If you can’t hear them, they don’t exist…

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#CanadaWAITS is the new hashtag by Globe & Mail’s health columnist Andre Picard highlighting the peaceful and apologetic Canadians that don’t mind waiting in line for socialized healthcare. Canadians love to wait.

If we see a line, we line up. “What is at the end? Who knows? It’s a line in Canada. We must wait. “

Eight months to see an autism specialist, 4.5 years for a neurologist, 12 years for a family doctor. No worries. I have waited longer.

“Sorry I have been in this line for so long that I lost bladder and bowel function. Let me clean that up. It’s my fault for not being patient enough.”

Ever since Winnie and Hostas picked up those noise cancelling headphones, they reduced their stress and improved their sleep. Healthcare is not an issue anymore. YEAH THE GREAT HOSTAS! No one is complaining. CAN’T HEAR THEM. No one is worried about what the doctors and nurses of the province having been crying about for years. FAT CATS. No one is suffering. NO HASHTAGS.

In fact, we are so lucky we have state covered health care that works very well in emergencies and extreme circumstances that no one cares about the day to day disabilities, the opioid/addiction crisis, and the plague of mental illness, the lost years, the lost productivity, and the lost lives.

If you can’t hear them suffering then their problems don’t exist.

Thank goodness. We have such leadership and empathy in our leaders.

REFERENCE: http://www.huffingtonpost.ca/sohail-gandhi/politicians-ignored-doctors-calls-to-fix-health-care-will-they-listen-to-a-hashtag_a_23266755/

REFERENCE: http://www.huffingtonpost.ca/2017/11/03/canada-doctor-patient-wait-times_a_23266026/

 

 

 

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ONE BIG DEAL

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Finally, after generations of bickering, ballooning debt, and making promises that no government could actually keep, the Minister of Health of this province has done what no other politician has done before. He has created a massive surplus in the annual provincial budget (approximately $75B), will pay off the $288B provincial debt (within 4 years) and, most importantly, turned his greatest opponents to allies in his path to be the province’s next Premier and eventual Prime Minister of Canada.

“I know many politicians have failed in this complex calculation, but I am a Rhodes Scholar. I don’t shy away from making BIG decisions. In fact, I have spent my whole life preparing to take over, sorry, improve the world around me”, the Minister said with a straight face to room full of reporters today. He took no questions.

Many critics cannot understand how giving away the LCBO and marijuana dispensing rights to both the Public Teachers Union and the province’s Medical Association to manage will help the province and not harm his voters. But very few have the intellectual prowess of this star politician.

“There is no way that educators and doctors will compromise their ethics”, the Health Minister said. “So why not give them all the revenues from booze and weed?”

Simply put, his idea is to stop funding health care (approximately $52B) and public education (approximately $26B) starting on July 1, 2017.

“Heck! It’s Canada Day so let’s celebrate!”

The teachers and physicians will collect all the profits for alcohol and marijuana sales moving forward. At present there will need to be some catch up growth since alcohol sales only make less than $2B/year, but we are not selling all the LCBO locations, we are giving it to them, so that needs to be factored in as well. The doctors and teachers in the province may need to work in the LCBO’s in the beginning to get their sales figures up but they are all very hard workers and willing to go the extra mile. They may even co-brand their LCBO’s with their schools and their medical clinics and their hospitals. They may even include these services with house calls or summer school classes. You get a “B” you get a beer. You get an “A” you get an apple brandy. They can charge whatever they want, they can set any rules, they can include it in baby formula, or they can demand that every medicine in the province has alcohol in it. The also get the revenue from liquor licenses. This is a great, great deal for them. The sky is the limit. BUT THEY MUST COMPLETELY FUND HEALTHCARE AND PUBLIC EDUCATION FOR EVERYONE IN THE PROVINCE. Whatever their profit is theirs to split any way they want. Of course, they still need to work part time volunteer hours as teachers and doctors and run all the hospitals and pay for all the tests that everyone wants. Let us be clear, there is going to be little difference from now in regards to the world class quality for education and healthcare in this province BUT THERE IS ONE BIG DIFFERENCE in which doctors and teachers are no longer restricted by government control in their fields WHATSOEVER.

“Look it’s going to be their little business and I am happy for them”, the Health Minister exclaimed with a toothy grin. “I have thrown in the marijuana business as an inducement! Who knows how much potential revenue that could make for them? I just want this to work out for everyone.”

THE NEW DEAL – moving healthcare downstream to the user. Thinking beyond regionalization to personalization

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We will move responsibility of healthcare from the province down to each individual. After graduating high school and reaching the age of adulthood, each citizen of Ontario is responsible for their own healthcare. This novel yet unstudied health care policy will provide timely access to the right person at the right time  and most importantly eliminate all health care providers, all hospitals, all keeping of medical records from the provincial purview.

Our motto: You, our special citizen (voter), will have unfettered access to every healthcare need, every procedure, and every medication you would like.

The patient is the best person to determine what their healthcare needs are.

Imagine the beauty of choosing your own testing, your own diagnosis, your own treatment, your own operation, and your own rehabilitation. No putting up with making appointments. No more putting up with medical jargon that you don’t understand. No more waiting in a waiting room. Your provincial taxes that will only modestly be increased will provide all of the following benefits listed below without charge.

You will be given full access to Google BYOFP (Be Your Own Family Physician) to determine what ails you. And the best news is that there is no charge for this service. No charge for doctor’s notes. No charges for parking at hospitals.

You will receive free access to the Google BYOPH (Be Your Own Pharmacist) and order what you require including dosing, quantity, and length of prescription. It will be delivered free. Why should you not try medications if you think they may help you?

You will have access to Google BYOPA (Be Your Own Paramedic) when you are involved in trauma and trained to start your own IV’s, arrange your own blood transfusions, and defibrillate yourself. Why do you need to be transported to a hospital and then be charged for the ambulance ride?

You will have free access to Google BYOPS (Be Your Own Psychiatrist) for your mental health issues to manage your own electroconvulsive therapy, prescribe your own neuropsychopharmacology, and do your own cognitive behavioural therapy. Why shouldn’t you have the latest medical diagnoses? Hypochondriasis is very hip these days. Your friends have it, why shouldn’t you?

You will have free access to Google BYOS (Be Your Own Surgeon) at surgical kiosks when you need your own screening colonoscopy, or your own brain surgery to shunt extra fluid, or an acute appendectomy. These multispeciality kiosks will be able to perform hangnail surgery to baby delivery to complicated organ transplants. Just read the options carefully prior to the sedation since we cannot offer refunds for a service that is free. These kiosks will be conveniently located at all pharmacies, casinos, gas stations, and liquor stores. Eventually we will have a home unit for your convenience. There will be no charge for using the service. At the same sites we will have blood testing kiosks (who says you cannot check for a rare disease), diagnostic imaging kiosks for x-rays to MRI’s (who says you cannot have an MRI for a stubbed toe), and interventional radiology kiosks (for dealing with coiling of aneurysms).

THE NEW DEAL is all about empowering you, our voter!

Enjoy exceptional personalized healthcare.

KATEY the CEO of the Popsicle stand

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This was Katey’s big chance!

Finally after years of managing the garbage of discarded Popsicle sticks then taping together the stand and then transporting the Popsicles from the corner store, she was in charge! But to really be in charge she needed puppets: people that could stand in front of the Popsicle stand that she could manipulate behind the scenes and they will step aside in times of glory or recognition and blame them when things went bad. Just like the previous CEO!

She chose Debbie to be in charge of the media spin, Ricky to be in charge of the Band-Aids from the splinters in the sticks, Bobbie to maintain the stand, and Charlie to collect the moolah.

She sold away part of the stand to the ice cream man who had real freezers that she thought she could borrow and lower her costs. But he wanted to charge her. She knew the Popsicles could not be kept cold so she let them melt and sold them as room temperature paletas for a higher price. So she sent Debbie out in the neighborhood to convince her customers that melted paletas were better than ice cold ice cream. And to appease the ice cream man she gave him a piece of her earnings. She gave everyone working for her a raise and everyone against her the media razzmatazz using alternative facts to paint them as pariahs.

Ricky had to shut up all the bleeding hearts. They wanted the sticks to be made safely, without splinters, and every time they got hurt they wanted a Band-Aid. What do you think? Band-Aids grow in Ontario?

Bobbie told her repeatedly that the stand was falling apart. “Use more duct tape and be quiet Bobbie”, she would say.

Charlie told her that she was losing moolah everyday. “I don’t care about that!” Katey didn’t listen. She would extract money from the bleeding hearts by charging for Band-Aids, raising the cost of refrigeration, take a fee when allowing the ice cold ice cream to be sold in the nearby grocery stores and compete against the ice cream man, and give all the really poor folk free melted paletas. The key was to concentrate on appearance more than substance.

How do you think she became CEO? Control the message!

It was better to use her old stock than buy new stock. It was better to spend more on advertising than actually investing on the Popsicle stand. She was untouchable. She could upset the customers for 3 years and then woo them all back in the last year before the next CEO vote.They had no long term memories and were easily managed.

Eventually she would have to remove the splinters and hand out Band-Aids. Eventually she would have to actually fix the Popsicle stand with wood and screws. Eventually the customers would realize melted paletas were just warm pop and were worth nothing. Eventually she would run out of money. But when the truth was known, she would be retired. She would be sitting on a golden Popsicle stand somewhere in the Bahamas. Laughing.

Oh this was Katey’s big chance to shine!

OSWALD the LUCKY RABBIT (incumbent) vs. MICKEY MOUSE (upstart)

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Oswald the Lucky Rabbit was the incumbent. He had spent considerable time playing gags, accepting injuries to make others laugh, and being truly entertaining. He was peppy, saucy, and venturesome. He and his girlfriend, Ortensia, were the darlings of the cartoon world. Even Felix the Cat was willing to allow Oswald to be the “leader”. He had done nothing wrong.

But the world was changing around him.

Mickey was an upstart. When he first came out he had no voice, unlike Oswald. He left his girlfriend Minnie at the dock in his second film, not as chivalrous as Oswald. He abused animals and made them play music against their will. Pete and Donald Duck challenged him often. It was debatable whether he would amount to anything.

But the world was changing around him.

Sometimes your skills and talents do not match the needs of your time. Sometimes what you offer is no longer appreciated. Sometimes being a leader requires you to step down and let others lead.

Oswald allowed Mickey to become the king of the cartoon world.

Was this the right thing to do?

Alternative Facts:Translating Trumpian Tales of True Talent

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We have gone through so many true leaders in Health Care over the years. I look back fondly at how things have progressed…

Furious George was an “attack poodle” that started the Wait Times Strategy and Aging at Home. His plan was to help ensure that there was a reduction in the wait time to age in your own home. He reduced the time from 315 days to get home health care services to 309 days. Progress!

Heavy David the Smoker took over and ensured that Smart Systems were developed to spend health care dollars on everything but patients. Why would you spend it on patients? There was money for office renovations, Tic Tacs, and long liquid lunches. Heaven on earth!

Then then Mean Grandmother took over. Boy was she smart with her big Doctorate and big ideas! She was integral to ensuring that we had big flying ORANGE ambulances that paid big directors to stay home and not be listed on the sunshine list. Totally defensible!

But I saved the best for last: Rhodes Scholar. Order of Canada. A Saviour to children in Africa. A member of the brotherhood and sisterhood. Angry Red was the answer to all of our prayers! He wanted to be in charge of everything in the health care system. Why would you want anyone else to help when you can do everything on your own? He is auditing all doctors salaries, he is in charge of all home care services, he is in charge of disciplining all doctors, he is in charge of all office hours, all sick leave, and is able to look into every patient chart in the province. Wow, that guy is truly a hard worker. Too bad everyone is so jealous of his good looks and credentials.

I wonder how things could possibly improve given our awesome ranking on the OECD health care indices.

The Liberalist Manifesto (the 41st bill) by Eric Marxkins and Kathrich Wyngels

Image result for communist manifesto bookPREAMBLE. Five percent of our patient’s use over 50% of our health care dollars. Every year with patients being treated, immigrants and international refugees moving into our region, and more life saving treatments, this is leading to unacceptable increases in healthcare utilization of 5% per year. We need to lower costs by 5% every year.

MANIFESTO. Now that we have Medical Assistance in Dying and are able to cull the high users of the health care system, WE, the Liberalist Party, will improve the health care system by creating a policing system of doctors using the following principles:

  1. The Minister needs to read all patient’s charts to understand what patients and doctors are doing in those little rooms. It will take time but he is curious about how to actually practice medicine.
  2. The Minister needs to audit doctors’ hours, sick leave, washroom and meal breaks, and so on. If he finds doctors working less than 23hours/day, he will have to demoralize them.
  3. The Minister needs to investigate clinical care and performance standards of each and every doctor though our quasi –scientific organization “Health Quality”. Expensive patient care will be penalized.

COROLLARY. Now is the time to stop doctors from being in charge of patient’s health. Why would you want a system that empowers doctors, who listen to patients and are trained in empathy, to make the hard decisions about spending our limited health care dollars?

They are not economists!       

They are not healthcare managers!         

They are not us!

Minister’s New Recipe – Pablum!

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The highly partisan, highly educated and highly sharp suited Minister complains to the media regarding the impasse in getting a deal with doctors in the province. “This is not a failure of government!” he screeches for all to hear.

The problem in the Minister’s estimation is that Doctors work too long hours, they help keep too many patients alive and well, they subsidize the health care system with their own money, they work more efficiently than any other doctor group in Canada, they hire too many people and invest in the economy, they actually talk to patients every day (his voters) and patients trust doctors, they continue to work AND fight the government instead of going on strike (which would really help the government’s cause), and they are united together against imperial intimidation.

The highly entitled, highly degreed, and highly decorated Minister cannot understand why the slightly less hard-working and slightly less educated professionals that used to be his colleagues just cannot accept the Pablum he is offering them. It’s nourishing and easy to digest. Who needs flavour?

​Walley’s Master Plan Reaches Final Stage

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For months now, doctors have been confused by OMA President Virginia Walley’s oscillating convictions. She started her term demanding binding arbitration, then allowed that to lapse in negotiations; she extolled a deal she deemed the best doctors could get, and now insists that they can do better. For those in the know, there’s a method to this madness. As insiders report, everything that has happened was part of her 3-step plan:

1) Convince the government she is on their side, pretending to sell the government’s most outrageous demands to her constituents.

2) Resoundingly lose a vote of confidence, as well as her negotiating team, legal counsel, and media consultants.

3) Tell the government what she wanted from the start – that a fair deal with binding arbitration isn’t optional.

While some may question her for bothering with steps 1 and 2, we should all be thankful that the government has fallen for her ruse. I look forward to them being bound by the favour Walley has accrued.

We Can Do Better

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This afternoon, a brave young medical student raised a concern about established doctors belittling younger OMA members for their inexperience. His gripe is perfectly legitimate: no matter what side of this debate you fall on, our goal should be to persuade each other, not berate others into submission. Some medical students have read the tPSA and supporting documentation, and have come to informed conclusions no less valuable than those of doctors. Meanwhile, there are both students and doctors who pretend to understand everything about the topic because they read a 1-page summary from a clearly-biased party (on either side). The reality is that this debate invokes major medical, legal, economic, social, and political issues, which very few of us (students or doctors) spend the time really analyzing. So to bemoan any group for being inherently unaware is both unfair and untrue. And we should strive to build each other up, not tear each other down. But what do I know? Apparently, I shouldn’t have gotten into medical school.