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Jon Meddings Profile picture
Jon Meddings
@JMeddings
Past Dean, Cumming School of Medicine; Gastroenterologist, Avid photographer in no particular order. Opinions are mine.
Aug 16 • 5 tweets • 2 min read
I'd like to take a stab at this as I think it is a major piece we are missing. Will take me longer than one reply and so I've reposted this as a thread. These are my thoughts.

The highest level of accountability is between citizen and government. /1 We pay taxes. We expect a well functioning and well managed h/c system. Right now we have neither and government shrug's their shoulders. *That* should not happen.

Second level is accountability between providers and the system. /2
Jun 17 • 5 tweets • 1 min read
Well, surprise, surprise. A brand new, flashy health care reorganization to fix all our problems.

We now have a *Hospital Based Leadership Structure*.

Amazing. I'm sure it will be wonderful. And instead of a few zones we now have 7 corridors. What a difference! /1 Lets take a look at these "massive" changes.

On top we have Alberta Health. Supposed to set provincial priorites. Next in line we have Acute Care AB which will translate the AH strategy into tactics for the hospitals.

Lots of hospitals so how to do that? /2
May 22 • 4 tweets • 1 min read
This is a great report (as usual) from Andrew Longhurst. I'm just going to point to a few key findings in a short thread.

First, it is a direct rebuke to our Premiers comments /1

Attack on Alberta Health Services reveals failings of privatization healthcoalition.ca/attack-on-albe… In Feb she claimed no matter how much $ she gave to AHS surgical rates were not increasing.

This *not* correct.

First, there has been no increase in funding. Only decreases.

One exception. In 22-23 a 14% increase in $ and a similar increase in surgery. /2
May 7 • 9 tweets • 2 min read
I'd like to comment on todays G&M editorial. It is a whopper and makes several points that I agree with.

Points that will predictably raise the blood pressure of the more heavily influenced members of our species.

A thread. /1

theglobeandmail.com/opinion/editor… The first, and overriding, point is that the return of a once eradicated disease, measles, is a remarkable failure of government.

Make no mistake. This is a killer disease that we once had under control.

There is no reason that 3 children in AB should be in the ICU. /2
May 2 • 6 tweets • 2 min read
I wish government understood this. A short thread.

We are desperately short of MD's. Comparable countries have roughly twice as many as we do.

We need to train more. Yesterday.

But there are problems with this. /1 It is not as simple as adding med school seats. We do need a major increase in seats. But....

ironically, med schools don't train doctors.

They train first year residents....

In order to become a fully fledged doctor a graduate needs 2- many years of training. /2
Mar 19 • 9 tweets • 2 min read
Great, but complicated article. Let me add some emphasis to the main point.

The original design of our health system was similar to other countries and very good.

In it government (A Health) provided vision and AHS was to manage the process. /1

cbc.ca/news/canada/ca… This was way back in 2008.

To be fair to government there is a problem with that. Any time there is an issue with healthcare people are upset and complain. To government.

As they should.

The response of government should be to hold AHS accountable to the vision. /2
Feb 24 • 7 tweets • 2 min read
Lets think a little about this. First, what exactly is this for those not immersed in the medical world.

Well, this is an 'on call' payment system. We have several types functioning right now. /1

cbc.ca/news/canada/ca… The most obvious one is during the night when everyone is asleep but you suddenly need an MD. Say a car crash or appendicitis or a baby.

Who does the ER call? We don't have enough MD's to work shifts. So someone will have worked all day but have to come in at night. /2
Feb 14 • 5 tweets • 1 min read
This is the idiocy I get on this hellsite.

But let me use it to explain a few things.

Why do we have the @CPSA_CA ? What does it do?

Well, its mandate is to "Protect the Public". From what you might ask?

And the answer is medical malpractice. /1 Physicians are licenced by the CPSA and maintenance of that licence is achieved by providing evidence based care or the best that it can be.

There is a lot of latitude already in this for areas where little good evidence exists. /2
Feb 13 • 6 tweets • 2 min read
The legal letter in this article is sordid reading.

After going through it (I need to read it again) I am struck by a few things. Note that these are the claims from only one side here - but they seem compelling. /1 The AHS CEO went out of her way to protect and get value for the public dollar.

At every stage she compared CSF pricing to internal AHS costs. Some companies were found to be competitive and were approved.

One company was not and had been rejected previously. /2
Feb 1 • 7 tweets • 2 min read
This is just bizarre. Some thoughts.

OK, government fires the AHS board and appoints a new CEO.

What I see from the bots/trolls here is pretty much - this isn't a problem. Wasn't working. Too much admin. They screwed up covid. Start over. /1

cbc.ca/news/canada/ca… So lets look at that.

This wasn't the board/senior admin that handled AHS through covid. They were fired 2 years ago and replaced by first an OA and then a handpicked board and CEO. (90 days...)

Who picked them? Entirely cabinet. Should have been pretty close ties to gov. /2
Jan 31 • 8 tweets • 2 min read
I've been thinking more about this post and the near catastrophic conditions we find ourselves in in Alberta.

A short thread to explain my thoughts.

First, this is a very dangerous time we find ourselves in. /1 As pointed out here we have a global situation of rapidly arising threats - H5N1 spreading rapidly in flu season, Ebola outbreak and TB.

We are emerging from a recent pandemic for which I think all agree we handled poorly.

Opposing reasons but still poorly. /2
Jan 10 • 8 tweets • 2 min read
I was hoping for this. I believe this a great ruling by the federal government. /1

Federal changes could result in a sea change in delivery of primary care via @ottawacitizenottawacitizen.com/news/local-new… In essence there are several loopholes in the Canada Health Act that provinces (esp AB and ON) have been exploiting.

This eliminates the first loophole. Prov's like AB have failed in providing primary care for all.

Instead of fixing this they have skirted the rules. /2
Dec 31, 2024 • 9 tweets • 2 min read
I'm going to leap from this question into an area that I think the Fraser Report opens. A thread.

First, the Fraser report is a compilation of self reported physician impressions of wait times. Take it for what it is. /1 However, wt times have been increasing in many areas and that is a concern we all have.

Second point is the Canada Health Act. Now, I am certainly not a lawyer and would welcome legal thoughts.

But what does the act say? It is a short act with some cogent pieces. /2
Oct 10, 2024 • 7 tweets • 2 min read
Sorry this story is incorrect.

It is announcing a new pay deal for residents. A thread. /1

Alberta health minister announces resident physician pay deal as family doctors wait via @edmontonjournaledmontonjournal.com/news/local-new… Don't get me wrong - paying our residents an equitable salary is wonderful and government should be thanked for doing this.

Frankly, it is something they should do simply because it is the right thing to do.

However, the rest is wrong. /2
Oct 10, 2024 • 5 tweets • 1 min read
So what else is our governments reorganization of healthcare getting us? A short thread.

One of the jewels in the crown of our provincial, award winning, integrated healthcare system (known as AHS), were the Strategic Clinical Networks. (SCN's for short). /1 They are being dismantled behind the scenes and so I think it is important for people to understand what we are losing. And, of course, the predictable consequences of their loss.

The goal of these were to study the problems of our h/c system and implement solutions. /2
Oct 9, 2024 • 15 tweets • 3 min read
This is pretty crazy. Obviously it is not supposed to work this way. A short thread...

AB healthcare is organized (or was) along a continuum.

There was an expectation that people would be able to access general healthcare locally. We call that primary care. /1 Mostly outpatient and low acuity.

However, it has always been clear that a subset of patients would need something more. Say appendicitis - a hospital would be necessary and staffed by people trained to handle this extra stuff.

We call this secondary care. /2
Oct 5, 2024 • 5 tweets • 1 min read
Let me take a crack at this and Paul @PfParks can add his comments.

1. CPSA does not record who is practicing in AB. The numbers refer only to licences.

Many get a licence (or keep one) even when out of province.
/1 Many are not practicing FM but doing sports or ER for eg.

So the numbers should be taken with a large dose of salt.

2. It is also easy to throw out “we recruited over a hundred docs”. But this is meaningless. /2
Sep 28, 2024 • 10 tweets • 2 min read
This is such a great question. Let me flesh this out a bit so that people can wonder about the hypocrisy inherent in how our government runs healthcare.

Right now our government is contracting many surgeries to private providers. Chartered Surgical Facilities (CSF's). /1 They argue that this will increase capacity. So lets examine that premise.

Lets ignore (for a moment) all the damage CSF's will do to the public system because they do not provide 24/7 emergency care.

Questions: 1. Where do they get their staff? /2
Sep 27, 2024 • 12 tweets • 3 min read
What an amazingly good thread! @PfParks absolutely nails it.

I am just going to bounce of this with a short thread on just one of the ways this action by government clearly, and predictably is making our healthcare system worse.

This is deliberate sabotage of healthcare./1 Government knows this, they've been told and they have done it anyway.

Lets get a few things clear to start.

In or current system OR's exist and dynamically manage cases that are either 'elective' (think a hip) or emergent (think a car crash). /2
Sep 23, 2024 • 14 tweets • 3 min read
This is a great article and worth a careful read. But then to think about the bigger picture. Here is a thread to illustrate a couple of these points.

These points apply across Canada but within each provincial system there is likely a different mix. /1 Why is our healthcare system so expensive?

I guess the first question to ask is "is it??". And the answer, by comparing ourselves to other OECD countries is, - yes. We spend far more than the average and get far less in return. /2
Aug 27, 2024 • 8 tweets • 2 min read
Read the article if you can. I still have a bad taste in my mouth.

So our government is going to look at "regulating the regulators" by legislation.

Let me comment a bit on the MD aspect of this. I am not speaking for the CPSA - but I have sat on their council. /1 This is in addition to the fact that the government already appoints about 1/2 the CPSA council. How much control do they want?

The point of a professional regulator is that there are things government can recognize and fix. They do that with legislation. /2