Trevor’s Take On: Conversations in your community

Collette D. Regional Tour, Trevor's Take On 1 Comment

Regional Tour Program

The College has been inviting itself to communities around Alberta as part of our regional tour program, to gain a better understanding of the issues and needs of the physicians who work in those settings as well as of representatives of the community (whether elected officials, members of the Chamber of Commerce, health advisory council members, PCN leaders or just those who show up to our public forums).

Our agenda is simple: We listen. While happy to answer questions or to respond to issues, we come to listen and to understand.

At a recent meeting, a physician who attended said to me:

I must apologize to my colleagues. I’d said to them “why should we go to hear what the principal has to say?” But this session wasn’t at all like listening to the principal.

I encourage members to join us for a conversation when we come to your community. We don’t come as the principal. We won’t have answers to all of your issues and questions, but I promise you we’ll listen, answer what we can, and do our best to pass on your issues to those who may be able to answer or address them. Learn more about our Regional Tour program.

Physician Assisted Dying (PAD)

A few days ago the federal government, supported by a number of provinces, asked the Supreme Court of Canada for an extension to the date (scheduled to be February 6, 2016) when the Criminal Code provisions prohibiting physician-assisted dying will be struck down.

Whether such an extension is granted or not, Alberta physicians should familiarize themselves with theCollege’s revised advice document on consent and PAD. We’ve made some changes to the consent provisions to make consent for PAD consistent with consent for any medical procedure. Specifically that means there is no age restriction on who can request and consent to PAD, just as there is no age restriction in law for consent to other procedures. Some have misinterpreted this advice. To be clear, I think physicians need to recognize that, in law, the question of consent to a medical procedure is contingent on capacity to consent and not on age. To create an artificial age limit for PAD would be contrary to the rules for consent for medical intervention.

In addition, we’ve clarified that the period of reflection for someone who wishes to access PAD and is found eligible should be proportional to the patient’s clinical situation. For some patients – like those who are terminally ill – the period of reflection between completion of the request and provision of the service should be consistent with the patient’s clinical state. In my view,  it would be unconscionable to force a patient with a terminal illness who requests PAD to wait a prescribed 14 days, for example. In other situations the period of reflection might be extended significantly, as the patient reassesses her/his condition.

On a related note, I’ve had the privilege of participating as Alberta’s representative to a provincial/territorial expert advisory group on PAD. Our report and recommendations was submitted to the Ontario Attorney General and Minister of Health and Long Term Care on November 30. Rumor has it that the report will be released publicly on December 14.

I believe this report is comprehensive and thought-provoking, offering a set of recommendations to help guide the implementation of PAD in Canada.

I want to publicly thank the co-chairs – Jennifer Gibson and Maureen Taylor – for their success in getting such a disparate group with strong views to agree on almost everything in the report, and I want to thank Alicia Neufeld and her team from the Attorney General’s office and the Ministry of Health in Ontario for the incredible support and coordination they provided to our efforts.

Health System Challenges

Anyone trying to balance a cheque book knows that spending 15% more than your income is going to catch up pretty quickly. Unfortunately, this is the situation in which the Notley government finds itself.

The budget for health takes up about 45% of the provincial budget. The budget for physicians – about $4.8 billion – is 10% of the provincial budget all by itself.

It’s not hard to guess where government will be looking to reduce costs, or to ‘bend the cost curve’, as the current catch phrase goes. The harder question is how should that be done, especially when health care costs typically rise about 6% per annum, and when a number of professions have contracts that include increases in wages or fees?

I’d like to think we can take some money out of health care by being more rational about our spending – by applying the practices advocated by Choosing Wisely Canada, for example. But it is hard to see where $1 billion (for example) can be cut without causing serious pain to somebody, if 70 to 80 per cent of every dollar spent on health care goes to pay salaries or fees. By my calculations there are only three options: cut wages (fees); reduce services (which means laying off staff); or raise revenue in some way in order to pay for health. For a government committed to public delivery and public funding, the choices are grim.

Continuity of Care

Last Christmas we conducted a random survey of physician office messages to check if they were compliant with our Standard of Practice on after-hours care. Sadly, only one-third of the messages were consistent with our expectations.

This Christmas we’ll repeat the telephone survey. I sincerely hope we will find a significant improvement as we move the profession toward 100% compliance. I know there remains some resistance to after-hours availability despite the clear requirement in the Continuity of Care Standard of Practice. My request to those of you not yet on-side: make it your Christmas present to your patients and your colleagues in diagnostic imaging and laboratory medicine.

And on that note I wish all of you a Merry Christmas! Whether you celebrate the birth of Jesus Christ or not, the Christmas holiday offers a time of reflection, recuperation, family gatherings and the opportunity to remind ourselves how fortunate we are to live in this country and this province.

As always, I welcome your comments below or by email at trevor.theman@cpsa.ab.ca.

Trevor Theman

1 Comment on Trevor’s Take On: Conversations in your community

Das Madhavan said : Subscribe Dec 10, 2015 at 5:12 PM

Some thoughts about prescribing cannabis and the use of the terminology " medical marijuana". As a front-line physician among the potential 'consumers' of this new provision of prescribed cannabis, I have serious concerns. The big business potential and expected multi-billion turn out are frequently a topic of the media now. This hyped up enthusiasm of people or firms counting on increasing the number of customers through doctors could naturally s**k in the physician community for meeting their profit targets ( perhaps at the expense of the health of vulnerable citizens).Even though the Canadian research into cannabis has been much less, globally it has been researched reasonably well, I think. Especially the focus on the correlation between cannabis and psychosis. The criteria should mandate that anyone addicted to cannabis or a potential for abuse/dependency be an exemption. Anyone with a history of unusual behaviour ( which could have been an undiagnosed psychotic episode) or with any psychotic illness or a family history of psychosis should also be exempted as a precaution. The term ' medical marijuana' acts as a powerful marketing boom on its own, giving a false sense of safety ( imagine 'medical alcohol' ). On one hand the WHO is alerting us of the global take over by mental illness as the leading cause of morbidity and who knows might be epidemic or pandemic in its scope! Definitely none of us wants to see another thalidomide havoc repeated and feel accountable as a community. I think it will be quite naive if we don't foresee a series of billion-dollar law suits in the future around this new practise of cannabis prescription. Just my thoughts and concerns.

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