BCMJ, Vol. 49, No. 9, November 2007, page(s) 502-508—Pulsimeter
JAW, Michael F. Myers, MD, Jeffrey P. Ludemann, MDCM, Navid Dehghani, MD, Sandie Braid, CEBS, Georgia Allison, CGA
Pulsimeter
The Methamphetamine Crisis: Strategies to save addicts, families, and communities. By H.C. Covey (ed). Westport: Praeger, 2006. ISBN 9780275993221. Hardcover, 276 pages. $70.01 (amazon.ca)–$101.95 (chapters.indigo.ca).
This is a multi-authored book from the US that attempts to chronicle the current status of what has been called a national methamphetamine epidemic by the majority of the officials working in US drug enforcement and treatment jurisdictions around that country.
Despite the overly repetitious messages delivered by the various contributing authors, the basic message is one of optimism. The majority of the authors are experienced nonmedical and paramedical professionals who write about what can be done not only for chronically addicted meth users but, more importantly, for the large number of children who are frequently living in extremely dangerous environments where methamphetamine is being used or manufactured.
Many current (and most older) publications have tended to dismiss the possibility that chronically addicted meth users are treatable, and permanent child apprehension recommendations abound. The contributors to this publication, however, not only provide a consistent sense of optimism, they also provide useful information regarding the safety of first responders, community case workers, and the at-risk children they are mandated to remove from physical environments described by many first responders as more dangerous than a war zone.
In addition to some frightening information about the enormous social impact of meth use and manufacture, there are extremely useful chapters describing the biochemistry of methamphetamine, its manufacture, and the serious medical impact of addiction. There are sections dedicated to the recognition of meth labs as well as to the clinical recognition features of meth-addicted individuals. This is followed by some useful sections dedicated to current treatment recommendations with realistic outcome goals supported by reasonable outcome statistics from a number of highly regarded US treatment facilities and addictionologists.
There are strong recommendations for flexible, open communications and policies among the multitude of agencies and professional individuals that are required to deal with meth use and manufacture, and several examples are provided that describe how some communities have successfully dealt with their meth problems. There is also a section describing effective legal strategies involving a “drug court” that includes some amazing statistics on how the introduction of a simple, dedicated drug court essentially saved one community.
Additionally, there are several testimonials written by meth users now in post-treatment that provide the reader with a glimpse into the seamy world of meth addiction. The gut-wrenching stories of these individuals and the ease with which they became addicted and quickly inculcated into the dangerous culture of meth-addiction was so similar that anyone with adolescent children (particularly females) reading this book will immediately become an aggressively watchful parent.
Though this book was written for a US audience of nonmedical and paramedical professionals, it will resonate just as strongly for Canadians. The methamphetamine problem is a significant and growing problem in this country and the strategies described in this book are likely useful as a template that could be modified to fit into our mostly inadequate drug treatment infrastructure.
I recommend this book for anyone involved in clinical medicine irrespective of the size of their community, the nature of their practice, or the demographic of their patient population. If you’re practising medicine you are going to see clinical and social problems secondary to meth abuse or manufacture. This book will help you.
—JAW
A Doctor’s Calling: A matter of conscience by Hazel J Magnussen. Parksville: Wembley Publishing, 2006. ISBN 0-9739843-0-9. $26.95
I had the good fortune to be in the audience when Ms Magnussen spoke at the International Conference on Physician Health in 2002. With eloquence and grace, she told us about the murder of her beloved brother Dr Doug Snider in 1999 in the small northern Alberta town of Fairview. He was felled by another physician, Dr Abe Cooper, now serving time for manslaughter. Dr Snider’s body has never been found. Now she has written this book, a loving tribute to her brother, a chronicle of his life and death.
The story is well known to the Canadian public so I won’t reiterate it here. But I do want to say a few words about the content and form of the book. Ms Magnussen writes well and engages the reader from start to finish. She accomplishes this not only with her fine prose but also with touching photographs of Dr Snider and other family members. She honors her brother by giving us much biographical detail of how he lived, not just how he died. This is important because too often individuals who suffer a violent death are eclipsed (and inadvertently diminished) by how they die. She walks us through the details of the interpersonal conflicts at Fairview Hospital Complex, the dismissal of Dr Cooper and his retaliatory lawsuit, the disappearance of Dr Snider, the stunned and grief-ridden family and community, the gathering of evidence, and the protracted trial. We learn how skewed our criminal justice system is. The book’s appendices are key, especially the recommendations that Ms Magnussen makes for regulatory reform.
This slim volume is important reading for all Canadian physicians. It gives us much insight into disruptive behavior by physicians in the medical workplace, an increasingly common and pressing issue in our health care system. It is a phenomenon that we must never take lightly. Our nation’s colleges of physicians and surgeons, provincial physician health programs, and all physicians in leadership and managerial positions will learn from Ms Magnussen’s gripping account and wise words. May Dr Snider’s life not be in vain.
—Michael F. Myers, MD
Vancouver
As part of a Choking Prevention and Quality Improvement Initiative, we would like to inform physicians that:
• Any patient who presents with coughing and/or wheezing after oral exposure to a high-risk object (such as a nut or nut fragment, piece of raw carrot, apple or pear, unpopped popcorn kernel, seed, dried bean, plastic toy part, thumbtack, or pin) should be considered to have a bronchial foreign body until proven otherwise.
• For patients with a round metallic disc in the esophagus, a disc battery must be urgently ruled out.
• To prevent complete laryngeal obstruction, hotdogs and grapes should be cut lengthwise into quarter sections until a child is at least 5 years old and has no development delay in terms of swallowing. Deflated balloons and gel candies (a.k.a. “fruit poppers;” available in many Asian markets) should be kept out of reach of young children. Please advise parents of these issues.
For more information, please refer to the BC Children’s Hospital Clinical Practice Guidelines for Bronchial and Esophageal Foreign Bodies at www.bcmj.org under November/Pulsimeter/Choking prevention.
—Jeffrey P. Ludemann, MDCM
—Navid Dehghani, MD
BC Children’s Hospital
Network of clinicians to share e-health experiences with peers
If you’re considering using e-health, you can soon benefit from the expertise of a network of colleagues who will provide mentorship and help navigate barriers. The Clinician eHealth Support Network is a group of health care providers who will provide hands-on support to colleagues in their respective jurisdictions to help them address challenges and uncover the opportunities and efficiencies that are associated with e-health.
Members of the Clinician eHealth Support Network will support their clinician colleagues contemplating the use of electronic health record solutions by providing:
• Individual demonstrations of electronic health records technology.
• Ongoing support and mentoring.
• Assistance in goal setting, prioritizing.
• Support offered on site and remotely.
The support network is organized by Canada Health Infoway, a federally funded, independent, not-for-profit organization that is leading the development and implementation of electronic health projects across Canada.
Commercial office insurance—Know your limits!
Typically, physicians or office managers purchase a commercial office insurance policy and then file it somewhere safe until it is needed to make a claim. Hopefully the policy will never be used, but the reality is that, sooner or later, the policy will likely be called upon to respond to a loss.
Almost all of the office insurance policies sold by insurers today are “all risk” or comprehensive package policies. These are the broadest type of policies available in the marketplace and cover various types of losses including fire, theft, water and wind damage, and mysterious disappearance. They also provide coverage for general liability, loss of business income, and crime.
While the coverage may appear to be the same, all of these packages have underlying sub-limits, or special limits, as they are more commonly known. Insurers place these limits in the policy to limit their exposure to certain types of losses or situations that tend to be suffered more frequently. These special limits can differ widely from insurer to insurer and can come as a nasty surprise when a claim is made. It is very frustrating to pull out your insurance policy after a claim, only to find the payout is severely restricted by a special limit in the policy.
The BCMA Commercial Office policy has been designed with today’s modern medical office in mind. This package provides high special limits and many features that are not included in most standard office insurance policies as noted in the Table.
Remember, when comparing commercial office insurance packages, an office insurance policy containing generous special limits provides the best value for your insurance dollars and can have a significant impact on the size of the payout following a loss.
—Sandie Braid, CEBS
BCMA Insurance
Results from BCMA annual report survey
Data from faxed and online responses to a survey on the BCMA Annual Report 2006/2007 show a high level of member satisfaction with the report. The survey collected a total of 144 responses to a series of multiple-choice and open-ended questions on the format and overall quality of the information provided to BCMA members in the report.
Overall interest in the report was high, with just over a quarter of respondents (26%) indicating they’d read 80% or more of the publication. Only 2% of respondents replied that they had not read the report at all, with the majority of those citing “lack of time” as a reason. When rating the report in comparison with the previous year’s publication, 70% of respondents rated the 2006 report as “good” or “excellent.”
The visual appeal of the report was acknowledged by respondents, with 70% rating the appearance of the publication as “good” or “excellent.” More than two-thirds (68%) of respondents felt that the report contributed to their level of confidence in the management and accountability of the association to a fair (47.2%) or great (21.1%) degree.
Slightly fewer respondents (63%) said they felt well informed regarding the association’s activities to a fair or great degree after reading the reports, with 28.3% stating they felt somewhat well informed, and 8.3% feeling not at all or poorly informed.
Regarding the length of the report, a strong majority (68%) felt that it was “just right,” with 25% of respondents indicating that the report was too long, and a few (6%) stating it was too short.
When asked to rate their level of interest in various areas of the report, respondents gave the highest ratings to Key Priorities for 06/07, the President’s report, Flashpoints and Milestones 06/07, and Key Priorities for 07/08. Other areas of interest included the Board of Directors report, the CEO’s report, the 2006 Financial Statements, BCMA Governance, and BCMA Committees.
Survey respondents were asked two open-ended questions at the end of the survey. When asked what they liked about the report, many cited the clear design and layout as contributing to readability, and some commented that the report was concise and to the point. Others praised the report’s theme of collaboration between the BCMA and the Ministry of Health, with some singling out the GPSC and PITO information provided as being of interest. Many found the report well organized and easier to read than in previous years.
Finally, readers were asked to provide input on what they would like to see changed next year. While the majority of respondents commented that they would leave the report as is, some suggestions for change included publishing the report in a less costly format (or online with the option for readers to download it as a PDF), re-incorporating the reports of the individual committees, and, on the other hand, making it shorter. Other suggestions were made regarding future themes for the report, such as focusing on the results of the Conversation on Health, or outlining joint projects with the CMA and other CMA affiliates.
Thanks to all survey respondents for their feedback and suggestions; once again we will use your input to improve the next report. Congratulations to this year’s survey draw winner, Dr Annette Lam, who won a 2-night stay at any Coast Hotel for participating in the survey.
Breast cancer survivors underestimate recurrence risk
Despite their fight with breast cancer and the wealth of resources available, survivors remain uninformed of the risk of cancer recurrence, according to a new Canadian survey. The survey, led by the Canadian Breast Cancer Network (CBCN) and conducted by Ipsos Reid, shows that only one in 10 women surveyed is aware of their risk of relapse after 5 years of tamoxifen treatment.
Results from the survey show that women with breast cancer need more information:
• Half of breast cancer survivors did not feel they were provided with information about their risk of recurrence.
• Four women in 10 felt cured after 5 years of tamoxifen therapy, previously used as the standard course of treatment for breast cancer.
• Half of women surveyed did not receive information about prescription treatments that could reduce their risk.
• The 5-year survival rate is now 86%. Treatment and better organized breast-screening programs are being attributed to a 25% decline in breast cancer death rates since 1986.
The survey was administered online and by mail 12 April to 28 May 2007 to breast cancer survivors who completed 4 years of standard therapy for the treatment of early, non-metastatic breast cancer. Invitations to complete either online or mail-back surveys were sent to women from a list obtained from the Canadian Breast Cancer Network and qualifying Ipsos Online Household Panel Members. Breast cancer associations, including CBCN, also posted invitations to complete the survey on their web sites. A total of 230 breast cancer survivors responded to the survey, resulting in an overall confidence interval of +/-6.5%.
First Nations doctor explores traditional medicine
Medicine Woman, a new 13-part series the premiered on VisionTV in September, follows Dr Daniele Behn Smith on a journey around the world to meet the shamans, herbalists, mystics, and others who preserve the centuries-old traditions and practices of natural healing. The series airs on Mondays at 7 p.m. and repeats on Saturdays at 5 p.m.
Dr Behn Smith is a First Nations woman just starting her career as a rural family physician. Though well versed in contemporary medicine, she believes that incorporating aspects of traditional healing into her practice will help her to deliver better care—especially to Aboriginal patients.
Her voyage takes her from New Zealand to the fringes of the Arctic Circle, to the lush jungles of South America, to the rolling green hills of Wales, to the arid deserts of southern Africa, and to her ancestral home, the Dene Reservation in Fort Nelson, BC.
Cardiac specialists from the heart centre, part of the Providence Heart + Lung Institute at St. Paul’s Hospital, are the first in North America to successfully perform two breakthrough heart-pump implants in patients with failing hearts using new-generation ventricular assist devices (VADs).
The small but powerful heart pumps, no heavier than a few grams, are intended as short-term relief for patients with declining heart function or following surgery.
The two procedures were performed about a week apart in mid-August, marking the first time outside of Europe the devices have been used and saving the lives of both patients, whose heart function had reached critically low levels.
Dr Anson Cheung, surgical director of Cardiac Transplant and Mechanical Circulatory Assist Device of BC, performed the procedures, assisted in the first case by cardiologists Drs Ron Carere and Eve Aymong.
The devices, known by the trade name Impella, can pump as much as 5.5 L of blood per minute, the equivalent of a healthy heart. They can sustain patients from a few hours to 10 days, until their heart has recovered or is strong enough to be transferred to another means of support.
The devices do not replace the much larger, long-term VADs, which use technology both inside and outside the body to maintain blood circulation and enable patients to go home with the device for up to a year or more.
In an effort to be more eco-friendly, the BCMA has distributed the CME and CPRSP entitlement packages by e-mail this year. You will be able to view all information electronically and should print only the respective application form from each package for submission.
We continue to look for more efficient and cost-effective ways of communicating with our members and feel that this initiative is a step in the right direction. The traditional distribution of these two packages in printed form to the entire membership has cost approximately $20 000 per annum. This translated into a cost to you as a member of the BCMA. By e-mailing these packages, we anticipate a 70% savings, based on the number of members who have signed up to accept information via e-mail.
Members who wish to receive information via e-mail in the future may contact us at the telephone numbers listed in the table above or e-mail benefits@bcma.bc.ca to change their preferences.
| Deadlines | Submission date | Expiry date |
| CPRSP |
7 December, 2007–if age 71 by December 31, 2007 21 January 2008–regular applications |
1 March 2008 for any unused 2005 entitlement |
| CME | 30 April 2008 when 2005 funds are expiring | 31 March 2008 for any unused 2005 entitlement |
| Contact information | Phone | Fax |
| CPRSP | 604 638-2926 or toll free in BC 1 800 665-2262, ext. 2926 | 604 638-2913 |
| CME | 604 638 2929 or toll free in BC 1 800 665-2262, ext. 2929 | 604 638-2913 |
—Georgia Allison, CGA
BCMA Accounting and Member Services
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BC innovation awards The BC Innovation Council recently announced the winners of the 2007 BC Innovation Council Awards, and, as usual, physicians were well represented. Dr Julio Montaner Dr Martin Gleave |
