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Friday, December 11, 2009

IN THE NEWS: Quebec will hear uranium-protest MDs' concerns

Quebec and anti-uranium MDs to talk
Quebec Health Minister Dr Yves Bolduc has agreed to meet with the 23 doctors who have now announced they are quitting their practices in Sept-Îles, Quebec, to protest the approval of a nearby uranium mining exploration project. [Le Devoir] The number of doctors reached 23 this week after the initial 20 went public last Thursday. [Rue Frontenac]

But the doctors may find themselves in a difficult situation. The Collège des médecins du Québec announced it will open an investigation to determine whether the doctors are in violation of their code of ethics by endangering the lives of their patients by making a political statement. College president Dr Yves Lamontagne told CBC News that physicians are forbidden "from taking part in a concerted action of a nature that would endanger the health or safety of a clientele or population." [CBC News]

The Montreal Gazette criticized the doctors' decision to quit in an editorial. [Montreal Gazette]

Alberta health costs far exceed projected budget
A government program going over budget? What a shock!

In all seriousness, however, the Alberta health system is facing colossal deficits of up to $1 billion or more this year and next. Government programs going over budget isn't news, but when they're $1 billion over? That's a lot of money. Top health bureaucrats reportedly said the provincial health system could run through its current fiscal year's budget by February -- before the next year's budget even arrives. Which would mean the health system could technically be described as being broke.

Alberta Liberal MLA Kevin Taft, the former party leader, however, took issue with the way government officials have handled the news. "Claiming that by February 2010 they will have no cash sends a message that they're going to have to close down hospitals and shut down the whole system, and that's just ridiculous," he told the Journal. "That's just not going to happen, so why create fear unless there is an agenda that fear serves? And that agenda is to create a crisis so that they can potentially dismantle big chunks of our system." [Edmonton Journal]

"When you spend next month's pay cheque on this month's groceries then you're going to run out of cash," said Health Minister Ron Liepert. [CTV Edmonton]

Diabetes care substandard across Canada
Diabetes care fails to meet the recommended level of care, a new Canadian Institute for Health Information study found.

Adults with diabetes are supposed to receive four tests from their physicians, the report said: blood glucose (A1c), urine protein, dilated eye exams, and foot exams. Only 32% of patients had been given all four. That number was only 21% in Newfoundland and Labrador, but it was as high as 39% at the very other end of the country, in BC. [CIHI report: Diabetes Care Gaps and Disparities in Canada (PDF)] [Canadian Press] [Canwest News Service]

Quebec urged to open supervised injection sites
Quebec should open supervised narcotics injection sites like the one in Vancouver, recommended the provincial public-health research agency last week.

Not only that, but the researchers also wrote that they consider the 2008 BC court decision, which shot down the federal government's demand that Vancouver's Insite supervised injection clinic be closed, to be proof positive that legal exemptions are no longer required to open supervised injection sites. [INSPQ report]

Health Minister Dr Yves Bolduc recently told a reporter that he was waiting to see the INSPQ's report before deciding on supervised injection sites. [Rue Frontenac]

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Thursday, December 10, 2009

Did Toronto MD take anti-poverty tactic too far?

Toronto doctor Roland Wong has for years approved every Special Diet Allowance application that patients receiving social assistance ask him to. Those forms, he says, are crucial tools to provide a little bit of extra income to families struggling to make ends meet, to buy healthier food and purchase dental care.

The College of Physicians and Surgeons of Ontario, the medical profession's regulatory body, sees it differently. Dr Wong now stands accused of being "incompetent" and having "failed to maintain the standard of practice of the profession" because he has been signing the applications without first confirming that patients have the food allergies or dietary restrictions that the Special Diet Allowance is intended to help with.

The allowance program has been a controversial one. Anti-poverty activists saw the program as a way to "take back" the money they felt the government should have provided to the poor, as the left-leaning Canadian newspaper The Dominion explained in 2006: essentially, physicians rationalized that even if patients didn't actually have medical conditions requiring the diet yet, living in poverty put them at risk of developing those conditions if they didn't eat better. More recently, disputes over which medical conditions necessitate the extra funding and accusations of discrimination against some patients led to a case before the provincial Human Rights Tribunal, and some changes to the way the program was administered. (You can consult the current regulations governing the program here.)

The complaint against Dr Wong was filed with the College by a local politician, and its roots may be partly financial. The province's auditor general's office last week released its annual report, which included the finding that the special dietary allowance program now costs 12 times what it did 9 years ago, as The Globe and Mail reported Wednesday in that paper's story on Dr Wong. (The Globe also published an extended interview with Dr Wong.)

The auditor general's report (PDF) found many requests were paid "under questionable circumstances" and placed responsibility for the cost increase on a "campaign by advocacy groups critical of Ontario works allowance amounts," which presumably includes prominently the Ontario Coalition Against Poverty, with whom Dr Wong has been involved. For example, the report notes that one family of 10 was identified in which all 10 members were receiving special dietary allowances, for a total of $29,700 in tax-fee aid per year.

The report also describes a doctor suspected of gaming the system, who sounds very much like he may be Dr Wong, or perhaps another doctor operating with similar goals:

In light of the significant increase in special dietary allowance expenditures, one of the service managers that we visited took the initiative to review more than 1,000 of its clients receiving the allowance. It found that one of the 318 health-care practitioners who approved the 1,000 applications reviewed was responsible for approving almost 20% of them. As well, that same practitioner, a general practitioner, diagnosed, on average, nine medical conditions per applicant, compared to an average of about two per applicant diagnosed by other health-care professionals. Furthermore, this doctor diagnosed Celiac disease in 99% of the applications, which we feel is unreasonably high given that the nationwide incidence of this disease is estimated at 1% of the population.
Besides what appears to be the College's concern about the government's concern about the cost of the program, there may another issue at hand. In regulatory-speak, Dr Wong's alleged transgression of simply signing off on the requests translates to "failure to take proper histories and failure to perform appropriate medical examinations, including diagnostic testing."

Consider for a moment that an application for the Special Diet Allowance represents an opportunity for the province to ensure that people on social assistance are screened by a physician. If it turns out Dr Wong was not only signing off without confirming patients' dietary restrictions but that he was also signing off without really examining the patients -- well, he might find himself in serious trouble.

Dr Wong is scheduled to appear at a hearing next Thursday to determine whether his medical licence should be suspended until his case his heard. A group of concerned physicians and professors, led by U of T assistant professor of family and community medicine Dr Gary Bloch, will be sending an open letter to College registrar Dr Rocco Gerace tomorrow to express their support for Dr Wong to retain his licence while the case progresses. "We cannot conceive of harm or injury to patients that might arise from the continuing ability of Dr. Wong to practice medicine," says a draft of the letter.

Update, Jan. 14: The College has decided not to suspend Dr Wong's licence before any decision is made on his case.

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Monday, December 7, 2009

IN THE NEWS: 20 doctors quit to protest Quebec uranium mine

20 doctors resign en masse over Sept-Îles uranium mine
A long-simmering dispute in Sept-Îles, Quebec, finally came to a head late last week when twenty physicians announced they will leave the region in protest against the provincial government's approval of nearby exploration for uranium mining they fear will pose a health hazard. Several have decided to leave the province altogether, and they warn that more may leave as well. [Presse Canadienne]

In their letter to the minister of health, Dr Yves Bolduc, dated Thursday, Dec. 3, the physicians wrote, "We regret the effect that this mass exodus will have on the population and the remaining medical staff but we believe it to be contrary to our code of ethics to not warn the authorities." Les Affaires published the full letter. [Les Affaires]

Sept-Îles is a city of just 28,000 people, so the loss of at least 20 doctors -- of whom four are psychiatrists, eight are family physicians and the rest are specialists -- is a major, major blow.

Serge Simard, the minister responsible for mines, said the uranium-extracting project would not be given the go-ahead without the permission of the community. [La Presse]

Québec solidaire MNA Amir Khadir, a Montreal physician, called the government's decision to let the mine development continue at the expense of losing 20 physicians "a pitiable example of the great power of the mining industry." [Québec solidaire news release]

UBC med student awarded Rhodes Scholarship
Jaspreet Khangura, fourth-year med student, will do an MSc in Global Health at Oxford. "Khangura's keen interest in social justice issues has inspired her to remain committed to volunteer work and community development projects both locally and globally." She's done aid work in Asia and in Vancouver's downtown eastside. [UBC news release]

H.M.'s famous brain to be preserved
The brain of H.M., the man whose inability to form new memories made him one of the most important neurology case studies in history, is being dissected and digitally mapped. Important work on H.M.'s case was carried out by researchers around the world, including some at the Montreal Neurological Institute. [New York Times]

Watch your fingers
A New York radiologist invented a safer bagel-cutting device. [Wall Street Journal]

Sound advice on Facebook
British doctors are warned not to chat -- and especially not to flirt -- with their patients via Facebook. [Medical Defence Union news release]

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