d o c t o r o n a s o a p b o x D r . C h r i s P e n g i l ly Dr. Chris Pengilly is Just For Canadian Doctors’ current affairs columnist. Please send your comments to him via his website at drpeng.ca.
History lesson
Reflecting on a long career that’s seen many big and broad changes in the medical field
at your
solution from Winter 2020 contest
service
It was also this decade that saw the useful utilization of diagnostic ultrasound. This provided a relatively inexpensive, safe and mostly effective diagnostic tool. It’s used, for example, in diagnosing gallbladder pathology or, probably most prominently, as the obstetrical ultrasound—undertaken productively about two or three times even in uncomplicated pregnancies. In 1981, there was the introduction of captopril, the first ACE inhibitor. Initially indicated for the treatment of refractory hypertension, it introduced the first welltolerated antihypertensive and was also more than useful in treating congestive cardiac failure. Though it is no longer available in Canada, it did blaze the trail for ramipril and a whole bunch of other ACEs. This was shortly followed by ARBs that have proven equally useful and better tolerated. The development of PDE-5 inhibitors in 1981 has revolutionized the treatment of the distress in pulmonary hypertension, with the very useful side use for erectile dysfunctions. This was a difficult condition to treat in family practice, leading to my sense of helplessness and prescribing the useless placebo of yohimbine. In 1982 I had the first case of AIDS admitted to hospital; he was discharged with the diagnosis “viral infection NYD.” At that time this was a 100% fatal illness but now it’s another chronic disease with which to exist under medication.
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Just For Canadian doctors Spring 2020
The result of these and many other changes means that physicians—all physicians—are able to offer patients many options and improved treatments. A few of these treatments will reduce the demands on the system; for example laparoscopy reduces hospital stays significantly. But this is more than offset by the needs of many patients—like the 59,000 hip replacements and 70,500 knee replacements last year in Canada. As I leave the profession it seems to be in a bit of a shambles. Wait times are becoming untenable again, and there is a chronic shortage of hospital beds and nursing home care. I am treading very carefully here because I want to avoid any misunderstanding. I am not suggesting an alternative private pay system. I am suggesting revisiting the politically unpalatable concept of a modest user fee for those that can afford it. As an example, my wife is now on a seven-to-nine-month waiting list (along with hundreds of others) to have a second knee replacement. During this time, I’ve witnessed her becoming increasingly disabled (now able to walk about 200 metres on the level). I’m fortunate to be able to pay a reasonable user fee—with no expectation of queue jumping. And I’d like to be able to do so. Can total medical care continue to be provided completely free? At the very least let us start a discussion…
sudoku 2 harder solution
8 6 2 4 9 1 5 7 3
3 9 5 2 7 6 4 8 1
1 7 4 8 3 5 6 9 2
7 2 1 6 8 3 9 5 4
5 8 6 9 4 2 3 1 7
4 3 9 5 1 7 2 6 8
2 5 3 7 6 8 1 4 9
9 1 7 3 5 4 8 2 6
6 4 8 1 2 9 7 3 5
Puzzle by websudoku.com
sudoku 1 easier solution solution from page 37
I
t has happened at last. I have finally terminated my provincial College licence. I orchestrated a soft landing from my original chaotic pace, but eventually had to quit taxiing along the runway and call it a day. This has inevitably made me look back over the 45 years since I first went into family practice in Canada in 1975. Looking back, the changes are great and numerous. I’ll admit that in 1969 (year of my UK graduation) I had hoped that by the time I retired from family practice I could say “oh, it’s just a cancer, take these and see me in a month…” Nevertheless, there have been many changes enabling physicians to offer hitherto unimaginable treatments as a result of unforeseen diagnostic tests and pharmacotherapies. I’m sure that many of the younger readers could not imagine practising medicine without the ready availability of the CT scan (1979), let alone the MRI (early 1980s) or even the PET scan (1995). This enhanced medical imaging, besides being a great help to oncology, also enabled (or at least facilitated) the development of effective and enduring joint replacements. The hip was first (early 1970s), then the knee (1970s through 1980s) and the successful shoulder (1985). The 1970s seem to have been a busy decade, during which the rapid development of computer chip-based microcameras was a pivotal event in the rapid introduction of laparoscopy and facilitation of flexible endoscopies.
7 4 3 8 9 6 2 1 5
5 2 1 7 4 3 8 9 6
8 6 9 2 5 1 4 3 7
9 1 4 5 3 7 6 2 8
6 5 2 4 1 8 3 7 9
3 8 7 6 2 9 1 5 4
4 3 8 1 7 5 9 6 2
1 7 6 9 8 2 5 4 3
2 9 5 3 6 4 7 8 1
Puzzle by websudoku.com
