dr
day: hospitals need to wise up
Your article "Experts duke it out over how to fund our
hospitals" (February 15, Vol 3, No 3, page 40) is excellent.
Proponents of the status quo will always fight for the
status quo. One of the future developments is that "health
policy experts," who base their views mostly on Op Eds
written by themselves and like-minded colleagues, are
likely to be displaced as true evidence-based reforms
are introduced. Academic institutions such as the new
UBC's Sauder Business School's Centre for Health Care
Management, with expertise in basic and practical economic
and business theory, will displace health policy groups
who promote theories that are largely ideology based.
We saw what Robert Evans and colleagues did for medical
school enrollment with their theory that too many doctors
and nurses were the driver for rising health costs.
It's no coincidence that the report
of Senator Michael Kirby, a PhD in mathematics who applied
simple logic and basic internal marketing principles,
came out solidly in support of patient-based funding
(PFF). In late October of 2006, the updated OECD report
also came out solidly in support of it. Of course there
must be safeguards in place, and it's not a panacea.
Smaller rural hospitals can actually outperform large
institutions, although the opposite has been claimed.
We're very lucky to have the British experiment to learn
from.
Dr Brian Day,
CMA President-Elect, Vancouver, BC
INTERNATIONAL
INCIDENT
Shame! Your article "Metabolic Syndrome wreaks heart
havoc" (February 15, Vol 3, No 3, page 10) uses US units!
How can a Canadian medical review do this?
It's not rocket science to convert
triglycerides, cholesterol and glucose from mg/dL to
mmol/L. Divide triglyceride by 88, cholesterol by 38
and glucose by 18. Several programs do this automatically.
Why bother with such an article in mg/dL? Amazing US
bias I am appalled.
Dr Mark S Silverman,
Ottawa, ON
Editor's response: We're
most decidedly Canadian-biased at NRM. Here are the
SI units as they should have appeared:
- raised triglyceride
level: >/=1.7 mmol/L, or specific treatment for
this lipid abnormality
- reduced HDL cholesterol:
< 1.03 mmol/L in males and < 1.29 mmol/L in
females, or specific treatment for this lipid abnormality
- raised fasting plasma glucose
(FPG): >/=5.6 mmol/L, or previously diagnosed type
II diabetes
The corrected table is available
at this link: www.nationalreviewofmedicine.com/issue/2007/02_15/4_patients_practice01_3.html
GREEN
AND NOT-SO-GREEN
Here's what some of your colleagues had to say about
our January 30 poll question, "Would you call the main
facility where you practise "environmentally friendly?"
for
full poll results click here):
- Our facility makes every
effort to reuse, recycle and minimize waste or use
of materials that are not recyclable. Washable gowns
and sheets, sterilizable speculae, etc, help to protect
our resources and reduce environmental stress.
- We have both old and new buildings.
"Old has mould!"
- I work in a converted dog research
lab and with old carpeting on the floor, spotty recycling
and terribly poor ventilation, the place is more of
a health hazard than anything. I try to do my best
to take plastic bags from home to recycle, avidly
blue boxing any and all appropriate paper, bringing
lunch in washable containers and recycling the endless
supply of water bottles that patients forget in my
office, but it all feels like an uphill battle. I
think that the place ought to be torn down but I bet
it's got asbestos in it somewhere!
- Every computer always on, every
light always on, doors propped open in the winter
to let excess heat out, minimal or no recycling. No
doctor would allow his own house to be run like we
run our hospitals. This should be a major priority.
The damage our hospitals do to the world and its citizens
violates "primum non nocere."
- No facility is environmentally
friendly unless you want to spend megabucks on that
same edifice. With the remuneration we receive, why
increase our overhead any more? It would be nice to
be enviro-friendly, but that's not very practical.
- Our building does not recycle
any recyclable materials. I'm trying to change this.
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