He’s even claimed counselling can rehabilitate ISIS without listening to psychiatrists who know more than a drama teacher how much care is needed to rehabilitate our own vets let alone those who want to kill us. Fewer resources are now being fought over by sick and well patients and activists feeling that they are ‘entitled to a daily MRI’ , angry that any doctor would question their right to the highest paid diagnostic tools, because to many health care is a ‘fashion ‘, a prop, entertainment or commodity. When the ‘worried well’ and the dying compete for resources the ‘worried well’ , the loud complainers , the entitled , the sociopaths and psychopaths win. The really sick and the dying don’t have the energy to impress the Minister of Health. By the time we’re old, sick and dying we’ve used up our resources. The young and angry and political and rich know how to work the system. The Ontario Liberal Government just offered free pharmacare for the young who generally don't need it while denying the sick and old life maintaining and life saving medications. The despair that psychiatric patients commonly arrive with is palpable. It's worse than I’ve witnessed in all the years of my career. Yet my leadership tells me that I'm wrong to care. They claim that professionalism is the callous disregard for humanity that they maintain. It's this heartlessness that gets them appointed by those above who seem only interested in cutting costs and saving money for their own dachas and jet setter trips. I see the homeless forgotten alone, alienated and very much aware of their ‘worthlessness’ and the ‘hopelessness of their situation’. The time the bean counters alot is gone before they can dry their tears.
If you’re considering resource management it’s called a shit show but a doctor will be called in for unprofessional language because it's so easy to police the doctors than the malingerers, violently insane, and psychopaths. It's no different with the increasing gun laws that tax and control law abiding citizens while criminals get more and more arms and have less and less consequences for this. Only the doctor is accountable for illness. The doctor when he’s with a patient whose a ‘victim’ and ‘blames everyone’ then the doctor is more often than not now trying to avoid becoming the ‘cause celebre’ of the entitled activist. Increasingly these people trust funds, criminal sources of money or on disability ,but generally having infinite time and resources to 'work the system'. and get the bureaucrats working and colluding with them. Meanwhile the the doctor has hundreds more patients and a College and government representatives poised with guns to shoot them in the back if they are not perfect. Only one in a hundred general practice patients fits this description but they concentrate in a psychiatric practice and especially in a dual diagnosis practice. Psychiatrists are the highest suicide risk in the profession and the College has general practitioners and lawyers talking to them rather than psychiatrists who governments distrust because their own personal insanity, early dementias and various addictions and character flaws are obvious to those trained to see the signs.
It’s like that now in practice. I don’t want to miss something. I don’t want to make a mistake. It’s not because i worry about an idiot in the beurocracy with too much ego and too little clinical skill or common sense but it’s the way most of us doctors are wired. We don’t need this massive industry of watch the doctor any more than the police need a fortune spent double checking on them. But there’s so much more money in ‘policing’ the front line workers and not going after the pedophiles and wankers far from the front lines. I believe we’d eliminate ‘fake news’ if we simply drug tested the media and parliament and congress. I’m so often afraid when I say good by to a patient at the end of an appointment that they won’t live till I see them again. The fentanyl epidemic has taken some of my young patients.
I diagnosis the missed ptsd and head injuries, addictions, the thyroid disorders, cancer sometimes, hep C and a whole burden of illness that previously was seen only in the hospital practices. Psychiatric patients especially drug and alcohol addicted are least likely to wait for 10 hours in the ER or for tests. Some days half my work seems to be convincing patients to get the tests done other doctors ordered or re writing tests the patients lost. Meanwhile the College and the lawyers are essentially telling doctors with winks and nudges , don’t dare ask about sex because some woman will be offended . Negligence is okay but we’ll deny everything because you’re on your own. Negligence is the norm in the Canadian Health Care System but no one neglects to 'chart'. The CMPA to help doctors defend against the iniquities of the College one day said for every 15 minutes of health care a doctor should do 15 minutes of charting. Overnight half the medical care in Canada was replaced by charting, yet there is no more time or money allotted for doctors charting. The time and energy comes out of direct patient care. There's no 'fat' in the front lines. All the fat cats are the bureaucrats and they're not taking any cuts or giving up their power or control any time soon.
The easiest practice is ‘mood disorders’. Call everything Bipolar II and play ‘let’s make the drug companies money ‘by randomly trying every pill in the pharmacopoeia till the natural history of the disease passes and the patient gets better or leaves. “The variation of this is “, I can’t treat your depression but I’m really good at treating side effects so I’ll give you something else and make myself look good as a doctor alll the while we’re not addressing your depression or anxiety. I will make you dependent on me. “I’m reminded of my mother saying if you don’t stop crying I’ll give you something to cry about.
The pain clinic exhaust its box of expensive investigation and treatments and 'fires' the patient who comes back to the family physician and psychiatrist even more jaded and disappointment. These new 'clinic's' don't have the notion that they are 'accountable ' for the patient but rather that they provide a 'treatment' and if that doesn't work the patient is 'somebody else's problem'. The "SEP" is the norm in the Modern Canadian Health Care system. The lack of family physicians is directly associated with the burden of chronic care and difficult patients with no 'solution' who gather in droves at the front lines and wail and keen far from the ears of the government offering 'free health care' to everyone else but denying the obligation to care for individuals who are 'outliers' and don't respond to the cheap standard 19th century approach.
I don’t feel I have time, today. Everyone wanting a piece of me and everyone wanting it ‘free’. The irony there is that increasingly people think what we’re doing isn’t worth what the health ‘coaches’ do because they ‘cost’ money and ‘health care’ is ‘free’ but then no one goes to the doctor anymore unless they’re really sick or they want to get a second opinion on the internet where the doctors and nurses have left the private face to face health care rat race to become entertainment doctors. So much of what I read in internet medicine is wrong and political and it's sad when patients find these sites that confirm their erroneous bias. I even had a bureaucrat describe medicine as " just entertainment". They actually encouraged me to “act”like doctor rather than be a doctor all the while saying that they didn't want me to be inauthentic, while nothing more inauthentic could be stated. Bureaucrats aren't trained in psychiatry, or psychiatric psychotherapy or psychiatric relationship therapy or advanced communication and obviously knows nothing about psychiatry or psychiatric patients but have all that arrogance that generalists have, like those patients of ours who having looked at the internet know more about their disease than all of us. When it comes to specialist medicine especially psychiatry which I likened to three dimensional chess compared to the unidimensional chess model of doctor as daddy fixing mom's brain with pills. The patriarchal nature of this 'i'm good, you no good' 'I'm well, you're not well', i'm police you criminal' 'My brain good, your brain bad' is so 1980's before all the research of transactional analysis and all the modern training in psychotherapy and 'behaviour change ' , but there's no arguing with these people. They have the gun so they need to be respected and doctors pretzel themselves and train themselves and waste years of their lives doing everything increasingly to serve the administration regardless of whether it truly helps the patients because the patients are increasingly the least important people in the new entertainment industry. It's really sick and creepy from one perspective. But then it's all a matter of perspective because even psychopaths and sociopaths believe they are good people helping others. So psychiatrists like most good doctors learn and turn and twist and do everything including sacrificing themselves by suicide because we're people pleasers and good citizens now at the mercy of psychopaths and sociopaths. Besides it's all fake news and there's an epidemic of 'false witness' deceit and systemic retrospective falsification.
20.Meanwhile I just want to help the really sick not the patients who know how to beat up doctors and suck the life blood and soul out of care givers. The Celestine prophecies described these as ‘soul sucker’s" and they’re just a whole lot more resourceful today. The Prochaska “stages of change” model (precontemplation, contemplation, determination and action )strongly suggests putting resources in at the determination or action phase and patient’s coming to specialist in the past were at that point while increasingly patients today are into contemplation, happy to talk to the doctor as infinitismal, entitled to the time and unwilling to leave the office but equally unwilling to change their chronic negative behaviours or thinking. Noncompliance and non adherence to medical regimen in chronic lifestyle disorders the new norm of medicine that generalists and especially specialists face.
Hail Mary, Mother of God pray for me in the hour of my death.