The patent on OxyContin has run out, the expected profit gone. Is it a coincidence that Purdue has stopped making it and replaced it with the new and improved OxyNEO? If Purdue can get Canadian doctors to prescribe it, their profits will continue. In a recent edition of the Medical Post, an industry-funded newspaper which goes …
We struggle in health care now as much with the system as we do with patient care. Fiscal pressures, mounting demands for treatment, new innovative treatments – all form an ever increasing set of expectations of and by patients, funders, and providers alike. We are being challenged to be more productive. To do more with …
Concerns about quality and a fire at a Sandoz plant in Quebec exacerbated the current drug shortage in Canada. Many are asking why the shutdown of a single facility could threaten the nation’s supply of vital prescription medications. While federal and provincial governments have been eager to play the blame game, a shared sense of …
Ontario’s Minister of Health is promising that people will soon have more timely access to their family physicians. The province’s 200 family health teams will come under the control of Ontario’s 14 local health integration networks (LHINs), the regional authorities that currently oversee the system. The goal is to give citizens speedier access to primary …
On February 8th 2012, the Ontario Ministry of Health and Long Term Care issued an Action Plan for Health Care, subtitled “Better patient care through better value from our health care dollars.” On page 7 of the document the Ministry says “Our Plan is obsessively patient-centred.” The document explains this term by saying that Ontarians …
Ontario recently announced funding for two birth centres that will be led by midwives. The government has indicated it is opening birth centres partly to move care out of hospitals and save money. Although birth centres are probably safe and may improve maternity care, it is less clear whether Ontario’s birth centres will indeed reduce …
The Ontario government recently tabled a budget which included a two year wage freeze for all public sector employees. This announcement has frustrated some Ontario nurse practitioners, many of whom have not had a wage increase for several years – despite increased responsibilities and significantly enhanced scope of practice. In Ontario, hospital-based NPs generally earn …
In Canada, doctors’ associations regularly incorporate new evidence about medications into clinical practice guidelines that are intended to influence patient care. The Ontario Ministry of Health and Long-Term Care reviews the same evidence to decide which medications it will pay for, and often comes to different conclusions. This results in doctors recommending medications which are …
The statistics are well known: 7-10% of hospitalizations include at least one “adverse event”, a broad definition including a variety of mishaps ranging in impact from the relatively benign to a lethal outcome. Health care systems have been late adopters of proactive policies in the area of patient safety. This delay can be partly attributed …
In an old episode of the Simpsons, Homer walks into a car lot and announces how much money he has to spend. After, a highly gratified dealer quickly inverts a 6 into a 9, a deal is made and off Homer goes to face further mishaps. This scene clearly illustrates how a consumer will always …
In the last decade, efforts to improve access to primary care in Ontario have led to major changes to how family doctors practice and are paid. A recent report suggests that these newer models of primary care are not meeting the needs of vulnerable populations, and that Community Health Centres (an older model of care) do …
I applaud Helen Walsh for her recent post about walking away from yet more invasive testing. Her post made me reflect on recent cases of medical expense from my own practice. Patient details have been altered to protect their identities. One patient has an annoying condition that gives him pain with some activities, related to …
I’ve been reading a new book called Oppression: A Social Determinant of Health, edited by Elizabeth McGibbon. The book raises the question of why we continue to have such vast health inequities in Canada, despite the volume of evidence pointing to the large role played by the social determinants of health in causing illness and …
My friend Ron is an energetic seventy-year-old who is diabetic. We live in northwestern Ontario, in a town called Kenora, two hundred kilometers east of Winnipeg, Manitoba. Ron’s life has just been complicated by the fact that his family doctor moved away recently. Why is this a particular complication for him? Because the lab in …
Alberta is introducing Strategic Clinical Networks in areas such as mental health and addictions, cancer care, diabetes, obesity and nutrition. These networks are meant to lead clinical practices province-wide, and improve the quality of care, outcomes and costs of health care services. This is an ambitious undertaking which may contain some lessons for Ontario. Alberta’s …
“A 41 year-old woman with no documented medical history or family history of disease presents to you complaining of occasional chest pains on exertion. How many would order a stress test to rule-out cardiovascular disease?” asks Dr. Gary Bloch, to a captivated audience of resident physicians currently in training at an academic learning day – …
The Drummond Report recommended no increase in total compensation for Ontario’s doctors. A number of factors affect how much Ontario pays doctors including the number of doctors in practice, how many patients they see, and how much they are paid for each service. Achieving zero growth would require difficult decisions and trade-offs. The February 2012 …
March 8th, 2012 marked the 101st annual celebration of International Women’s Day. Originally conceived in Europe in 1911 to draw attention to the struggle for women’s equal participation in society, IWD has become both a day of celebration and an opportunity to highlight the progress still needed to achieve women’s equality. Certainly, great gains have …
Health Apps will be “prescribed” by clinicians for their patients in the near future. This article tries to sketch out how this “TechRx” and “Apps Pharmacy” process could/should develop. According to a recent report from Healthcare Information Management Systems Society, there are about 17,000 healthcare apps currently in use. This compares to a reported 300,000 …
Almost a decade ago, in my mid thirties, a routine physical showed elevated liver enzymes. Follow-up tests three months later showed them rising. My doctor was diligent, and referred me to the liver clinic at Toronto Western Hospital. What followed was a year-long series of interventions, which at first were benign – lose ten pounds …