August 5, 2019

Since my grandson and his partner moved in we have a little or a rather huge critter living in our basement. The cat belongs to our grandson’s partner and our two animals had a bit of trouble adjusting to this creature downstairs. At first, whenever Lunar escaped from his home and snuck up the stairs my two creatures would bark and chase poor Lunar back down the stairs. Things have improved and now when Gaby starts her barking which sounds more like yelling she is wagging her tail. When I shake my finger at her and tell her to be quiet, she listens, at least for a while.   Patches only barks when Gaby tells him to. Sounds crazy, I know, but she has a way of nudging him so that he knows exactly what she expects him to do. Here are a few pictures of the creatures in our zoo.

 

 

 

 

 

 

 

My pain during these last few weeks has been quite severe again.  This morning I had had enough.  When this happens, I tend to hide away in my den and write.

A researcher at McGill University says that for the most part, the health care community focuses on medical advances and shows little interest in finding treatments for chronic pain. (iStock)  CBC News.

I felt it was important to add this article, published September 28, 2013, to my blog in case my readers did not notice it online.  The article reads as follows.

For many Canadian doctors, managing pain is ‘not a high priority’.  The headlines are full of breakthroughs heralding new treatments and cures for a host of debilitating and lethal diseases and conditions.  But for the millions of Canadians who suffer from chronic pain, relief – let alone a cure – is still elusive.

According to the Canadian Pain Society, one in five Canadians suffers from chronic pain. Yet treatment has not been a priority in our health care system; instead, people who complain of chronic pain are all too often derided as whiners.  They say doctors are incredulous that their pain – which might have no apparent cause – could possibly be that bad.  Or else they’re just counseled to grin and bear it.

That nonchalance reflects an attitude in western cultures, where pain is largely considered a sign of virtue and a test of character, says Dr. Fernando Cervero, director of the Alan Edwards Centre for Research on Pain at McGill University.

Attitudes slowly changing

But Dr. Cervero notes that social attitudes are changing. Patients and their advocates are demanding better and more timely treatment for chronic pain. But the medical establishment has not kept pace with those changes. For example, veterinary students receive much more training in pain management than medical students.

The societal change in attitudes toward pain “has not completely permeated all the way to the medical schools,” Dr. Cervero told The Sunday Edition’s, Michael Enright. “In a curriculum that is getting more and more busy with more and more discoveries in medicine – and we all have to fight for time in the medical curriculum – pain is not a high priority.”

Dr. Cervero, who will be speaking at an international symposium on pain at McGill University says more must be done to make the relief of pain, especially for chronic pain sufferers, a top priority in Canadian health care.

“It’s not right for people to suffer unnecessarily,” he said.

It seems that medical professionals, both in Canada and the United States,  have not listened to someone like Dr. Cervero.  Instead of helping people who suffer from chronic pain, our doctors have made many of our lives hell on earth.  They certainly have done nothing to make the relief of chronic pain a top priority in Canadian health care.  Many doctors are afraid of prescribing pain medication because they fear censure.   What about the patient’s fear?

According to the internet, chronic pain patients are not only having problems getting opioid medication, but most are also finding it hard just finding a  doctor willing to treat their pain, according to a new survey.  Over 70 percent of patients said they are no longer being prescribed opioid medication or are getting a lower dose.   Mar 16, 2017

The following Canadian Code of Ethics for Doctors is an interesting read.  There are quite a number of points that my doctors have not bothered to follow.  Sadly, I and many others are the ones who suffer.

CMA Code of Ethics  (Update 2004) Last reviewed March 2018: Still Relevant

Fundamental Responsibilities:

1. Consider first the well-being of the patient.
2. Practice the profession of medicine in a manner that treats the patient with dignity and as a person worthy of respect.
3. Provide for appropriate care for your patient, even when cure is no longer possible, including physical comfort and spiritual and psychosocial support.
4. Consider the well-being of society in matters affecting health.
5. Practice the art and science of medicine competently, with integrity and without impairment.
6. Engage in lifelong learning to maintain and improve your professional knowledge, skills, and attitudes.
7. Resist any influence or interference that could undermine your professional integrity.
8. Contribute to the development of the medical profession, whether through clinical practice, research, teaching, administration or advocating on behalf of the profession or the public.
9. Refuse to participate in or support practices that violate basic human rights.
10. Promote and maintain your own health and well-being.

Responsibilities to the Patient – General Responsibilities

11. Recognize and disclose conflicts of interest that arise in the course of your professional duties and activities, and resolve them in the best interest of patients.
12. Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.
13. Do not exploit patients for personal advantage.
14. Take all reasonable steps to prevent harm to patients; should harm occur, disclose it to the patient.
15. Recognize your limitations and, when indicated, recommend or seek additional opinions and services.
16. In determining professional fees to patients for non-insured services, consider both the nature of the service provided and the ability of the patient to pay, and be prepared to discuss the fee with the patient.

Initiating and Dissolving a Patient-Physician Relationship

17. In providing medical service, do not discriminate against any patient on such grounds as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, or socioeconomic status. This does not abrogate the physician’s right to refuse to accept a patient for legitimate reasons.
18. Provide whatever appropriate assistance you can to any person with an urgent need for medical care.
19. Having accepted professional responsibility for a patient, continue to provide services until they are no longer required or wanted; until another suitable physician has assumed responsibility for the patient; or until the patient has been given reasonable notice that you intend to terminate the relationship.
20. Limit treatment of yourself or members of your immediate family to minor or emergency services and only when another physician is not readily available; there should be no fee for such treatment.

Communication, Decision Making, and Consent

21. Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability.
22. Make every reasonable effort to communicate with your patients in such a way that information exchanged is understood.
23. Recommend only those diagnostic and therapeutic services that you consider to be beneficial to your patient or to others. If a service is recommended for the benefit of others, as for example in matters of public health, inform your patient of this fact and proceed only with explicit informed consent or where required by law.
24. Respect the right of a competent patient to accept or reject any medical care recommended.
25. Recognize the need to balance the developing competency of minors and the role of families in medical decision-making. Respect the autonomy of those minors who are authorized to consent to treatment.
26. Respect your patient’s reasonable request for a second opinion from a physician of the patient’s choice.
27. Ascertain wherever possible and recognize your patient’s wishes about the initiation, continuation or cessation of life-sustaining treatment.
28. Respect the intentions of an incompetent patient as they were expressed (e.g., through a valid advance directive or proxy designation) before the patient became incompetent.
29. When the intentions of an incompetent patient are unknown and when no formal mechanism for making treatment decisions is in place, render such treatment as you believe to be in accordance with the patient’s values or, if these are unknown, the patient’s best interests.
30. Be considerate of the patient’s family and significant others and cooperate with them in the patient’s interest.

Privacy and Confidentiality

31. Protect the personal health information of your patients.
32. Provide information reasonable in the circumstances to patients about the reasons for the collection, use, and disclosure of their personal health information.
33. Be aware of your patient’s rights with respect to the collection, use, disclosure and access to their personal health information; ensure that such information is recorded accurately.
34. Avoid public discussions or comments about patients that could reasonably be seen as revealing confidential or identifying information.
35. Disclose your patients’ personal health information to third parties only with their consent, or as provided for by law, such as when the maintenance of confidentiality would result in a significant risk of substantial harm to others or, in the case of incompetent patients, to the patients themselves. In such cases take all reasonable steps to inform the patients that the usual requirements for confidentiality will be breached.
36. When acting on behalf of a third party, take reasonable steps to ensure that the patient understands the nature and extent of your responsibility to the third party.
37. Upon a patient’s request, provide the patient or a third party with a copy of his or her medical record, unless there is a compelling reason to believe that information contained in the record will result in substantial harm to the patient or others.

Research

38. Ensure that any research in which you participate is evaluated both scientifically and ethically and is approved by a research ethics board that meets current standards of practice.
39. Inform the potential research subject, or proxy, about the purpose of the study, its source of funding, nature and relative probability of harms and benefits, and the nature of your participation including any compensation.
40. Before proceeding with the study, obtain the informed consent of the subject, or proxy, and advise prospective subjects that they have the right to decline or withdraw from the study at any time, without prejudice to their ongoing care.

Responsibilities to Society 

41. Recognize that community, society and the environment are important factors in the health of individual patients.
42. Recognize the profession’s responsibility to society in matters relating to public health, health education, environmental protection, legislation affecting the health or well-being of the community and the need for testimony at judicial proceedings.
43. Recognize the responsibility of physicians to promote equitable access to health care resources.
44. Use health care resources prudently.
45. Recognize a responsibility to give generally held opinions of the profession when interpreting scientific knowledge to the public; when presenting an opinion that is contrary to the generally held opinion of the profession, so indicate.

Responsibilities to the Profession

46. Recognize that the self-regulation of the profession is a privilege and that each physician has a continuing responsibility to merit this privilege and to support its institutions.
47. Be willing to teach and learn from medical students, residents, other colleagues, and other health professionals.
48. Avoid impugning the reputation of colleagues for personal motives; however, report to the appropriate authority any unprofessional conduct by colleagues.
49. Be willing to participate in peer review of other physicians and to undergo review by your peers. Enter into associations, contracts, and agreements only if you can maintain your professional integrity and safeguard the interests of your patients.
50. Avoid promoting, as a member of the medical profession, any service (except your own) or product for personal gain.
51. Do not keep secret from colleagues the diagnostic or therapeutic agents and procedures that you employ.
52. Collaborate with other physicians and health professionals in the care of patients and the functioning and improvement of health services. Treat your colleagues with dignity and as persons worthy of respect.

Responsibilities to Oneself

53. Seek help from colleagues and appropriately qualified professionals for personal problems that might adversely affect your service to patients, society or the profession.
54. Protect and enhance your own health and well being by identifying those stress factors in your professional and personal lives that can be managed by developing and practicing appropriate coping strategies.

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