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Posts Tagged "medical"

3Jul

Maple Ridge medical marijuana patient fighting her strata’s no-smoking bylaw

by admin

Tammy Gadsby credits medical marijuana for ending her use of serious pharmaceuticals that included a tranquilizer and an opioid.

With marijuana, the 60-year-old Maple Ridge resident said she has been able to better manage her fibromyalgia, depression, anxiety and PTSD than with any other drugs she has tried. Inhaling marijuana produces nearly immediate relief and also helps keep up her appetite, she said.

But smoking the drug now has Gadsby afoul of a recently passed strata bylaw in her condominium development that she said prohibits any smoking or vaping of any substance anywhere on the property. Many strata councils around B.C. have adopted similar bylaws late last year in anticipation of the legalization of recreational marijuana.

Gadsby said her strata has not granted her an exception to the rule, even though she says she holds a family physician-provided prescription and has been a medical marijuana user since 2015. And for Gadsby, it’s a serious enough matter that she said she plans to take it to the B.C. Human Rights Tribunal.

“I gave up three prescription medications and just use medical cannabis now,” Gadsby said. “This is the best thing I’ve ever found to deal with all the different issues that I do deal with.”

Grant Inglis, the head of the strata council, said the council — through its lawyer — had requested additional information from Gadsby so that it could make a fair and informed decision about her request for an exemption from the bylaw on medical grounds. To date that information had not been received, he said.

Earlier this month, Eric Mollema, a lawyer representing the strata, sent a letter to a lawyer for Gadsby stating that the strata corporation was obliged to consider exempting her from the bylaw, but that it did require documents first.


‘I gave up three prescription medications and just use medical cannabis now,’ says Tammy Gadsby. ‘This is the best thing I’ve ever found to deal with all the different issues that I do deal with.’

Francis Georgian /

PNG

That included written confirmation from a board-certified medical practitioner that Gadsby had a marijuana prescription and that detailed her medical conditions, explained why “traditional medicines” are contraindicative to those conditions and stated why smoking marijuana is the preferred dosing method.

Mollema said he could not comment on the ongoing matter.

For Gadsby, asking for that extent of personal medical information goes too far.

“It goes to a strata. These people are not a medical panel by any means … they are individuals that live in the strata. And you want me to provide you with all of my medical background?”

Paul Mendes, a lawyer who mainly represents strata corporations but who has also represented individual owners, said he could not speak to the specifics of the case. But he said conflicts over no-smoking bylaws can turn into human rights issues.

“For this to be a human rights issue, the owner has to establish that she has a disability. And once she satisfies the strata that she has a disability, the strata then has a duty to accommodate her disability to the point of an undue hardship on the strata.”

In the case of marijuana smoking, the main problem tends to be smell, Mendes said. One thing the strata can consider in such cases is asking an owner to consider vaping or taking edibles rather than smoking combustibles. But if a strata takes the position that there is no way to accommodate, “then it is really a human rights matter,” he said.

What the Human Rights Tribunal would look at is whether the bylaw adversely affects the property owner’s disability. If they have evidence they use medical marijuana for that disability, it would be hard to argue that a zero tolerance policy does not adversely affect them, Mendes said. 

“It’s not a slam dunk for either side on this. It’s really going to depend on the evidence,” he said.

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28Mar

Some medical waits shrink, but B.C. still has long waits compared to several other provinces

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Health Minister Adrian Dix tours a hip and knee program replacement program on Vancouver Island last year.


Don Craig | B.C. Government / PNG

B.C. performs worse than several other provinces when it comes to meeting recommended waiting times for various medical procedures, including cancer radiation therapy, a federal report released today shows.

Benchmarks are defined as “evidence-based goals each province or territory strives to meet.” They reflect the maximum waiting time that medical experts consider appropriate to wait for a particular procedure.

The Canadian Institute for Health Information report shows that while there are glimmers of improvement in some categories, B.C. generally lags behind a handful of other provinces.

For hip replacements, for example, 67 per cent of patients got their surgery in B.C. within the recommended six months in 2018, compared to 61 per cent in 2016. The national average in 2018, however, was 75 per cent. And in Ontario, 84 per cent of patients got surgery within the time period; in Quebec, 80 per cent.

Long waiting times are generally a function of operating rooms being available for surgeons and other resources like funding, hospital beds, nurses for the operating rooms, recovery and ward beds.

For knee replacements, 59 per cent of B.C. residents got the surgery within the six-month recommended time. That was an improvement over 47 per cent in 2016, but again, lower than the national average of 69 per cent.

For cataract surgery, 64 per cent of B.C. residents got the cataract removal procedure within the recommended wait of four months for high-risk patients. That was slightly worse than in 2016 when it was 66 per cent of patients. The federal average in 2018 was 70 per cent.

For procedures that are especially time-sensitive, B.C. was near the bottom.

For hip fracture repairs, it is recommended that patients wait no longer than 48 hours. In 2018, 85 per cent of B.C. patients got surgery within the recommended time; the national statistic was 88 per cent.  Alberta was tops at 94 per cent meeting the benchmark. Only Saskatchewan and Prince Edward Island had longer waiting times than B.C. on this measure.

On radiation therapy, B.C. had the worst ranking with 93 per cent of patients getting treatment within the benchmark of 28 days. The other provinces reported that 95 to 100 per cent of patients were treated within 28 days.

The B.C. Health ministry says on its website that the number of patients waiting for radiation in 2017/18 rose to a high of 467 and the number of cancer patients who got radiation therapy in 2017 declined substantially to 10,663, from about 13,000 from 2015. It is unclear if far fewer patients required radiation or whether B.C. Cancer can’t offer it to as many patients as in prior years.

In an emailed statement, Health Minister Adrian Dix said the report shows B.C. is on “the right track” to improving surgical care, especially for case types that have the longest waiting times.

“We are seeing improvements throughout the health authorities. For example, Island Health’s rate for hip replacements within the benchmark went from 45 per cent in 2016 to 49 per cent in 2017 and 66 per cent in 2018. The rate for knee replacements was even more stunning: In 2016, 29 per cent; in 2017, 32 per cent and in 2018, 57 per cent.

“We know there is more work to do (and) our surgical and diagnostic strategy is not a one-time effort. It is a multi-year plan that is supported with ongoing targeted funding of $75 million starting in 2018-19, and increasing to $100 million in 2019-20,” Dix said, noting that targeted funding should ensure that other surgeries, besides the ones benchmarked, don’t fall behind.

Bacchus Barua, associate director of health policy studies at the conservative think-tank, Fraser Institute, said the CIHI reports shows that many British Columbians still do not receive their treatments within “remarkably long pan-Canadian benchmarks.

“Our own annual survey of waiting times reveals that while the total wait time (between referral from a family doctor to treatment) across 12 specialties has fallen in B.C. between 2016 and 2018, last year’s 23.2-week median wait is nevertheless more than twice as long as the 10.4 week wait time in 1993.

“Wait times are not benign inconveniences. They can, and do, have a real impact on patients’ lives,” he said.

 

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13Mar

Private medical clinics get year-long reprieve as Victoria delays medicare amendment

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Dr Brian Day says Day said the fact that the cabinet order was passed was proof the medicare amendment was unnecessary in the first place.


Nick Procaylo / PNG

Private diagnostic and surgical clinics have won another reprieve, this time from their nemesis — the provincial government, which would prefer to see them shut down.

It means that doctors providing care to patients seeking expedited treatment at private clinics across B.C. can continue doing so for at least for another year, as long as they don’t double bill both the government and patients.

The government has put off bringing into force a Medicare Protection Act amendment that would have harshly penalized doctors who provided expedited care to patients in private clinics. The decision was in the form of an NDP cabinet order and there was no press release announcing the decision.

The amendment — which allowed for fines and even criminal fraud charges — were supposed to take effect last October and could have forced dozens of clinics to close.

But surgery clinics won an injunction in November that effectively ordered the government not to enforce the amendment until after the marathon trial over medicare that began three years ago, initiated by lead plaintiff Dr. Brian Day, is over sometime this year or next.

The government tried, but was denied, to get leave to appeal the injunction two months ago.

Since the injunction dealt only with private surgery clinics, it left diagnostic clinics offering private MRI, CT and PET scan imaging out. The government had said that on April 1, diagnostic clinics would have to comply with the act.

Dennis Hummerston, senior director of Canada Diagnostic Centre, said diagnostic clinics were planning their own injunction application but then got word about the cabinet order.

The amendment is now scheduled to take effect on March 31, 2020, which means private facilities have at least another year in business. The clinics have always disputed the rationale for “draconian” fines and penalties and maintained the legislation would force them out of business.

Hummerston said he’s not aware of any clinics that have gone out of business but said some have lost administrative staff, technologists and radiologists due to the legal uncertainty.

Stephen May, a spokesman for the Ministry of Health, said the government changed the date when the Act will take effect because of the medicare trial and the injunction.

“Consistent with the court’s decision to grant an injunction in a similar case, section 18.1 of the Medicare Protection Act will not come in to force until March 31, 2020 — after the expected completion of the Cambie Surgeries trial. This decision respects the court’s prior decision. … (But) we are committed to stop extra billing.”

May said the government has put an additional $11 million into magnetic resonance imaging in the public system to reach a total of 225,000 MRIs in 2018-19.

“This is approximately 35,000 more MRI exams than the previous year. We are ahead of these targets with hundreds of more operating hours added across the province and more MRI machines running 24/7 than ever,” he said.

Day said the fact that the cabinet order was passed was proof the amendment was unnecessary in the first place.

“The action confirms that there is, and never has been, any health-related rationale for pursuing these amendments. They were merely aimed at prohibiting patients from accessing private options to care for themselves, especially when the actions were taken during the course of a trial aimed at discovering the legality of those prohibitions. It is a perfect example of ideology taking precedence over reason and logic, not to mention ideology trumping the rights of suffering patients.”

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28Feb

Daphne Bramham: First Nations’ solution to a modern, medical crisis

by admin

Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.

First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.

Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.

They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.

It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.

“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.

What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”


Dr. Evan Adams is the Chief Medical Officer for the First Nations Health Authority.

Jason Payne /

PNG

“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”

Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.

“They need healers who can do ceremony. Maybe they need love. They need justice.

“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.

The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.

“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”

It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.

Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.


The Crosstown Clinic in downtown Vancouver.

JONATHAN HAYWARD /

THE CANADIAN PRESS

“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”

To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.

“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”

What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.

Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.

That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.

This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.

With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.

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Twitter: @bramham_daphne


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20Feb

Task force set up to tackle sexual harassment at UBC medical school

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UBC medical students are being sexually harassed more often than students in other Canadian medical schools, according to a new report.

An internal memo written by Dr. Andrea Townson, acting co-head of the UBC department of medicine, and sent to medical faculty at the University of British Columbia, refers to the “deeply concerning” results from a 2018 questionnaire of students who graduated from the 17 medical schools across Canada. Sexual remarks, uninvited touching and sexual assault are examples of harassment.

• Twelve per cent of students at UBC reported unwanted sexual advances and touching by faculty, fellow students, health professionals or patients, compared to a national average of 6.5 per cent.

• Thirty-three per cent of students at UBC said they were subjected to offensive sexist remarks, compared to the national average of 25 per cent.

• A third of UBC medical students also said they were subjected to racially offensive remarks, compared to the Canadian average of 12 per cent.

“We aren’t unique or isolated with these concerns but we are obviously not happy to see these high reported rates so it’s launched a number of different initiatives,” said Dr. Deborah Money, executive vice dean of the UBC medical school.

UBC results from the annual report have been “steady” over the past number of years, according to Money.

Money is chairing a dean’s task force meant to find ways to change the culture and environment at the medical school and to prevent mistreatment and harassment at the more than 80 training sites where UBC medical students learn, such as hospitals and clinics.

“Part of our work has to focus on learning from others, so we know what best practices look like.”

Sixty per cent of UBC medical graduates said they had been publicly humiliated. This may include being asked a question by a professor in a group setting, not knowing the answer and feeling shame about it because of, for example, how the instructor reacted.

This raises the question of whether students are becoming more sensitive to these kinds of learning tools.

“That’s a tough question. It’s an old style of teaching and how it’s done or how it’s perceived may be different in each scenario. We have actually made a video that tries to distinguish between being challenged academically and being bullied or called out so much that people feel humiliated,” she said.

Money said staff have collected data on the reported incidents of public humiliation, racially or sexually offensive remarks and unwanted sexual advances experienced by students.

Townson told clinical faculty members in the memo obtained by Postmedia that if they are concerned they’ve made a comment that might have been misinterpreted and want “a safe place to debrief” they should come and speak to her.

She said in the memo that “addressing student mistreatment” is a priority and students need a clear mechanism for reporting concerns. UBC has several satellite sites — Vancouver, Victoria, Kelowna and Prince George — where undergraduate students learn and Townson said in her memo that the disturbing reports are “not isolated to a single site or a single rotation.”

Money said there are about 700 professors in the medical school and about 7,000 clinical instructors. When students complain about a particular instructor or fellow student, an investigation is launched to determine whether coaching or discipline is required. Money said she couldn’t say how often that occurs but said expulsion is “rare and extreme.”

The survey of medical school graduates in Canada covers a broad range of topics about the quality of education and student experience and has been conducted annually by the Association of Faculties of Medicine of Canada since 2015.

UBC is the fifth largest medical school in North America with 288 students admitted each year, and 4,500 students doing residencies and other postgraduate work.

At the same time as UBC is grappling with the mistreatment issue, the Lancet has published the results of an alarming survey showing that sexual harassment — by patients, teachers and peers of medical students — is common in Canada.

The study by researchers in Ontario and Alberta shows that despite policies and complaint mechanisms intended to promote respectful conduct and to prevent harassment, students are subjected to everything from sexist remarks to rape. A total of 807 incidents were reported by 188 respondents to the 2016 anonymous survey. The harassment occurred in clinics, medical schools and social settings; patients requested medical students touch their sexual organs and they groped doctors. One student said she was raped by a fellow student. Faculty members were implicated in about 20 per cent of the incidents that were predominately experienced by female students. Men were the most frequent perpetrators.

The authors say that faculty, peers and victims come to almost normalize sexual harassment. Students try their best to ignore it while at the same time finding it “confusing, upsetting and embarrassing.”

Many don’t report it because staying silent is seen as “less risky than confrontation or official reporting.”

Dr. Susan Phillips, a professor at Queen’s University and co-author of the Lancet study, said it is clear that women who are practising doctors or studying to become doctors are not immune to harassment and sexual assault.

“This is a societal problem. And we have to find ways to decrease the incidence,” said Phillips, who several years ago published a study in the New England Journal of Medicine showing that 78 per cent of female doctors had been harassed by inappropriate comments or conduct by patients.

“Medical schools can’t fix societal problems but they can do more to legitimize student concerns. That means if they hear about a patient or faculty member making inappropriate comments, they don’t let it go. There has to be zero tolerance and in the case of faculty members, it has to be enforced.”

One limitation of the Lancet study is that few medical students completed the survey. There are about 11,600 medical students across Canada and just under 300 completed the consent form to submit answers to the anonymous survey.

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31Jan

Chief medical health officer shares plan to stop Vancouver drug deaths

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Judy Darcy, B.C.’s minister of mental health and addictions (left), with Dr. Patricia Daly, the chief medical health officer at Vancouver Coastal Health, at the Lookout Housing and Health Society facility on Powell Street in Vancouver.


Jason Payne / PNG

Vancouver Coastal Health’s chief medical officer is urging health authorities to make it easier for people to start and stay on treatments for addictions as a way to spare lives during B.C.’s continuing overdose crisis.

Dr. Patricia Daly presented an update on the crisis at a public board meeting Wednesday that included four recommendations. She wants the health authority to implement treatment standards and monitor outcomes for patients’ addictions care, expand access to “opioid-agonist therapies” such as Suboxone and methadone, establish a safe and regulated supply of drugs, and expand addiction-prevention programs.

Daly’s first recommendation is to ensure that people who begin treatments for opioid addiction don’t slip through the cracks over time. She said residential treatment centres should have a standard of care and keep track of patients’ treatments.

“When we start people on treatment for their opioid addiction, they’re not retained on treatment in the long-term. So we need to have a system that will really track people over the long-term, including when they go into detox and recovery,” Daly told Postmedia. “There are people who are dying who just left detox and recovery because they’re not put on opioid-agonist therapy or being maintained on it.”

Daly wants it to be easier for people to access treatment in the first place. Many aren’t wiling to go to visit a clinic to begin opioid-agonist therapies, so the health authority needs to consider dispensing such treatments from emergency departments, and working with pharmacists to make it easier for people to access methadone, including at multiple pharmacies, Daly said.

People who are subsequently hospitalized or jailed must not miss doses of those treatments and risk relapse, she added.

Despite the expansion of harm-reduction measures such as naloxone and overdose-prevention sites, people are still dying from a fentanyl-poisoned street drug supply, which is why Daly is recommending a safer supply for people when other treatments fail.

Made with Flourish

She pointed to four sites offering injectable therapies, including a pilot program run by Dr. Christy Sutherland of the Portland Hotel Society which has started more than 300 people on injectable hydromorphone since 2016, and which in January introduced a tablet version of the drug for 50 new participants to crush and inject under observation.

The B.C. Centre for Disease Control has been planning for a similar pilot program that allows participants to take the pills with them, which Daly said is important for people who struggle to make multiple daily visits for supervised injection.

“I think we have to acknowledge that we’re in this crisis because of what’s happened to the illegal drug supply, and people are going to consume illegal substances,” she said. “We have to do everything we can to reduce the risk of people developing substance-use disorder, providing evidence-based treatments.”

Ensuring access to stimulants should be a next step, Daly added.

According to her report, 39 per cent of people who died of an overdose in Vancouver in 2017 used opioids daily, but another 19 per cent drank alcohol daily, 12 per cent used stimulants daily, and 18 per cent used both alcohol and stimulants daily.

Finally, Daly wants to see expanded addiction-prevention programs for youth, people living with chronic pain and First Nations people, who are five times more likely than non-First Nations people to experience an overdose, and three times more likely to die.

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4Jan

Memoir of a medical rebel: A conversation with Dr. Michael Klein

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Vancouver-based medical maverick Dr. Michael Klein has released an autobiography, Dissident Doctor: Catching Babies and Challenging the Medical Status Quo, describing his five decades in medicine.

Klein graduated from medical school at Stanford University in 1966, doing practical training in pediatrics and maternity care in Mexico and Ethiopia, before fleeing to Montreal with his wife Bonnie Sherr Klein to avoid being drafted in the Vietnam War.  

After heading the department of family medicine at McGill University for 17 years, Klein was appointed head of the department of family practice at B.C. Children’s and Women’s Hospital where he remained for 10 years. He is known for his advocacy of midwifery and doulas, of family-friendly birthing practices and groundbreaking research that helped reduce unnecessary episiotomies and epidurals, all of which led to critical rethinks on unnecessary medical interventions during childbirth. 

His family includes highly accomplished son Seth, until recently, the director of the Canadian Centre for Policy Alternatives, and daughter Naomi, a high profile social activist and author. Klein also has a daughter, Misha, from a first marriage.

Klein, who is semi-retired but still teaches at UBC, recently chatted with Postmedia News. The interview has been condensed and edited.


Dr. Michael Klein examining a baby. Klein is semi-retired but still teaches at UBC.

PNG

Q: You’ve had a long career in medicine and the book has a lot of detail. I’m assuming you’ve kept a journal all these decades?

A: Actually, I have never kept a diary, everything in the book is straight from my memory. Certain things I never forget. Basically, I remember every birth I’ve attended and there have been a few thousand.

Q: The title of your book is perfectly appropriate since you’ve always bucked the status quo. You have been, for 50 years, an agitator, a feisty iconoclast, a maverick, a nonconformist; of course everything we want our medical leaders to be!

A: That’s nice of you to say, I take it as a compliment. The title was chosen by the publisher. Mine would have been “The Making of a Radical Physician.”

Q: You call yourself a red diaper baby.

A: I don’t know who coined the term, but basically it refers to children of left wingers from the pre-McCarthy period.

Q: You were already a political activist by the age of three, actually living in a protest tent city in Los Angeles, participating in political rallies. 

A: Of course I have no memory of these things, like “scab” being the first word I said. They are family stories.

Q: You write in the book that Vietnam was a “bogus, illegal, immoral, unwinnable war” and you were willing to go to jail rather than serve.  In 1967, just when Montreal was hosting Expo, you became a draft dodger and moved to Montreal with your new wife. There was a measles outbreak just when you got there and the vaccine to prevent it was made by Dow chemicals, the manufacturer of Napalm.

A: That’s one of many ironies in the book. In Quebec at the time, the government supported its own vaccine producer and it wasn’t ready yet. Children were really being damaged by measles, so rather than wait for the government to develop its own vaccine, I got my hands on the Dow product. It was a necessary compromise with my principals.  

Q: And now we routinely have infectious disease outbreaks because of parents who refuse to vaccinate their kids based on religious reasons or hocus-pocus studies. 

A: Well, its ongoing. In the Fraser Valley, we have communities that refuse to immunize their children so of course we have outbreaks of measles and mumps in places where it shouldn’t happen. That debate among vaccine deniers is not going to go away soon. People think of it as a personal right as opposed to collective rights. The public needs to recognize these diseases are not benign.

Q: When I became the medical/health reporter in 1996, one of the first controversies I heard about had to do with you. You were making waves at B.C. Women’s Hospital to bring midwifery into the fold. Other doctors were aghast. You had also just handed out envelopes to each doctor with information inside showing their personal rates of episiotomy, labour induction, C-sections, etc. I recall it didn’t go over well with some. 

A: I arrived in Vancouver in 1993. In Montreal, I had worked with midwives when it was being implemented and I felt they could make a contribution. There was an absolute need to be focused not on what doctors needed but what women and the public needed. I was asked by B.C. Women’s to support the development of legalized midwifery. There was a need for all midwifery births to be attended by a licensed physician so there was a group of family doctors I put together who attended all these births. Obstetricians were tired of the role (supervising midwives), some felt it was beneath them, so they wanted family doctors to take it on. Eventually, it became redundant for us (family doctors) to be present too. Observations and evidence showed the midwives were quite skilled.

Q: The payment model for midwives really offended doctors. It’s tricky when you have to piss off colleagues. Your skin only got thicker, I suppose.

A: You’re not kidding! The family doctors were especially threatened because of the way midwifery was implemented. When the NDP government rolled it out, they did it in a way that was guaranteed to cause conflict. They failed to explain all the differences in the fee payment models. The midwives weren’t being overpaid, they were being differently paid but none of this was adequately explained. So it was a prescription for conflict when it was rolled out by the government. And today, there are lingering aspects of this which is unfortunate. But in some cases, midwives and doctors are collaborating, pooling their incomes. It’s experimental but its exciting. And everyone is doing this with a lot of goodwill.

Q: There’s a scene in the TV series, The Crown, when Queen Elizabeth is delivering a baby in 1960, and she’s knocked out for the whole thing. Is this how it worked? Doctors pulled babies out of heavily sedated women who couldn’t push?

A: The uterus is a pretty clever organ in the way it contracts on its own. But what was happening up to the end of the 1950s was that women were given twilight sedation so they couldn’t feel or remember a damn thing. They got episiotomies and doctors used forceps routinely.

Q: B.C. is known as the C-section capital of Canada

A: There is a false belief that C-sections are safer, that childbirth is an opportunity for things to go wrong as opposed to being a transformative experience. That women are unexploded bombs. Some Asians and certain women from the Middle East have been exposed to mythologies about what a vagina is for: it serves one purpose only and not for babies. Those macho cultures tend to have higher C-section rates.

Q: You’ve been very outspoken in your support of the provincial governments position against private surgery clinics. You say Canada’s health care system is drifting towards the American model and the private provision of medical care must be stamped out. Why do folks on the left always stoke fears about the American system? All the European countries — including the ones that consistently rank at the top in terms of health care systems — have private options as well.

A: You’re right. It may be a sensational tactic, but at the same time we know we’re vulnerable to American multinational health care companies that are ready to come here. The only good thing about the Canadian system is it is a little bit better than the American system because we cover our whole population. But we don’t actually have a health system, we have a payment system for medical services. In France, New Zealand, Australia and the Scandinavian countries they have a fully organized system to deliver health care.

Q: You’ve had surgery yourself in a private clinic?

A: Across the street from St. Paul’s Hospital is an orthopedic surgery centre. I had shoulder surgery there (but) I paid nothing. The government (health authority) negotiated the rate (through a contract). It works fine, I don’t have a problem with these public pay, private delivery models. It provides extra operating room time. My difficulty is with private pay, private delivery. We all know that if the government put more money into keeping operating rooms open and supporting necessary nurses and surgeons, private surgery centres would be diminished substantially, or even vanish. This is a political decision about how much money to put into the public system.

Q: Pro-medicare folks sometimes sound hypocritical when they criticize private clinics and the individuals who use them. You ignore the long waiting times. You portray people who use private surgery clinics as rich but I interview these people a lot and, trust me, they aren’t rich, they just don’t want to suffer while waiting many months for their non-emergency surgery.

A: They’re not all rich people, I agree. The problem is people are told by the same surgeon that they will have to wait nine months for the surgery in a public hospital but only two weeks in a private clinic so they dip into their savings and do it. I know the waiting lists are too long but that violates the essential principals of equity. Our system needs a complete rethink. I’m in favour of improving medicare, not defying it.


Dr. Michael Klein at BBQ. Klein is known for his advocacy of midwifery and doulas, and family-friendly birthing practices.

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Twitter: @MedicineMatters

 

   




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