Canadian Medicine

"Spotty progress" in latest Wait Time Alliance report card
The 2009 report card by the Wait Time Alliance, its fourth annual one, shows small improvements on some measures in some provinces, but the authors of the report, entitled Unfinished Business, insist that is not enough. [ (PDF)]

Unfortunately, the report card's accuracy is inherently limited by the lack of reliable data collected and disseminated by the provinces. That in itself is one of Canada's major hurdles in the struggle to reduce wait times, according to the report's authors. "People can go online and track the progress of a package they shipped from one end of the country to another, yet in many parts of Canada patients still cannot find out how long they can expect to wait for critical medical treatments and procedures," Dr Lorne Bellan, a co-chair of the Wait Time Alliance, said in a release. "We need to do a better job of tracking and reporting on the full wait that patients experience to access necessary medical care." []

Dr Robert Ouellet, the president of the Canadian Medical Association (which is a member of the Wait Time Alliance), commented Thursday, "Right now, patients receive excellent care, but too often it is in spite of the system, rather than because of it."

The WTA is a research and advocacy group formed by associations of medical specialists from a number of fields of medicine.

Presumably coincidentally, a Vancouver-based company called Timely Medical Alternatives announced plans to offer patients faster specialist access -- for a fee.

The company's president, Rick Baker, claimed the new service is not illegal. "All we will be providing is research," he said. The government has not yet evaluated the new service's legality.

The company has made headlines in the past with the service it currently offers patients: it will connect them with American facilities and physicians to treat patients faster than they can be treated in Canada.

Controversy pushes chair off eHealth Ontario board
eHealth Ontario board chair Dr Alan Hudson has resigned from the agency's board as controversy continues to rock the province's Liberal government after it was reported that millions of dollars of contracts given to consultants were not opened up for bidding.

Dr Hudson, a neurosurgeon and former president of Toronto's giant University Health Network group of hospitals, was largely responsible for the province's wait times reduction efforts over the last several years.

CEO Sarah Kramer was dismissed from her job last week for similar reasons. [Canadian Medicine]

In discussing the recent dismissal of Ms Kramer and Dr Hudson's departure, Premier Dalton McGuinty said, apparently with a straight face, "The buck stops with me."

No H1N1 flu field hospital in Manitoba
Health Canada declined requests to set up a field hospital to combat the fast spread of the H1N1 flu in First Nations communities in a remote area of Manitoba especially hard hit by the virus.

The H1N1 flu has been spreading particularly quickly in Manitoba of late.

Isotope alternatives not as safe: doctors
With fewer and fewer radioisotopes available to nuclear medicine specialists, some doctors are turning to older diagnostic scanning methods.

Robert Atcher, the president of the US-based Society of Nuclear Medicine (which held meetings this week in Toronto), said that alternative scanning techniques and materials are less safe and less effective than the molybdenum-99 that is now in short supply globally.

Some Canadian nuclear medicine experts are complaining publicly that the government should have consulted them before appointing Dr Alexander McEwan the new radioisotope-shortage adviser to the health minister. "We feel the nomination of an individual without proper consultation infringes on his ability to speak freely to the government, and we feel that if he was nominated by his peers and if he had to respond to his peers, he would have to do a better job," Dr Norman Laurin, the president of the Canadian Association of Nuclear Medicine, said. "If you've been picked personally by a minister and not the object of a formal recommendation, you are somehow indebted to that minister."

And, in what is perhaps an unnecessarily obvious observation, the Toronto Star's editorial board bemoaned the fact the government has much, much more to do to solve the problems the radioisotope shortage has posed. "This crisis will not be solved by wishful thinking in Ottawa." Drat!

C-sections not always needed in breech births
At its annual meeting in Halifax, the Society of Obstetricians and Gynecologists of Canada announced that its latest guidelines on delivering babies in the breech position will state that C-sections are not always necessary. [ (PDF)]

"Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic," Dr Robert Gagnon, one of the authors of the guidelines, said in a release. "What we've found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery."

Of course, as is true in all medical specialties, changing guidelines is no guarantee that many practitioners will be changing practices. But SOGC president Dr André Lalonde has acknowledged as much. "The onus is now on us as a profession to ensure that Canadian obstetricians have the necessary training to offer women the choice to deliver vaginally when possible."

But in the current issue of the Journal of Obstetrics and Gynecology Canada Dr Andrew Kotaska, from the Northwest Territories, questioned how useful it will be to put the effort in to teach obstetricians how to avoid caesarean sections. [ (PDF)]

Treatment and travel
The June issues of and magazines are now available online.

Lawsuit over Quebec breast cancer test scandal
A request has been filed to begin a class-action lawsuit against the province of Quebec over the breast cancer testing problems that were recently brought to light. The request was made by breast cancer patient and community organizer Marianne Tonnelier, who described the government's handling of the news that as many as 20% of breast cancer hormone tests could be flawed as "offensive" and "reckless." []

Earlier this month, Health Minister Dr Yves Bolduc (right) took the advice of a panel of experts he had convened and announced the province would re-do 2,100 tests to make sure no patients were being treated incorrectly. [Canadian Medicine]

Isotope shortage felt across Canada
Up to 12,000 Quebec patients have had their cardiac and cancer diagnostic tests postponed over the last two weeks as a result of the ongoing radioisotope shortage. "No one has died in Quebec because of this crisis, but if it continues, that could happen," Francois Lamoureux, the president of the Nuclear Medicine Specialists Association of Quebec, said.

CTV News reported dozens of delayed tests in BC, Alberta and Saskatchewan. Most hospitals appear to have been able to get by so far on what they had in storage from their last shipments, but supplies of radioisotopes are dwindling. []

Health Canada announced on Monday that it has approved a source of the radioisotope technetium-99m that had previously not been available to Canadians. The approval should lead to an increase in the supply of necessary isotopes, the agency said. []

Meanwhile, Ontario and Alberta researchers have developed a replacement for molybdenum-99, called F sodium fluoride, which can be produced in existing cyclotrons in several Canadian cities.

MSF Canada appoints new president
The Canadian branch of Doctors Without Borders has appointed Halifax family doctor Joni Guptill its new president. Dr Guptill, who helped establish the Canadian branch in 1991, takes over from the departing Montreal pediatrician Joanna Liu. Dr Guptill has treated patients in humanitarian disasters in Turkey, Somalia, China, Iraq and Sudan.

In a release, Dr Guptill said, "I like the challenge. I like working with people from other cultures. There's nothing more rewarding, more satisfying than doing a job well where the need exists. I've always wanted to do this kind of work, and it's been the most satisfying work of my medical career."

Grand Rounds
The excellent American medical profession newspaper ACP Internist hosted this week's edition of Grand Rounds, the anthology of the best medical blogging from around the web. Canadian Medicine is proud to account for the entire international contingent this week.

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