Past Dean, Cumming School of Medicine; Gastroenterologist, Avid photographer in no particular order. Opinions are mine.
Nov 20 • 15 tweets • 4 min read
Everyone here seems to be arguing various ideological positions on using private facilities to ease AB's health woes.
Lets look at some data and try to have an evidence based view of some of this. In fact lets look at AB data. /1
Around 2018 AB noted that wait times for what it called priority surgical procedures were longer than the Cdn average. Not a good look for a province that felt it had a good system.
So why were these times increasing? Lots of reasons but a major one is shown in the graph. /2
Nov 18 • 10 tweets • 2 min read
Let me just put out there another major problem with this.
The creation of a public and private stream of medicine and the ability of physicians to work in both - at their discretion - is an incredible boon to physicians.
So lets imagine a physician who believes that what they do, should be compensated better. I know a lot for whom this is actually true.
Now we have a solution. You can charge the patient directly and if they are able/willing to pay you get what you think you deserve. /2
Nov 16 • 8 tweets • 3 min read
OK. Lets look at how the GoA's strategy to suppress/oops, administer C-19 vaccination is going this year. Data from the Respiratory dashboard.
We are about 8 weeks into the "campaign" at this point. /1
Remember, GoA has restricted where you can get the shot, asked most to pay for it, under ordered supply and put up other barriers.
We would predict poor uptake this year. So lets see. /2
Nov 5 • 7 tweets • 2 min read
I've had a great conversation with someone who knows how vaccines are ordered and distributed.
Let's see where the blame lies for the vaccine shortfall in AB this year.
A bit of necessary background. Vaccines are not like regular drugs. For something like penicillin - /1
It is the same 'formula'. Vaccines, however, are tailored to this years virus. They have no shelf life and are useless if not used in the year they are designed for.
So companies do not 'over produce' them. For things like flu an order for the fall must be in by Feb. /2
Nov 1 • 12 tweets • 3 min read
This is simply so wrong..... Although several of us have explained it before let me try again. A short thread. /1
Opinion: Private-pay option will improve access to MRIs and CT scans via @edmontonjournaledmontonjournal.com/opinion/column…
The main premise of this is that the healthcare system is like a market place. If you allow the free market in it will solve the issues we have.
Specifically, if you allow some of us to pay for our MRI then this will increase overall capacity and all will benefit. /2
Oct 26 • 15 tweets • 3 min read
I want to paint a picture of how AB's "Pay for your own Screening" is likely going to go. A thread.
I'm going to use a fictional example from my own specialty that I've now just retired from. I'm positive that these discussions have already started. /1
Who am I to guess at this? Years ago I was one of the creators of the Calgary Colon Cancer Screening Center - something I'm very proud of.
It does amazing work but there was a difficult balance in keeping it part of the public system. Today I don't think it would be. /2
Oct 24 • 11 tweets • 3 min read
Just got my flu shot. Some interesting (to me at least) thoughts about this - and so a short thread.
I'm in rural AB right now and so on a trip into town for groceries stopped at an independent pharmacist. Always fun to chat to these people. /1
I asked about getting vaccinated. Was told that sure he could give me my flu shot and if I wanted, C-19. Of course the latter he would have to be a special order and would be $150.
I asked why he didn't have any of the C-19 on hand. /2
Oct 22 • 7 tweets • 2 min read
There is a huge problem with this that many of us recognize. A short thread.
We call it the incidentaloma issue.
Let me use an example that has actually happened. Imagine you believe young adults should be screened for abdominal cancer to 'protect' their loved ones. /1
Much like the stomach cancer mentioned in this ad.
So you advertise cheap CT scans for young healthy adults to 'prevent the scourge of cancer'. Pay a small amount for piece of mind. What could go wrong?
And people come forward. They get low dose CT abdominal CT's. /2
Oct 22 • 10 tweets • 2 min read
Let me see if I can explain this a bit. A short thread.
First, we've recognized a paradox for decades.
Cancer cells are different from us - 'self'. Our immune system is there to reject 'non-self'. So why does it not get rid of cancer cells? /1
In fact, we probably generate small cancers all the time that our immune system does dispose of.
But every once in a while along comes a sneaky cancer that can hide from the immune system. This is a dangerous one.
Sometimes we can see this in action. /2
Oct 17 • 16 tweets • 4 min read
OK - a short set of thoughts on the crisis of Canadian healthcare. It expresses itself in many ways across every province these days.
How do we know it is in crisis? /1
Witness waiting times, #'s who can't find a family MD, ER closures and most recently the resignation of an entire department of O&G in Kamloops.
We are in a mess and need to understand what the problem is. If we don't we risk spending time and $ on the wrong things. /2
Aug 21 • 14 tweets • 4 min read
OK - a thread. There are a lot of suggestions as to how we improve our h/c system.
But there are naysayers - some who will say everything the UCP/CPC do is just fine but also some with thoughtful objections.
The commonest of these is the "we have no more $" one. /1
So I thought I'd take a dive into comparative h/c spending and the results different countries get from spending.
First, lets look at all the OECD countries and what they spend per capita.
You can see that Canada sits at the high end. /2
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
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.
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?
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
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
