. Dr Frank Plummer, the director general of the National Microbiology Laboratory in Winnipeg that was said to have made the purported breakthrough, told the Canadian Press that Health Minister Leona Aglukkaq "misspoke." He added that Health Canada's press release "mistunderstood" the distinction "in their enthusiasms for the findings."[Canadian Press]

Dr Margaret Chan, the Canadian-trained physician who's currently the director general of the World Health Organization and the woman at the head of the global response to the H1N1 outbreak, was profiled in the New York Times earlier this month. "[I]t all started," the article explained, "because her boyfriend decided to move to Canada." [New York Times]

Aiming for faster breast cancer diagnoses
Princess Margaret Hospital announced it will offer same-day breast cancer diagnoses. "The vision for this groundbreaking initiative is that when completely
operational, women and men suspected of having breast cancer will be able to
receive all their tests, diagnosis and treatment plan in one day at Princess
Margaret Hospital." [Princess Margaret Hospital news release] [CTV News] [Globe and Mail]

Sask. radiologist review finds 'concerns'
Saskatchewan health officials will hold a news conference today to elaborate on the hints they gave yesterday about "identified concerns related to significant clinical differences of opinion in the interpretation of diagnostic images in the [Sunrise] region" stemming from an investigation of an as-yet-unnamed radiologist. [CBC News]

Ontario will allow non-doctors to prescribe, order exams
New legislation proposed in Ontario means nurse practitioners and physiotherapists will be able to order diagnostic imaging exams, midwives will be permitted to draw blood, and pharmacists will be allowed to renew prescriptions at their discretion. [CBC News] You can read the full text of the bill, if you're so inclined, at the Legislative Assembly of Ontario's website. [Bill 179]

MORE NEWS FROM ACROSS CANADA
Ontario aims for all-electronic prescribing by 2012. [Canadian Press] [Toronto Star]

Newfoundland and Labrador nurses, still mired in what appears to be an ever-worsening dispute with the provincial government (and, perhaps, in an increasingly personal dispute with Premier Danny Williams), have said they will refuse to work overtime beginning today. The nurses' union has referred to the impasse as a lockout, while the government has called it a strike. [CBC News]
Update, Wednesday, May 20: The union and the government reached an agreement early this morning after negotiations overnight lasted until 5am. Nurses will receive a pay increase of a minimum of 21.5%. [The Telegram]

Orthopedic surgeons in Prince George, BC, refused to add more non-urgent patients to their wait lists unless they are granted more OR time. "We're not being provided with the resources we need, and it makes no sense to us to keep adding to the never-ending list," said Dr Michael Moran, the head of the six-doctor team. [Prince George Citizen]

Dr Brian Day appeared in commercials produced by the advocacy group Conservatives for Patients' Rights, which is lobbying against reforms in the United States that would increase the government's role in the healthcare market. [Conservatives for Patients' Rights] [National Post] The Canadian Health Coalition has doggedly pursued its fight against Dr Day across the border, writing a letter to President Barack Obama. "It remains shocking to us that Dr. Day, a past president of the CMA, is participating in a campaign to de-rail the efforts of the American people to secure their right to health care by misrepresenting the facts about Canada. This is a breach of fundamental ethical obligations of the medical profession, namely, a commitment to best evidence and avoidance of conflict of interest." The letter ended with a personal message to Mr Obama from the coalition's Michael McBane. "We wish you every success in your efforts to reform America’s health care system for the benefit of all your citizens. If we can at any time share with you or your team the benefits of our excellent system, we would be happy to do so." [Canadian Health Coalition open letter (PDF)]

A Canadian researcher, Konan Michel Yao, was charged with smuggling biological material into US. Mr Yao was on his way from his old job at the National Microbiology Lab, in Winnipeg, to a new post at the US National Institutes of Health's Biodefense Research Laboratory, in Maryland, when he was caught with 22 vials, including samples of genetic material from the Ebola virus. He told police he didn't want to start his work from scratch at his new job. [CBC News]

Surgeons performed the first surgery on a fetus ever in Canada, at Toronto's Hospital for Sick Children. [CTV News]

Alberta Health Minister Ron Liepert introduced legislation that would allow the province to sue convicts for crime-related healthcare costs. "Our caucus does not believe taxpayers should have to foot the health care costs of someone who commits a crime," Mr Liepert told CTV News. "We need to send a message that we are going to make you pay if you get involved in criminal activity." [CTV News]

The Manitoba Nurses Union said it will ask the provincial government to outlaw the practice employed by the quarterly magazine of the College of Registered Nurses of Manitoba, RN Journal, of publishing the names of drug-addicted nurses. "These nurses are ill. We go a long way in this province to protect personal health information and in my mind this is treating nurses like second-class citizens," said union president Sandi Mowat. [Canadian Press]

Wondering how to get your pediatric patients to eat better? Follow the example of their schools: lock 'em up. [CBC News]

Image: Shutterstock

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48 comments:

  1. sharonMay 20, 2009 at 8:46 AM

    If heath reporting is designed to generate a sense of indignation..........(are you applying Selye's Stress Adaptation Theory ) .... this "medly of malady " accomplishes it...

    RE: "Crying wolf" from the COPD

    THe " what if's" should not capture the attention of professionals proclaiming "evidence-based practice " based on scientific research.

    In the urban commercial housing market it has long been common to entice old tenants into new digs through lease relief . The real question is "are the monies paid balanced against monies saved?"

    [ watch Ice Age again and be "Diego" ! ...i.e. not into groupthink "pack" mentality ]

    RE: isotopes availability

    Don't report on this without a watchful eye on "uranium mining bans"..... they are inextricably linked.

    RE: H1N1 reporting

    The New york Times Article explains the capacity of Dr. Chan to survive both the negative and positive applications of "discrimination"..... this should not be trivialised by profiling remarks on her private life in the absence of context and chronology.

    RE: Prescribing/Invasive procedures devolution

    Physicians would be wise to demand/?provide:
    1. revised "standing orders",
    2. redefinedregulated health professions duties, and
    3. "place" data-mining requirements to track aberrations

    Downsizing, devolution and deregulation are hitting professional standards "where they live".....

    RE: Comments on Dr. Day from the Canadian Health Coalition

    Look at this sentence:
    "This is a breach of fundamental ethical obligations of the medical profession, namely, a commitment to best evidence and avoidance of conflict of interest."

    I ask you the following:

    Are a "commitment to best evidence" and " avoidance of conflict of interest" fundamental ethics in the medical profession??????

    If that is the case you need to ponder the following reality.

    The threat to the quantity and quality of professional "medical" service lies in the marriage of scientific-based research(SBR) AND evidence-based practice (EBP).

    The real danger to long established medical ethic is integrated firmly in evidence-based practice (EBP).

    This perspective allows the individual practitioners level of expertise to " redefine" treatment protocol on a case-by-case basis while financially trapped by carepath costing.

    [This manipulation of patient health/value/humanity is akin to the "streaming" process started in primary grades in the 1970's that prevented many brilliant children from moving on into higher education in this present age.]

    Then..... and now..... the impact of " EBP" has created a crisis of enormous proportions as it feeds back statistical information enforcing and reinforcing the SBR/EBP cycle.

    It is EBP that is undermining the capacity to create uniformity in the carepath.

    It is EBP that permits treatment guidelines to be individualised to the point where the resulting chaos and lack of uniformity causes administration to discard treatment and rehabilitation protocols into the waiting arms of the " harm reduction" alternative that denies the concept of "cure".

    Is there a path back to PCP ( Patient-centered Practice ) in " truth" ?

    Offload the EBP ethic ...and maybe you will find your way back to that.

    [ If you really think the "eureka" expereinces of D.L. SAckett ( ? father of EBP) is equivalent to the scholarly approach of Hippocrates ...read this ...and quiver!

    http://www.jameslindlibrary.org/trial_records/20th_Century/1950s/chalmers_et_al/chalmers-commentary.html

    P.S. SBR has recently been replaced with BRE ( best research evidence ).
    Read this and weep, Physicians, ..... for yourself :( ...and your profession

    Delete
  2. Sam SolomonMay 21, 2009 at 3:01 PM

    Here's an update on the Ontario situation, sent by the COFP to all Ontario family physicians.May 21, 2009

    In our previous Bulletin to you, we brought to your attention two important developments, which are of serious concern to us all:

    A. The freeze on new physician registration in Patient Enrolment Models (PEMs), and

    B. The new OMA headquarters leasing fiasco.

    The leasing matter remains unresolved and exposes us to potential increases in OMA dues and/or cuts to OMA programmes. However, the OMA recently announced that the freeze on new physician enrolment in PEMs has been lifted. Unfortunately, we believe this announcement is critically misleading for the reasons outlined below.

    On May 14, 2009, The OMA President's Update announced that the Government has lifted its sudden freeze on physician entry into Patient Enrolment Models. The freeze on Family Health Teams (FHTs) continues. Although this as been hailed by the OMA as significant progress in resolving this contentious issue, a careful analysis of the announcement clearly shows that while the freeze on the other PEM's has been lifted, the freeze on the formation of FHOs has not been lifted at all.

    As of now, you may form a new CCM, FHG or FHN, but you may not form a new FHO, but only apply to join an existing FHO, creating a backlog of applications and delays which the government has already acknowledged. Why is this so important and what are the implications for you?

    For the majority of you who have not formed or transformed your practice group into a FHO, you may still not do so, and there is no indication as to when this situation will change. As many of you may know, the FHO has turned out to be a very popular model for physicians – including new physicians – because of the practice-style and financial advantages that it offers. There is now a long list of applications to form a new FHO, as well as the long lineup to join the limited number of existing FHOs.

    (continued in next comment)

    Delete
  3. Sam SolomonMay 21, 2009 at 3:01 PM

    (continued from previous comment)


    If, for example, you are presently in a FHG and wish to transform into a FHO, you cannot do so. How then will you attract new physicians to join your group or retain the existing ones? This will prove very difficult, as you cannot compete with established FHOs which were fortunate enough to form before the freeze. The result is a very uncertain future which makes it very difficult to make any plans and investment decisions. It may also drive new physicians away from Ontario, since their practice opportunities will now be severely limited.

    What in effect is created by the present freeze on new FHOs is a two-tier system for family physician compensation, with those in existing FHO being rewarded while most of you will likely be relegated to the "have-not" category.

    Moreover, because the FHO is a very popular PEM, the freeze also put in question the entire commitment of the Government and the OMA to the Patient Enrolment Models of practice, which they have so ardently touted. If the Government has come to the conclusion that it may not be able to afford a capitation approach now or in the future, they should not resort to creating two-tier inequities in dealing with this problem, but rather look at new ways of funding health care in Ontario.

    As for the OMA, it should highlight the continuing freeze on FHOs as a serious problem rather than burying it, as in the latest President’s Update. We expect our representative body to represent our interests and demand an immediate lifting of the freeze on new FHOs.

    We urge you to become involved in this matter, since it has serious implications for your professional futures. You can contact the OMA and simply inquire if you are now able to form a FHO. Or you can also write to the OMA President, Dr. Suzanne Strasberg, voicing your concerns. We urge you to do both, and to do so as soon as possible. If you wish, you may use the letter at the bottom of this Bulletin and fax it to the OMA at the fax number provided.

    Yours truly,

    Douglas Mark MD, President
    and the Board of the Coalition of Family Physicians of Ontario

    Delete
  4. sharonMay 21, 2009 at 6:18 PM

    paste

    Family Health Organization (FHO)

    The Family Health Organization Model represents the alignment of Primary Care Networks and Health Service Organizations into one model.
    FHOs are groups of physicians who provide comprehensive primary health care services to their patients with a focus on illness prevention.
    Through Institutional Substitution Program Grants, allied health professionals are part of some of the teams as well.
    FHOs provide care during regular and extended office hours and patients have access to a nurse staffed Telephone Health Advisory Service.


    end of paste

    source: 2007. Health force Ontario

    Did this happen? Is there a "model"...or simply an alliance of sorts?

    Is there some reason the governors have to create seperate entry points now for "allied" professionals?

    Have physicians confused/substituted "inter" disciplinary with "intra" disciplinary ?

    Has anything happened that hearkens back to the days of fee-splitting?

    Has the mandate of "prevention" become passe now that harm reduction is the focus ( in the physicians eyes)?

    What say you?

    Delete
  5. WellescentMay 22, 2009 at 10:07 AM

    The situation with AECL and medical isotope creation is quite ridiculous. With all the known issues of the existing reactor and its nearing end of life, who in their right mind thought that abandoning the MAPLE isotope reactors was a good idea.

    When we foolishly push forward with nuclear power reactors when there are alternatives and yet abandon a reactor that can create life saving products when the supply of product is so limited, it is obvious that the government priorities are completely messed up.

    Delete
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