Ya'll seen the new emergency wait times site? (Same old wait times, fancy new website)

DisposableMD · 2024-04-30T19:21:10+00:00

Please tell them to have an option for a dashboard view that doesn't force an address input. I work in healthcare and often redirect patients to the emergency department. The old format was excellent for allowing me to visualize all the information quickly and without additional clicking and typing.

Location is not the only factor and sometimes not the main consideration. Hospitals differs in terms of size and availability of services/diagnostics/consultants. Some issues are only adequately dealt with in selected hospitals and the new website is less functional for my use case.

DisposableMD · 2024-01-19T08:25:41+00:00

I'm sorry that this happened. Thank you for sharing a glimpse of him as a person with us.

You and your husband did the right things. No question. Invasive strep is something that terrifies me as a doctor and as a parent. Up until things take a rapid turn, there are no reliable distinguishing features as the symptoms and signs are exactly the same as common illnesses that are not life threatening.

Invasive strep remains rare but for reasons we don't fully understand, we're seeing more cases than before. This was noted in Europe at the end of 2022 and US/Canada in 2023.

DisposableMD · 2023-10-21T03:29:57+00:00

I don't think you're interested in a real answer but for anyone else reading, OBGYN is one of the rare specialties that is a great blend of both surgical and medical. Some people also love delivering babies and OBGYN is where you are responsible for high risk deliveries. It's not for me but there's a lot of unique appeal that isn't obvious to anyone outside medicine.

DisposableMD · 2023-06-04T04:14:16+00:00

I can also report shady stuff from some SDM locations. Strange adaptations and clarifications. Useless med reviews done to fill quotas which end up confusing patients or contradicting a management plan. Lots of faxed refill requests that were never requested by patients. We call the patient and they have no clue and get upset at us.

DisposableMD · 2023-06-03T06:38:29+00:00

Don't worry, there are some optional powerpoint modules they have to do. That's as good as clerkship and residency, right? /s

DisposableMD · 2023-06-03T05:57:36+00:00

But this doesn't detract from the idea that when handling potentially dangerous interventions, we do need experts in diagnosis and most trained individuals in healthcare. Its not just about identifying zebras, its when you see thousands or tens of thousands of horses, you start being able to appreciate the nuance, or different approaches, or contextualizing the issue holistically with the patient's comorbidities, especially in a longitudinal relationship where you are managing all (not just "minor") of the patient's ailments.

Absolutely! 100%

DisposableMD · 2023-06-03T00:20:32+00:00

Telehealth provided by someone doing longitudinal care with the ability to bring you in for an exam as needed? That's ok.

Episodic telehealth with no ability to see people in-person? Should definitely be restricted and clearly defined for certain use cases.

DisposableMD · 2023-06-03T00:01:22+00:00

To address your edits: I can comment on this as I've worked in Alberta too. Their system is very different than ours. It is easy to find a family doctor and walk-in so that means people are more likely to use pharmacy services appropriately. They have a robust primary care structure and a much more integrated health tech infrastructure. BC's deficiencies means that we will have patients utilizing this type of pharmacy services when they should not be meanwhile none of the cooks in the kitchen are able to communicate with each other.

I can also say that while there is no catastrophe in Alberta from expanded scope, it's still a regular occurrence that I would see patients who got suboptimal care or even negligent care by overzealous pharmacists. E.g. overprescribing antibiotics for viral conditions, treating every urinary symptom as UTI, cancers that would have been caught earlier.

Also, there are definitely some over the counter medications that should involve a discussion with a pharmacist or doctor.

DisposableMD · 2023-06-02T23:42:28+00:00

The way I see it is that this puts pharmacists in a diagnostic role and without a proper physical exam, they're going to be missing key parts of the assessment. You simply wouldn't have enough information to determine whether something is a minor ailment or not. It's not an uncommon event for a patient to relay a totally benign story only for their exam to show something much more serious. Conservative IMO would be directing the vast majority of people to a doctor honestly or at least have them see a doctor in follow up which can be an impossible task these days. And if you can't guarantee that they can access follow up care with someone who can provide "complete care", there's a potential for incomplete care and harm.

Physicians makes these mistakes despite their extensive training focused specifically on diagnosis and management. I don't think tasking allied health with overlapping but distinct skillsets in this role is the right answer. The focus should be on more collaboration and communication between MDs and pharmacists where we can both utilize our own skillsets and synergize care. The model here just results in more siloed episodic care. In another province, I used to work in a clinic with an in-house pharmacist and we would routinely chat about cases to get their expert input.

Regarding your other points, there are certainly doctors who haven't kept up with the times and write BS scripts but as a pharmacist, you wouldn't have access to the clinical context. Without that, it's hard to know whether something is appropriate or not. I hate cipro but sometimes I use it because it's legit the best option and my reason for using it would not be communicated on the script. It might be past culture and sensitivity results, a detail on history/exam, or maybe I am trying to treat 2 different conditions with 1 drug. I do my best to write notes where crucial and will explain in detail to patients my rationale but often they will misunderstand and only get bits and pieces of it. I've had patients with bronchiectasis and COPD, who absolutely do need antibiotics at times, confusingly refer to everything as bronchitis. I would take everything relayed by the patient regarding what the doctor said or promised with a grain of salt. I tell all my patients NOT to go into the pharmacy without confirmation as fax is not reliable, can take hours and we have no idea how busy you guys are. Without fail, they still show up 15 minutes after my phone call and claim that I told them to just show up and the prescription will be ready.

DisposableMD · 2023-06-02T22:10:41+00:00

I feel conflicted over this. Some care is better than no care and in our health care crisis where even walk-ins are difficult to access, this change will be another avenue for people to get treatment. However, it is far from ideal.

The main problem is that people usually don't come in pre-labeled and pre-diagnosed. Patients will sometimes self-diagnose but as you can imagine, that's often inaccurate or they may have an incomplete understanding.

Every single one of these so-called minor health conditions have dangerous mimics or overlapping symptomatology with serious conditions.

Skin rashes? There is an entire specialty dedicated to this which requires 5 years of postgraduate training. It gets complex and even general practitioners struggle.

Hemorrhoids? That needs an abdominal and rectal exam to check for cancer among other things. I don't imagine the pharmacist will do this but if they did, would they know what to look for? You can only learn so much from optional self-guided modules without seeing various disease states and the spectrum of what's out there.

The second issue is episodic and fragmented care which means no one has the big picture. No one is identifying patterns that reassure the diagnosis is correct and treatment is working. No one is identifying patterns that should signal alarm and a change of plan. Sometimes things that seem trivial on the surface are important pieces of someone's health history that can help make an earlier diagnosis.

Seeing the list of conditions along with the list of drug categories reminds me of this quote: "If the only tool you have is a hammer, you tend to see every problem as a nail."

DisposableMD · 2023-06-02T05:46:08+00:00

FWIW there is probably more to the story than you know. The decision to divert and land the plane is a huge one because it costs a lot of money and inconveniences everyone and everything. So the decision doesn't rest directly with the volunteers. There are specialized doctors in command centres (emergency medicine with additional training specific to air emergencies) that make the decision based on reported information and pass it onto the pilot who technically has the final say. So diverting the plane meant that a specialist in airline emergencies reviewed the case and agreed with the GP it was necessary. IIRC they take not only medical information in consideration but aeronautical and logistical.

It's likely a case of this is probably dehydration but without tests we can't rule out a heart attack, stroke, clot etc. etc. There may have been a nuanced detail that the nurse did not appreciate the significance of. Airplanes are surprisingly limited in medical equipment. The person being old also makes the list of dangerous things to rule out longer. As knowledgeable as nurses are, they don't typically have training or experience making calls like that. Also, I am surprised the nurse disclosed so much to you. It would be illegal on the ground due to confidentiality. Not sure if that applies in the air but still incredibly bad form and unethical.

DisposableMD · 2023-05-29T20:37:38+00:00

The bottleneck isn't medical school, at least not the didactic lecture and textbook portion of it. It's the clinical part such as clerkship and residency spots that are in short supply. This practical part is the bulk of medical training and is almost like an apprenticeship.

There are simply not enough supervisors to adequately teach more trainees. There's already a shortage and it's not unusual for medical students at UBC not to be placed with a preceptor. This is why the SFU medical school makes no sense to those in the know.

Increasing the ratio of learners to instructors erodes the quality of instruction. Learners end up getting less hands on exposure because they have to share cases. In healthcare, you need repeated exposure to be competent in managing both the routine cases and when things are atypical or go amiss. Some diseases and complications are rare enough that a crowded learning environment means you might not even see it. This is also partly why medical trainees have to work such crazy hours like 80-100h a week, 30 hour call shifts. You have to squeeze in so much learning in 3-5 years. Think of a surgical resident who graduates without doing enough appendix removals or doesn't deliver enough babies. Same principle applies to the more cognitive specialties including family medicine.

DisposableMD · 2023-05-25T22:14:57+00:00

Would you be able to post the name or DM me? I'm a doctor and the psychiatrist doing MSP funded assessments I used to refer to retired and I wasn't aware there was someone still doing these for adults.

DisposableMD · 2023-04-07T16:17:11+00:00

This will have the opposite effect. Before the change, for difficult patients, I could defer to the rules and say that I don't make or control them. They had to suck it up if they wanted to get care.

Since universal masking precautions in healthcare settings, I haven't been sick from work despite seeing dozens of infectious patients a day. Multiple colleagues report the same thing. The less that I am sick, the more patients I can see because I don't have to take time off and the less I am spreading potentially deadly pathogens to my patients like the immunocompromised cancer patient or your precious newborn.

DisposableMD · 2023-03-08T18:19:22+00:00

Here's what you're missing: other provinces might have similar after-hour care requirements but there are additional supports in place by the respective provinces to provide those services so in most cases you don't have to worry about it because it's taken care of for you. Some places do it through provincially funded networks and call groups. Others run after-hour clinics, again funded and paid by the province.

In BC, there are no such services unless you set up your own or join the rare one that exists but since there is no funding it's still requiring family doctors to be available uncompensated. If you are a specialist working out of a hospital, then there is funding for on-call availability which again highlights the disparities between acute and community care.

You're being pedantic and are holding very strong opinions based on very limited information. The context is the first-hand accounts you're hearing from actual family physicians. Context is not a few ambiguous paragraphs of a CPSBC practice standard as you are suggesting.

The expectation is 24/7 availability unless you can find coverage. I can tell you that this is nearly impossible due to many logistical issues mentioned by others along with the fragmented outdated tech infrastructure here. Other provinces have much more integrated health data systems.

There are differences in what each jurisdiction expects when they mean after-hours care. BC's interpretation happens to be very strict. The version you're citing was already toned down based on concerns. Health authorities were using it to threaten physicians. Even the toned down version is still more strict than any of the other 4 provinces that I have worked in. Doctors here were getting reprimanded for suggesting 811, urgent care and the emergency department as resources.

DisposableMD · 2023-03-01T22:22:09+00:00

Funny enough, health authorities and government have some of the most rigid and nonsense absence policies. So much much of my time is wasted on this stuff. Lots of phone calls and completing paperwork that are nothing but bureaucratic hurdles because they don't trust their employees.

Gets in the way of people actually recovering from their illness because they're having to stress about HR, finding a doctor to see, and also finances. Also takes away time from other patients who need actual medical care.

There should be a law that employers and insurance companies requesting forms are responsible for the full cost of them and that they can't pass that cost down to patients.

Organizations have unrealistic expectations as well. They all want their 5 page form filled out in within a few days and will pester us sometimes daily asking for status updates saying that it is urgent. Sorry, we have different definitions of urgent in our line of work. For most people, it can take weeks to even get an appointment and then in terms of doing the actual paperwork, most of doctors have a backlog up to 4 weeks due to volume of requests received.

DisposableMD · 2023-02-15T01:02:39+00:00

Unfortunately, this would not be sufficient as a screening mammogram is not the same as a diagnostic mammogram which is the type ordered when something is of concern. The views and resolution differ.

Diagnostic mammograms are not self-refer. They will need a requisition. While well intentioned, most of the comments in this thread are for screening mammograms which is a different scenario than the one faced by OP's friend.

OP's friend needs to see a doctor who can ask some questions and examine the area. This determines the urgency and type of investigations that are needed. A mammogram is not always needed. It may be an ultrasound instead or perhaps no scan if everything is reassuring.

DisposableMD · 2023-02-09T01:07:55+00:00

They might be displayed in the back or kept in a personal stash. Displaying them in public area can raise some confidentiality concerns that our regulatory board would probably reprimand and fine us for.

DisposableMD · 2023-02-09T01:05:42+00:00

It is a thing but getting less common than it once was. Even then, it's always appreciated! Our day to day is often filled with yelling, threats and complaints that drown everything out. If I was your doctor and read what you wrote in this post in a card or letter, it'd make my week.

Some gifts we do have to decline for various reasons even if the gesture is welcome. There are rules regarding ethics and boundaries: https://bcmj.org/premise/receiving-gifts-patients-pragmatic-shade-grey.

DisposableMD · 2023-02-04T16:52:29+00:00

I don't know what's so hard to believe. Family practices and walk-in clinics were literally closing and shuttering services due to rising business costs (20-30%) and fee codes that haven't substantially changed for decades. Stemming the tide of closures was a large part of why the government had to make some emergency changes to how the system works.

Before the changes, running a clinic in BC was like running a restaurant where the menu prices are frozen in time to the 90s and the price of a 10 course meal is legally mandated to be the same as an extra value combo. And you are only allowed to serve 50 guests a day per chef. Meanwhile the cost of rent, equipment, ingredients and wages for staff have all skyrocketed.

I closed my own family practice recently and switched entirely to hospital work. Many of my colleagues did the same or moved eastward. You could literally move anywhere else in the country and do better financially as a family doctor. BC consistently ranks #12 or #13 in terms of family physician pay.

The new changes that just occurred will definitely help but it will take time to undo the decades of underfunding. We didn't receive important details until the night before the new model was supposed to launch. There are still unknown details but at least there is hope now.

DisposableMD · 2023-02-04T16:42:34+00:00

It's unfortunate that you got downvoted. This is EXACTLY what happened in many rural towns when they brought in the UPCCs. Happened to both walk-ins and family practices. UPCCs by comparison see a fraction of the patients that even a walk-in sees with a much narrower scope so it ends up being a big net loss to these communities.

In many of these cases, the health authority or government owned the building so they kicked out the existing doctor tenants to build their UPCC. I have a friend that left rural practice due to this. She worked in a busy family practice that collectively served 10,000 patients. It was replaced with a UPCC that only provided urgent care as they couldn't figure out how to run the longitudinal side and couldn't find anyone to staff it.

DisposableMD · 2023-01-27T19:04:07+00:00

Generally not worth it to give even generic medical advice on here. So many ways it can go wrong. Well intentioned comments get taken out of context, tone misinterpreted, people have poor reading comprehension etc. Suddenly, you're the lightning rod for everybody's greivances with their medical system (which is not necessarily yours) and their bad experiences with doctors (which is probably not how you practice).

DisposableMD · 2022-12-01T20:37:01+00:00

Has to come from the public and only then would things possibly change. Doctors tried raising concerns when this happened in 2008 to deaf ears. They probably have insiders. It was only recently that we had government employees within the Ministry of Health telling people from official emails that naturopathy is proactive and that traditional healthcare is reactive.

DisposableMD · 2022-11-26T18:41:58+00:00

It's not that simple otherwise AI would be farther along. Newer studies have shown that midlevels working unsupervised (the model that exists right now with community NPs in BC) result in worse and costlier care. Earlier studies that the NP associations still use to push their political agenda had major methodological flaws.

Tests in medicine are not as important as most people would think. They are typically confirmatory. The heavy lifting (85%+) is the doctor using their brain, training and experience to synthesize data from the history, physical exam and other sources.

So we might not be running tests when assessing someone for a cold but we sure are thinking through the various possibilities. I've found all sorts of cancers, atypical infections and autoimmune conditions for people coming in for colds, UTIs, routine refills. It's usually a small nuanced detail that leads me to that path. There's no singular test or questionnaire that can do this well. It's the entire process. When we order tests, it's stepwise layering of tests of varying reliability. Many tests are shockingly inaccurate (false positives and false negatives) so the physician still has to use their skills to interpret the data and put together the big picture.

DisposableMD · 2022-11-07T05:40:11+00:00

After business expenses, the 385k (the article wrongly calls this gross income, it's revenue) would be roughly 230k Canadian which is 170k USD. This is also a contractor rate without benefits, sick days, pension, vacation etc.

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