One of the great myths of Canada says that doctors are leaving in record numbers because of their terrible health system. It simply isn’t true, according to the Canadian Institute for Health Information : (I’m essentially quoting Don McCanne’s Quote of the Day here, a great listserv that if you’re not on, you’re missing):

Over the past five years, the proportion of Canadian physicians moving in and out of the country has decreased by 30.6%. While both the number leaving and the number returning to the country are on the decline, Canada has seen a larger decrease in the number of physicians leaving the country. As a result, the proportion of physicians returning to the country is now greater than the
proportion leaving.

When comparing the number of physicians moving abroad to the number of physicians returning from abroad, Canada registered net physician losses from 2001 to 2003. Starting in 2004, Canada began registering net gains of 85 physicians in 2004 and 61 physicians in 2005 due to
international migration.

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… are mostly due to inability to show benefit greater than placebo or current therapies . Yikes.

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A little pricey, but cool–you can record stethescope audio onto the Nano.

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She spoke with a sharp Texas tongue and wrote just the same, criticizing every insane policy and putting people in their place. She died from breast cancer at the age of 62 yesterday. Goodbye, Molly.

Molly Ivins on universal health care and our health care crisis .

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Over 90 million of us have poor “health literacy” –that is, we don’t get what the doctor is talking about when he or she slips into medicalese. The linked article goes into strategies doctors should use, but I can’t believe this one was recommended:

Doctors should use plain language, not medical jargon, vague terms and words that may have different meanings to a lay person. They should say chest pain instead of angina, hamburger instead of red meat and, “You don’t have H.I.V.” instead of “Your H.I.V. test was negative.”

This is part of the reason that medicalese is confusing, but saying “Your HIV test was negative” does not mean the same as “You don’t have HIV,” and honestly, especially in a case like HIV, with false-negative windows of several months, it’s scary that that’s being recommended.

Whenever you do a test in medicine, there’s a chance that the test won’t catch whatever disease you’re looking for. This is called the sensitivity of the test. While we try to make sure our initial tests are sensitive ones, sometimes they miss things for any number of reasons.

So when a test is “negative,” that means the test didn’t find what you were looking for. If the test is a good one, it usually means you don’t have whatever disease or condition they were looking for, but it doesn’t always mean that you don’t have it–just that the test missed it.

Is this confusing? Yes, but I don’t think we should be jumping to false conclusions with patients just to simplify things.

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Big name bloggers like Orac and Dr. RW and KevinMD are all up in arms about how “medical schools are going the wrong way” and asking “Does anyone in academic medicine care about the integrity of medical education?” They like to talk about the fluffy “woo” of medical school, as if we’re all hippies out in our commune who have sacrilegiously sacrificed our Evidence and Data to a golden cow.

Give. Me. A. Break.

They’re whining as if this is the most scandalous thing to have happened to American Medicine. Are you kidding me?

This is the same American Medicine (and academic medicine) that has played a part in the Vioxx scandal, who often have so many industry ties to their work that it’s hard to know if anyone is objective anymore. This is the same medical system where doctors at prestigious medical centers install medical devices and get a kickback , where doctors (academic and non) get paid big bucks to sign their patients up for clinical trials, and get flown to lavish vacations for industry-sponsored “education.” (I could dig up more examples if you really want.)

I’d ask these bloggers: Does anyone in medicine care about the integrity of medicine? If they don’t do any of these unethical things, great, but if you’re that upset about “integrity,” why not take a stand and try to change the system?

First off, do I believe in “Complimentary” or “Alternative” medicine (CAM)? I can’t say. It hasn’t been studied enough. Does this mean it doesn’t work? No. (I also realize this means that we can’t say it does work, either.) My own experience with acupuncture was that it helped my back. But I think some parts of CAM make sense: eating healthy, local foods, more produce, less processed foods. It’s extremely granola, but the American diet is so far from that, that a little overcompensation is fine in my book.

Either way, many patients use CAM, whether I think it’s a good idea or not–and honestly, I’d much rather have some sort of idea about what CAM is and what I need to know about it than be ignorant of it completely. Some herbs affect medication dosages, for instance. While I’m not ready to go advocate for my patients to take Chinese herbs for their liver failure, I unfortunately don’t get to control what they do in their own free time. I’d prefer to meet the patient where he or she is at than write them off or be ignorant when they ask me a CAM question. (And yes, Western Medicine is still lacking in the “cures” department–if a placebo effect helps someone, should we honestly ruin it for them if we don’t have anything better to offer?)

You know, it often comes back to the Almighty Dollar in many of these cases. And while I don’t think that most CAM people are in it for the money, the money is clearly there–people spend billions on CAM and vitamins and supplements that probably aren’t doing anything for them.

But if the CAM folks are in it for the money, who can blame them? What has American medicine (and by that, I mean doctors) focused on? Money, money, money. Specialists now try to do more procedures. Why? We put stents and devices into people all day long, sometimes without evidence or data of better outcomes. Why? Money.

There are many things in American medicine that disturb me. Is teaching a future doctor about treatments that aren’t proven bad? I’d say yes. But is that the worst of our problems? Hell no.

(PS: Did no one in medical school learn anything that turned out to be totally wrong, or totally bad for a patient? I know I already have.)

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