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The Patient-Physician Covenant: An Affirmation of Asklepios from Annals of Internal Medicine
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Medicine is, at its center, a moral enterprise grounded in a covenant of trust. This covenant obliges physicians to be competent and to use their competence in the patient's best interests. Physicians, therefore, are both intellectually and morally obliged to act as advocates for the sick wherever their welfare is threatened and for their health at all times.

Today, this covenant of trust is significantly threatened.

The Bhagavad Gita Comes Alive
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The Bhagavad Gita Comes Alive coverDr Chris Sedegreen.

Some time before the Christmas holiday a colleague mentioned a book, The Bhagavad Gita Comes Alive, on the Doclounge listserve. I’d like to thank him for bringing this lovely book to our attention. I ordered and received the paperback version (somewhat cheaper than the hard cover, but in retrospect I wish I'd ordered the hard cover). This publication is beautifully printed.

The Future of Psychiatry?
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Dr. Chris Sedergreen.

A highly respected psychiatrist has recently sent a letter to her patients announcing her decision not to return to clinical practice. I've known her professionally for over 15 years and can attest that her departure will leave a gap in her patient's lives that will be almost impossible to fill.

What loud bells will wake BC doctors and the public to the dangers of Bill 36, the HPOA?
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Dr. Zafar Essak, MD - Vancouver, BC - November 6, 2023.

Image of the great bell ben.There is a sleeping sickness throughout our land. It has found its way into health care and affected all the doctors. It is not some esoteric thing happening in some small political arena or lawyers club. This impacts all of BC and all of us: the ability of doctors to practice medicine the way they were taught and trained, according to their conscience and oath for the benefit of patients.

The significance of Bill 36, the Health Professions and Occupations Act, is profound and the association, Doctors of BC, should be ringing alarm bells. Instead, they are subduing the importance of it, convincing all doctors to move on to the regulations, like lemmings over the cliff. Not only is this unhelpful to doctors, it is actually dangerous for doctors with their purpose and professional obligations to deliver health care to patients. Bells need to ring everywhere, and the association should be dissolved.

Rethinking the Internet: How We Lost Control and How To Take It Back
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Rethinking the Internet, scene of the debate.This is an interesting and thought provoking 1 hour video interview and debate. It begins with a 5 minute overview and then proceeds with an interview by moderator Bill Blakemore with Jaron Lanier, a long-time computer scientist and developer and the father of virtual reality, who is concerned about the use of behaviour modification "to engage and addict you to algorithmic exploration until we find whatever it is that will get you".

Following the interview there is a debate with four speakers; Tim Hwang, Meredith Whittaker, Aviv Ovadya, and Brett Frischmann. They touch on many aspects of not only the Internet but also power in organizations, how it's lost and who has it.

What are ethics and why are they important?
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PM Justin Trudeau, politics and tech giants.2019-03-12 Dr Z.Essak, MD - Vancouver, BC

Ethics are a big part of our lives as principles that govern our actions. Doctors take an oath to serve the patient's interest and not their own or that of others.

We expect ethical actions of people involved with our daily lives: teachers, accountants, professionals, merchants and others. It is the basis of the trust we have in them. We depend on them as people with privilege and power over ourselves, children and others.

It's not just ethics in medicine and health: it's ethics in politics, in technology, in corporations and the list goes on. People are growing more concerned about the decline of ethical leadership in politics and also business tech giants like Facebook, Google and others.

What happens when an individual's actions run contrary to ethical principles?

The late Dr Morris VanAndel, a well-respected GP and subsequent Registrar of the BC College of Physicians and Surgeons, reminded doctors in 2002 this way: "An ethical principle, by nature, is not modified by circumstances, regardless of the validity or justification of the reasons leading to the action."

BC Auditor General issues report on Electronic Health Record (EHR) Implementation.
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Health professionals not effectively or adequately engaged.

Approach should ensure health professionals, stakeholders and the public are informed.

BC Auditor General, EHR implementation in BCOn February 17, 2010 the Auditor General of BC, John Doyle, issued his report on “Electronic Health Record Implementation in British Columbia” which is available on their website http://www.bcauditor.com

In his report, the BC Auditor General, acknowledges “The development and implementation of an EHR system … is a complex and high-risk endeavour … because of the large investment of public funds” and “because collecting, storing and disclosing information electronically raises concerns about the privacy and security of personal health information”.

The I Ching or Book Of Changes
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I Ching Wilhelm Baynes translation title page imageThe I Ching, or Book Of Changes, is an ancient Chinese book. While there are many translations, the German translation by Richard Wilhelm rendered into English by Cary F. Baynes (1950) has become a well respected classic. The book includes a foreword by CG Jung, psychiatrist and psychoanalyst, who has elsewhere described using the I Ching in his psychiatric practice from time to time. An electronic version of the text related to the hexagrams (the oracle), from the first part of the translation, can be viewed online or downloaded using the link below.

Times-Colonist OpEd: Dix needs to listen to healthcare providers
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Dix needs to listen to healthcare providers, The Times Colonist.Please read the OpEd by a BC family doctor that while Health Minister Adrian Dix uses findings of the Cayton report to defend the rapid introduction of Bill 36, the HPOA, he refuses to comment on the contradictory content in the report and snubs the issues raised by the Doctors of BC.

Cannabis, marijuana, what do we know?
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Chemurgy2016-10-16 Dr Z. Essak, MD - Vancouver, BC

Cannabis is a plant that has been part of human history for thousands of years and on every continent. The uses of cannabis are far beyond just medical and recreational use.

What do we really know about cannabis?

Is cannabis more than just good for medical and health use, is it also good for the economy and the environment?

Mistakes were made (but not by me): Cognitive dissonance
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Mistakes were made (but not by me): Why we justify foolish beliefs, bad decisions, and hurtful acts... a book co-authored by Elliot Aronson.

Psychiatrists specialize in the ails of individuals. Social psychologists specialize in the ails of groups. The eminent social psychologist Elliot Aronson was interviewed in a CBC audio "podcast" available from the following site:

http://podcast.cbc.ca/mp3/ideas_20080428_5430.mp3

It is an interesting program from the CBC radio “Ideas” on the subject of cognitive dissonance. It offers some insight into how people can so badly misinterpret things to fit their preconceived notions and prejudices and become incapable of accepting any other view.

The program runs about 50 minutes and I suspect if people even listen to just the first 12 minutes they might find it sufficiently compelling to listen to the rest. (The MP3 file can be imported into iTunes or other music manager or burned to CD.)

Don’t FIPPA your PIPA without knowing this when it comes to personal health information.
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Vancouver, BC – May 3, 2010

Stethoscope and keyboardWhen it comes to the privacy of personal health information everyone in British Columbia needs to know how FIPPA (also known as FOIPPA) is different from PIPA, and the same may apply in other jurisdictions across Canada and elsewhere.

This is of particular importance when information is shared between your doctor's private office and a hospital or clinic operated by the Health Authority which is a public body.

In BC, three different legislative Acts govern the privacy and protection of individual personal health information.  There are some very important differences in how these work and the results they have that should be known to all doctors, health providers and patients/clients.

Judicial Review of Dr. Bonnie Henry’s Orders begins in BC Supreme Court on Monday, November 20, 2023.
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Update (April 12, 2024): A Judgment has not yet been delivered. Many people hoped it would be sooner and still hope it will be soon.

Dr. Z. Essak, MD - Vancouver, BC - November 19, 2023.

Vancouver Law CourtsFinally, an opportunity for everyone to hear a BC Judicial Review of the ongoing orders of Dr. Bonnie Henry, Public Health Officer, and the BC Government that, since November 2021, have impacted the livelihood of thousands of health care workers in BC who are unvaccinated, prohibiting them from working in health care. BC and Nova Scotia are the only jurisdictions in the world that have not allowed unvaccinated health care workers to return to work. Orders and actions that have caused severe division even among health professionals and workers; where nurses, doctors, paramedics, porters and others are not sure who is safe to talk to if they disagree or think consent for vaccination is paramount.

Starting Monday, November 20, 2023, the BC Supreme Court will begin the Judicial Review of Dr Henry’s orders and the October 2023 amendment perpetuating them.

Burnout and Resilience
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Vancouver BC - Oct 19, 2011.

burning candleA talk on burnout in doctors at a recent conference in Vancouver provided good information and stimulated further exploration.

During questions the speaker said the prevalence of burnout in doctors is 20 percent and tends to occur in pockets or clusters.

The talk focused on burnout resulting from lack of recognition while caring for others. Although burnout can also result from lack of recognition from colleagues and co-workers, lack of resources, and degree of bureaucracy.

Burnout can also occur in other aspects of our lives besides our work.

Good news from the talk is research shows that when individuals examined their level of burnout and attended to the risk of burnout they were not only able to reduce their current risk but their future risk of burnout continued to remain less and even improved further over time.

Requirements to be Deputy Registrar at College of Physicians and Surgeons (CPSBC) – Is something different?
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Z. Essak, MD – Vancouver, BC – 2015 Apr 23

medical regulation shield imageThe College of Physicians and Surgeons of BC is looking to hire a new Deputy Registrar with the deadline for applications of April 30, 2015 fast approaching.

Is there something different about the experience required in this job posting – “a career opportunity in medical regulation”?

The proven experience and qualifications all candidates should have begins with, "minimum 10 years of senior administrative experience in a complex health-related organization (e.g. regulator, health authority, association, etc.)"

Also the requirements, while including "medical degree preferred", are open to others with "master of business/health administration or law degree also accepted".

Is this a sign of changes or a shift underway at the College (CPSBC)?

News Items

Requirements to be Deputy Registrar at College of Physicians and Surgeons (CPSBC) – Is something different?
Public

Z. Essak, MD – Vancouver, BC – 2015 Apr 23

medical regulation shield imageThe College of Physicians and Surgeons of BC is looking to hire a new Deputy Registrar with the deadline for applications of April 30, 2015 fast approaching.

Is there something different about the experience required in this job posting – “a career opportunity in medical regulation”?

The proven experience and qualifications all candidates should have begins with, "minimum 10 years of senior administrative experience in a complex health-related organization (e.g. regulator, health authority, association, etc.)"

Also the requirements, while including "medical degree preferred", are open to others with "master of business/health administration or law degree also accepted".

Is this a sign of changes or a shift underway at the College (CPSBC)?

Rick Mercer's 2013 Rant - Scientists Muzzled Again
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Rick Mercer Rant Scientists Muzzled Again

This is one of my favorite Rick's Rants. In less than 2 minutes he lays it all out. Beginning with the problem for scientists then in the middle he turns it up a notch, "Get over yourselves. It's not like scientists are the only ones being told to shut up. No, it's everyone." Then after some fine examples he ends with a polite, "Thank you for not talking." A great entertaining and thought provoking rant.

are you sure you want to drive this car ?
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You are done driving your bicycle, as you have successfully completed your race car driving school.

You decide that it is time to buy a car and put your training to use, driving people around, to feed your family, pay your student loans, mortgage etc …

You go to the only car dealerships available, all state owned dealerships, and you have no choice as they have a state sanctioned monopoly.

Has the BC Medical Association been stolen from the members?
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Doctors and members of the BC Medical Association (Doctors Of BC) are asking what is happening at the helm of the BCMA? Some are saying they think the new CEO Allan Seckel is not good for the Association and a sign that bad things are happening to the Association.

Who is Allan Seckel? How did he get to be the BCMA CEO? What is he doing as the CEO? And what is the BCMA Board doing?

Disagreement is central to progress
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It's never too late to change the world !

Ted Talks - Margaret Heffernan - Dare to disagreeIn this TED talks video Margaret Heffernan demonstrates "that disagreement is central to progress, that the best partners aren't echo chambers and how great businesses allow people to disagree".

http://www.ted.com/talks/lang/en/margaret_heffernan_dare_to_disagree.html

JN Mahy MD FRCSC

Dr Karpiak on Bill Good CKNW - Bureaucracy in health care is not sustainable
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Dr Dennis Karpiak, Internist and former BCMA Board Director from the Interior of BC speaking on the Bill Good Show CKNW radio 980 on July 10, 2012.

"It's become increasingly more difficult to sustain a practice in this province."

"The BCMA 20 years ago formed the Regionalization committee that predicted the rise of bureaucracy and a decline in patient care funding."

"Currently you can walk through any hospital and you'll see more administration offices than patient rooms."

Listen to the whole interview.

Burnout and Resilience
Public

Vancouver BC - Oct 19, 2011.

burning candleA talk on burnout in doctors at a recent conference in Vancouver provided good information and stimulated further exploration.

During questions the speaker said the prevalence of burnout in doctors is 20 percent and tends to occur in pockets or clusters.

The talk focused on burnout resulting from lack of recognition while caring for others. Although burnout can also result from lack of recognition from colleagues and co-workers, lack of resources, and degree of bureaucracy.

Burnout can also occur in other aspects of our lives besides our work.

Good news from the talk is research shows that when individuals examined their level of burnout and attended to the risk of burnout they were not only able to reduce their current risk but their future risk of burnout continued to remain less and even improved further over time.

Health issues for adults born with cerebral palsy
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What happens to children born with cerebral palsy when they become adults?

In one case an individual born with cerebral palsy when they were an adult in their early 30’s had progressive deterioration of function involving their affected upper limb.

The individual was reviewed by their orthopedic surgeon who suggested botox injections for spasms and possibly some cosmetic improvement to the upper extremity although not optimistic for functional improvement.

The 3D defence; Deny, Delay, Destroy.
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Corporate Personality Disorder book coverBook Review

The book, "Corporate Personality Disorder, Surviving & Saving Sick Organizations" by Eli Sopow, PhD draws heavily on medical practice examples and describes how "at the core of the Organizational Family Tree is the Triangle of Trust, which combines authority, responsibility, and accountability through a harmonious balance of communications, cooperation, and connectivity to others." He offers critical success factors for each of these six factors.

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