All Posts Tagged With: "doctors"

New computer system detects unwashed hands

A newly developed computer system may help combat bacterial infections in hospitals.

The technology is being developed by a professor of computer science at Worcester Polytechnic Institute, in partnership with the University of Massachusetts Medical School.

Health care workers will wear badges and computer hardware will be attached to soap dispensers, beds and the doors of patients’ rooms, watching for unwashed hands. If a doctor, nurse, or technician forgets to wash up before entering the room, the badge will turn red and results will be instantly sent to nurses’ stations and multiple computers.

“It can track things in real time, and those things can easily be fixed — they can wash their hands,” Elke Rundensteiner, the professor of computer science who is developing the technology, said in an interview with the Telegram.

In addition to detecting unwashed hands, the technology could also be used in situations such as massive evacuations during natural disasters, re-routing medical personnel and water during emergencies.

It’s great that the problem of bacterial infections in hospitals is being addressed, but it’s kind of disturbing to think that doctors or any health care workers need a reminder to wash their hands. I thought infections due to unwashed hands was more of an 18th century kind of problem, before the invention of hygiene. At least those surgeons didn’t know any better. What excuse do today’s doctors have?

-Photo courtesy of Hygiene Matters

Ontario government announces 75 new residency positions

Canada is in the middle of a doctor shortage, but reinforcements are on the way. The Ontario government recently announced that 75 specialty residence positions will be created over the course of the next five years, starting in the summer of 2011.

According to the Government of Ontario news release, since 2003 there’s been an 80 per cent increase in the number of postgraduate specialty training positions, and by 2014 more than twice as many doctors will be graduating from Ontario’s medical schools than in 2003.

-photo courtesy of  Klobetime

Gastrointeritis: symptoms may include a drastic lack of preparation for exams.

When a student goes to the doctor and complains of vomiting and stomach pains with no specific cause there’s a catch-all term that readily applies. Doctors call it gastrointeritis, a diagnosis that’s familiar to professors and instructors everywhere. So the doctor scribbles this word on a medical form of some description or other, and just like that the student has his or her “get out of exam free” card.

Students do occasionally become ill. And sometimes illness is badly timed and affects exams, midterms, and assorted deadlines. But this whole regime of medical notes is absurd and hypocritical and what’s more everyone knows it. The students who make a habit of such things know darn well they can get a note based on non-specific symptoms (i.e. “my tummy hurts”) any time they like. They even know which clinics to go to and how much they’ll charge. The doctors aren’t remotely qualified to evaluate any student’s ability to write an exam or complete an assignment while ill and still they’ll produce a note on the subject. And the administrators who require this exercise and the professors who receive the notes understand that 90 per cent or more of the claims are bogus, yet we continue to play the game by the agreed upon rules.

Again, the major problem here is the mistaken belief that doctors are qualified to judge whether or not a student is healthy enough to sit an exam. They are not. They receive no such training and any doctor will freely admit as much. When I was involved in Workplace Safety and Insurance work I had the opportunity to review a variety of documentation relating to injured workers and their ability to perform various tasks and jobs. Doctors who do this stuff for real are highly specialized and they spend a lot of time evaluating their patients before making a report. Even then their work is subject to doubt and controversy. It’s very subjective. So there is no way a family doctor, on the basis of a ten minute discussion, can genuinely report on a student’s ability to get his or her school work done. The diagnosis of gastrointeritis is nothing more than a repetition of the student’s claim about vomiting and stomach pain. There’s no possible test to verify these symptoms.

None of this is meant to suggest that I’m out to punish the poor “sick” students. Common wisdom accepts that students don’t really benefit from blowing off tests, from pushing deadlines, and from deferring exams. They get some relief in the short term, yes, but they only delay their problems. They do make more work for their instructors and that is kind of annoying at times. But they aren’t “cheating” in the sense that they gain anything. So the obvious solution is just to take students at their word and accept the stupid forms. I find myself doing it just as so many instructors have done so before. But it’s still a ridiculous exercise.

A very wise administrator once pointed out to me how truly stupid this all is by making this observation. The students who are genuinely sick don’t benefit significantly from seeing a doctor. The treatment for vomiting, stomach pains, and general flu-like symptoms (in other words, actual gastrointeritis) is just bed rest and fluids. Dragging yourself to a walk-in clinic and sitting around for a couple hours waiting for a note is just about the worst thing you can do. And on top of that, we’re just wasting doctors’ very valuable time with this pointless crap, by turning them into gatekeepers for an academic regime that needs to maintain the illusion of scrutiny. Surely their time could be better spent treating people who are actually ill.

For some this may come as news. If you never realized before how easy it is to get a doctor’s note, well, now you know. But it still isn’t in your interests to do it, so I wouldn’t recommend suddenly becoming “ill” the next time there’s a test. And for those who knew this already, you might as well be aware that we know it too. We know which doctors and clinics you are going to and we know exactly what you’re saying to them and we know how empty the process really is. We just don’t know what to do about it–aside from ensuring that the make up tests are harder than the originals and that no one (including the genuinely ill) ever derives any advantage from the process.

Sometimes, the system just doesn’t work very well for anyone. It makes my tummy hurt.

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Questions are welcome at jeff.rybak@utoronto.ca. Even the ones I don’t post will still receive answers, and where I do use them here I’ll remove identifying information.

Or: why is everyone taking offense at facts that aren’t offensive?

It’s old news, it isn’t bad news, it isn’t anyone’s fault and it isn’t even all that difficult to deal with — and yet each and every mention of Canada’s doctor shortage causes a certain number of Canadians to start crying “discrimination!”

The facts, which Maclean’s made a cover a story a year and a half ago (and which the predecessor to this website first mentioned several months earlier) are as follows: female doctors tend to work fewer hours than the physicians of a previous generation, and fewer hours too than their male counterparts. And given that the majority of the students at Canada’s medical schools are female, and thus the majority of our new doctors are female, and given that all doctors and in particular female doctors work somewhat less than their predecessors, we are experiencing and will continue to experience a doctor shortage. Each average doctor of the future will be able to treat somewhat fewer patients than the average doctor of the past. That’s just a fact. It would appear that it’s easily remedied: all we have to do is increase medical school enrollment and/or increase the number of trained physicians recruited abroad.

This isn’t a crisis. Nobody’s suggesting that women physicians be somehow blamed or punished for the fact that you may be having trouble finding a family doctor or booking an appointment with a specialist; nobody’s calling for female doctors to be ordered to work more. There will be no roundup of women doctors for ritual stoning in the town square. Really. The facts are so banal that they should defy controversy. It’s just basic math: if a hypothetical family doctor can handle a patient roster of 1,000 patients, then a town of 1,000 people needs one family doctor. But if the average family doctor can only cover 500 patients, then we need to double our imaginary town’s physician population. That’s it. That’s all. Everyone take a Valium.

Perhaps if the researchers who first compiled these statistics had declined to be curious about the cause of our physician shortage, and had simply reported that, for reasons unknown and unknowable, today’s young doctors work somewhat less than yesterday’s doctors, we would all have moved on to considering how to address the situation. Maybe that would have been better. Instead, we’re wasting our time feeling wounded and alleging that women are victims of “scapegoating.” It’s depressing. Prescribe a course of treatment and discharge this patient already.

The tricks provinces play to keep medical school graduates from moving

Last week, certain parts of Quebec’s French-language media got themselves all hot and bothered by the following discovery: many graduates of McGill University medical school move to… Ontario. Or Western Canada. Or the rest of the world.

The table below shows where 2006 graduates of Canada’s medical school were practicing, two years after exiting their post-MD training. McGill’s “problem”? It has the highest percentage of graduates who have moved to another province or country.

Training physicians is expensive, and provincial governments assume much of the cost of that training, hence the complaint. And the desire, on the part of some, to find ways to further fence in med school graduates: you know, if you want to go to medical school, you have to promise to never leave the country, or to spend umpteen years in a rural area. Some provinces, in particular Quebec, appear to feel themselves squeezed in the same way as some Third World countries are: their best and brightest and most educated leave.

But restrictions on mobility, as the experience of any Third World country can tell us, don’t tend to work. And Canada already imposes extensive restrictions on the labour mobility of doctors. And yet we still have doctor shortages in many places.

Canada’s restrictions on physicians start right up front–when prospective doctors apply to medical school. In all other areas, Canadian higher education is open to the most talented, regardless of whether they come from other provinces or overseas. The University of British Columbia does not turn away qualified applicants because they happen to live in Manitoba or Ontario — unless, that is, those applicants want to go to medical school. By order of every provincial government except one, medical school seats are overwhelmingly restricted to those who already live in the province. Just look at page 2 of this table, from the Association of Faculties of Medicine of Canada.

The one province that does not impose a locals-only policy on its medical schools? Ontario.

UBC, the only medical school in BC, reserves 95% of its seats for BC residents. U Saskatchewan and U Manitoba, the only medical schools in their respective provinces, each set aside 90% of seats for locals. Dalhousie and Memorial, the only medical schools in Atlantic Canada, take the same approach, with a careful apportioning of seats among residents of the various Atlantic provinces. Quebec puts its medical schools in the same straight jacket, such that McGill — one of North America’s oldest and most prestigious medical schools — must reserve 91% of its seats for provincial residents.

And yet a substantial percentage of grads from almost every medical school leave the province. McGill’s numbers are the highest, but all Canadian medical schools are “bleeding” graduates to other provinces or countries. Look at Memorial: almost all of its students come from Atlantic Canada, yet a third of those who exited its post-MD training in 2006 are practicing elsewhere. (Go to page 132 of this document and you see that they have moved to Ontario, Manitoba, Alberta and BC). Even UBC, which accepts almost no non-BC medical students, sends a substantial number of its graduates outside the province. (Most went to Ontario and Alberta. A few went to Quebec).