Pulsimeter

Book reviews

Vancouver General Hospital: 100 Years of Care and Service by Donald Luxton. Vancouver General Hospital and Heather Heritage Society, 2006. Hardcover. $35. To order, contact the Heather Heritage Society, 1011 456 Moberly Road, Vancouver, BC V5Z 4L7, tel/fax: 604 224-3607, or e-mail m.ford@telus.net.

This narrative history of the Vancouver General Hospital is a well-presented pictorial essay that highlights some of the milestones in the hospital’s development and evolution. 

In just over 100 pages, Donald Luxton describes some of the history of what was once Canada’s largest hospital. Photographs from varied archival sources are supplemented by narratives that give the reader a sense of the amazing advances in hospital care that have occurred in the past century. The result is a book that is easy to look through and serves as a reminder of the important place that VGH has in BC medical history. The era when infectious diseases were so prevalent, the introduction of X-rays, the development of the nursing school, and the period spanning before, during, and after the two world wars are well covered. 

There are significant gaps in the story, with the 1960s, 1970s, and 1980s receiving relatively little attention. With a little more research, perhaps through appealing to those who worked at the hospital in those decades, those gaps could have been filled with interesting and relevant illustrative material. For example, the full-page story describing the Charnley hip replacement comprises a simple generic commentary on joint replacement with little of specific relevance to VGH, failing to mention that Sir John Charnley visited and taught at VGH. 

Despite this criticism, many will enjoy reading this book. The illustrations are interesting and the book is well produced. The Vancouver General Hospital has been and remains a great institution. All who have worked there during the past 100 years should be proud of their contribution to its legacy.

—BD

Bloodletting and Miraculous Cures by Vincent Lam, MD. Anchor Canada, 2005. ISBN 0-385-66144-4. Paperback, 353 pp. $17.95.

So Dr Lam writes a little book about the flu (reviewed in the December 2006 issue) and thinks he is an author. The “Laminator” has now written his first novel, which collected the 2006 Giller Prize. Well, here at the Editorial Board, Giller Prizes, in the words of that other great Canadian artist, Shania Twain, “Don’t impress us much.” The editors have so many Gillers, Pulitzers, and even Nobel Prizes, we are running out of storage room. So, with that in mind I recently cozied up with Vincent’s new book. The twelve chapters are stand-alone stories about a group of young people as they move from pre-med through medical school and on to their chosen fields. The chapters are chronological but leave gaps and jump among the characters. Apparently, Margaret Atwood once told Dr Lam that he could write. Well, I guess she was right. He’s one of us, and it shows, as the book is a trip down medical memory lane. As the students prepare for their final exams, I was taken back to my own days of writing science finals in huge rooms with hundreds of students. As they begin first year anatomy, I was there again adjusting to working with a cadaver and dealing with the associated smells. I found myself nodding with agreement at an emergency doctor’s emotional struggle as he prepares for his upcoming shift. The story dealing with SARS is one of the best I’ve read in a long time. It powerfully explores the issues not only of those afflicted but also of the health care professionals forced to the front lines. So maybe we don’t really have any Giller Prizes, but Vincent does, and you should read his book.

—DRR

Penny receives Order of Canada

Her Excellency the Right Honourable Michaëlle Jean, Governor General of Canada, has appointed Dr Norgrove Penny as a member of the Order of Canada for his services to health. 

In 1996 Dr Penny left a thriving practice in Victoria, BC, to join Christian Blind Mission’s (CBM) work with impoverished and disabled children in Africa. Dr Penny established Uganda’s first comprehensive children’s orthopaedic rehabilitation program, which has since become a model project—the Uganda Clubfoot Project.

For 6 years, Dr Penny worked tirelessly with CBM coworkers, transforming the lives of thousands of children who had orthopaedic disabilities. 

Dr Penny returned to Victoria and in 2003 began a new orthopaedic pediatric program at Queen Alexandra Centre for Children’s Health. He continues to practise there today and also serves as CBM’s international director for orthopaedic work, promoting services to help children and adults receive surgery enabling them to walk again.

Rural procedures manual

With the growing shortage of paramedics and ambulance coverage in rural British Columbia, it is timely that the Society of Rural Physicians of Canada has published a manual instructing rural physicians and nurse practitioners in resourceful methods to undertake various medical procedures with the tools and materials at hand. 

The Manual of Rural Practice is the product of 4 years of research focusing on procedures that new doctors working in remote areas will not have learned in any medical school. 

Two chapters were written by Dr George Magee, who practised in Burns Lake for nearly 4 decades and is now in semi-retirement. Drawing on his vast knowledge of procedures that have been done for decades in rural practice, Dr Magee features procedures on dealing with facial lacerations and testicular torsion, two types of injuries for which better outcomes can be predicted if dealt with on site, eliminating the travel time required to transfer the patient to a major centre. 

Regarding facial laceration, Dr Magee recommends plastic surgery techniques that can be done on site using techniques that can apply to lacerations anywhere on the body. Although many rural GPs are reluctant to perform on-site surgeries on facial lacerations, Dr Magee points out that if the initial procedure is undertaken with the greatest care, sometimes the first repair can be the best and can eliminate the need for more plastic surgery in the future. Testicular torsion, another injury with which rural GPs are often faced in teenaged and young adult males, requires a procedure in which the outcome is truly dictated by time. Practitioners have 4 to 6 hours to deal with such an injury and in many areas the travel time is too long, increasing the possibility that the testicle could be lost.

The 280-page book, which features 320 illustrations, offers instructions on a total of 40 unusual procedures, such as removing a fish hook, delivering a breech baby outside of a hospital, and using a power drill to relieve pressure caused by epidural bleeding inside the skull, a drastic procedure Dr Magee has undertaken in the past.

The chapter on the removal of fish hooks was contributed by popular author and Order of Canada member, Dr Harvey Thommasen, of Masset, BC, in collaboration with Dr C. Stuart Johnston of Vanderhoof. 

Other procedures outlined in the manual draw from articles published in the Canadian Journal of Rural Medicine’s “occasional procedure” series, which features submissions from rural physicians across Canada. 

The motivation behind the project was to determine a scope for teaching rural procedures, particularly in the new medical faculty at UNBC and at the Northern Ontario School of Medicine, but interest in the book has spread beyond its use as a teaching tool.

Dr Magee says that neither he nor the Society of Rural Practitioners realized how timely the creation of the manual would be when the idea was initially conceived, and he has been pleasantly surprised by the level of interest in the publication not just from medical students but also from physicians already practising in rural areas. The manual can be purchased from the Society of Rural Physicians on their web site at www.srpc.ca.

—Tara Lyon
BCMA Communications

Pandemic preparedness exercise

For the first time in British Columbia a regional preparedness exercise that focused on a community’s response to pandemic influenza was conducted in Cranbrook on 20 February 2007. As a member of the Psychosocial Issues Committee of the Ministry of Health’s Pandemic Planning initiative, I was invited to attend as an observer.

The exercise was coordinated by Just Like Real Exercises Inc., a group that specializes in organizing various types of disaster drill. Dr. Tracey Parnell (an emergency physician) and Murray Bertram (a retired Canadian Air Force colonel) are two of the principals in this group that conducts integrated emergency response exercises in accordance with the mandated British Columbia Emergency Response Management System (BCERMS) and the Incident Command System.

Participants included ambulance, fire, and RCMP detachments, volunteer rescue crews from nearby communities, experienced clinical staff from the local hospital and college, and many volunteers from the community, who along with mannequins acted as victims. Representatives from regional health authorities, who have strategic planning responsibilities, were also well represented among the observers.

To create a sense of realism, the exercise was preceded by news releases from the WHO declaring Phase 6 of pandemic influenza warning, with the active spread of H5N1 virus between humans that began in Southeast Asia, now having spread to nearby communities in Alberta. Staff were on call-in alert and the exercise began at 8 a.m. Throughout the exercise, a strong emphasis on participant safety was evident, such as during the introductory briefing for first responders held in the gymnasium of the College of the Rockies. Their nursing teaching wing was reconfigured to act as an alternative treatment centre, with the use of portable beds and specific areas for triage, emergency treatment areas with an adjacent “lab,” an intensive care ward with portable X-ray, and several wards set up in classrooms, including palliative care. During the drill staff wore N95 masks, gowns, and gloves and also had an opportunity to try the new 3M positive pressure hoods that operate from an 8-hour battery pack fastened with a quick-connect belt.

The local Telus office set up an emergency operations centre, where multiple phone lines received calls from local citizens, including specific representation from the First Nations community. Operators used the reported symptoms as telephone triage to dispatch home assessment teams. A drill like this can identify how challenging effective response to something like the delayed availability of road maps can be! The two-person teams, again all wearing barrier protection, performed a structured assessment and decided on telephone follow-up, with social services support, or arranged for BC Ambulance Service transportation for the more severely ill.

Once those transported arrived at “hospital,” they went through the initial triage assessment at the alternative treatment centre. If that wasn’t challenging enough, a mass casualty incident was staged at 1:30 p.m., involving a vehicle fire and a mock crash between a school bus and a car. The heavy snow at the peak of the exercise was a reminder that the real events could take place in any weather condition. Police were the first on the scene, followed by BCAS and a fire truck. The sense of teamwork and coordination was very impressive.

The weak link in this exercise, from my point of view, was the lack of integration of family doctors in the community and of hospital-based physicians into the planning and the exercise itself. There was also the lack of Regional Health Authority and governmental support for the initiative. This seems to be a national phenomenon. Addressing this deficit could do a lot as a springboard for primary care renewal, not to mention the public health benefits that would result. Glitches such as overload of the call centre, errors in prioritizing ambulance calls, overload of coroner’s and mortuary services, lack of enough pastoral/spiritual care support, inattention to the stress caused by the care needs of victims’ pets or farm animals are some examples of how a region can improve on its strategic planning.

Overall, this was an excellently run exercise, of great benefit to the local community, and an effective approach to learning.

—Ian A. Gillespie, MD
Victoria

Pharmaceutical disposal

Despite the fact that unused pharmaceuticals are a significant health, safety, and environmental hazard, disposing of them in a responsible manner is often a challenge. Patients may bring in their unused meds to doctors’ offices, and drug reps give many samples of their products. This leaves many physicians wondering what to do with pharmaceutical waste. Many may not be aware that the Province of BC regulates this waste under the Recycling Regulation within the Environmental Management Act. This regulation holds the producers responsible for their waste under a system of extended producer responsibility (EPR). In response, the brand owners set up the Post-Consumer Pharmaceutical Stewardship Association (PCPSA). More information and a list of all participating pharmacies is available at www.medicationsreturn.ca/british_columbia_en.php. In this system, consumers can take their unused medications to any of the pharmacies (90% of the ones in BC) at no charge. The containers are provided to the pharmacies for free and the brand owners pay for the disposal through the PCPSA. Herbal medications, throat lozenges, and mineral supplements are included under this regulation. Patients do not have to take the medications back to the pharmacy where they purchased them.

Unfortunately, the regulation specifically excludes unused or expired drugs from hospitals and offices of medical practitioners, possibly a result of an assumption that these areas have their own systems in place. This leaves each medical office to sort out its own arrangements. While this is possible through companies like Hospital Sterilization Services, Clean Harbors, and Stericycle, the question remains as to whether the producers should be responsible for some pharmaceutical waste or all of it. Part of the goal of extended producer responsibility is not just to have the producers look after the waste but to drive changes that might reduce the waste, like better management of samples or provision of different dosage sizes. So the bottom line is that physicians still have to look after the waste. Some steps that could be taken are:

• Ensure pharmacy representatives take back any unused samples.

• Let patients know that they can return unused meds to local pharmacies (posters may be available through PCPSA).

• Write to the Ministry of Environment asking for the regulation to include all pharmaceutical waste.

• Arrange for responsible disposal of any remaining medications.

More information is available at www.env.gov.bc.ca/epd/epdpa/ips/meds/index.html.

—Sue Maxwell, BSc, MEM
Regional Program Coordinator, Environmental Management, 
Vancouver Coastal Health Authority

Agreement news update

The home page on the members’ web site has been redesigned, so it’s easier for you to find information about the 2006 Agreement. Material is now grouped into three main areas: Member Information, Agreement News, and Public Information. The links under Agreement News take you to updates on topics such as information technology in physicians’ offices (PITO), general practice items (GPSC), general compensation changes, rural programs, MOCAP, emergency medicine, specialist services, and alternative payments.

PITO

The request for proposals for developing electronic medical records was released at the end of February. Interested vendors had until the beginning of April to submit their proposals, and up to a maximum of six successful applicants will be selected at the beginning of July. A pilot project with practising physicians will begin this summer, with further implementation starting in early 2008. For more information, please refer to the February PITO update on the members’ web site.

GPSC—Practice Support Program

GPs, you and your MOA are invited to attend a 1-day, hands-on workshop designed to help you increase your practice efficiency and revenue without working longer hours, and to improve the quality of your work life. A number of these workshops will be held throughout the province this summer between 1 May and 14 June. 

At the workshop, many practice-related topics will be covered. For example, you can learn how to conduct a practice assessment to determine what percentage of your patients are meeting CDM clinical guidelines and in which areas you are under-billing. Other issues include learning how to:

• Create and use patient registries.

• Implement and manage group visits.

• Manage patients with chronic diseases.

• Help patients use disease self-management tools.

• Implement more efficient patient scheduling. 

The workshop will be delivered by your health authority’s Regional Practice Support Team, a team of GP and MOA peer champions, and family practice resource personnel. Each topic is organized so that it is flexible and can be tailored to meet the needs of your practice. You will have the opportunity to discuss your practice situations with fellow physicians and MOAs and receive reference guide books to take home.

For at least 18 months following the workshops, there will be ongoing peer support from members of the Regional Practice Support Team and more learning opportunities for you to take advantage of. This ongoing support will enable you to continue to implement the kind of changes you want with input from your peers.

For details and to register, please go to the web site and click on Practice Support Program.

—Fiona Youatt
BCMA Communications

Pregnant BC physicians take note

Apply now for the Pregnancy Leave Program. Physicians practising medicine in BC who are having a baby or planning a pregnancy in the period of 1 April 2007 to 31 March 2008 can take advantage of the BCMA Pregnancy Leave Program (PLP). The PLP is the new name of the Maternity Leave Benefit Program that was negotiated for you in the 2001 working agreement between the BCMA and the government of British Columbia and continued under the 2006 Letter of Agreement. The PLP provides a benefit to assist new mothers to recover from pregnancy and delivery. Application for benefits must be made no later than 8 weeks after the birth of your baby. For more information, contact Ms Lorie Arlitt, PLP Administrator (see below).

Pregnancy and disability insurance. Did you know that pregnancy complications experienced by a female physician are covered under the BCMA disability insurance plans (Physicians’ Disability Insurance (PDI) and/or BCMA Disability Income Insurance)? Births requiring a cesarean section are considered complicated. In most cases disability payments will be considered by the insurer for a maximum 6-week post-operative recovery period or until the claimant returns to work (whichever occurs first). The duration of payment can be extended beyond 6 weeks in the event that complications occur post-operatively that further delay recovery. Under the PDI Plan, unless otherwise stated in the physician’s certificate of insurance, benefits commence from the first day of hospitalization. Receipt of disability benefits from either plan will not reduce Pregnancy Leave Program payments.

If you have any questions about either the Pregnancy Leave Program or the Disability Insurance plans, Ms Lorie Arlitt will be happy to assist you. You can reach Lorie at 800 665-2262, ext. 2882, 604 638-2882, or larlitt@bcma.bc.ca.

—Sandie Braid, CEBS
BCMA Benefits Department