Company Doctors: Professionalism and Political Correctness

Historically, physicians among professionals have had the highest rating for trustworthiness and truthfulness.By contrast lawyers have been at the bottom of the heap.  Some actually say it’s sad that 90% of lawyers give the other 10% a bad name.  My old lawyer friend had insisted that this was  a product of the rise in social legislation that followed Prime Minister Pierre Trudeau’s reign.  My friend, an  old man, had  practiced law in Scotland before coming to Canada.

“I was proud to be a lawyer. It was a very honoured profession in my youth. Today I sometimes feel it’s just because of the money lawyers are perceived so negatively. I did well enough but if money was the sole criteria I’d not be thought as good a lawyer as some of my colleagues who sought celebrity and seemed only interested in the fame and fortune.  When I became a professional I saw it as a duty and service and frankly most of my colleagues saw it as that too.  We were there to serve people. Our independence and autonomy as professionals allowed us to protect our clients from governments and corporations alike.”

It wasn’t long after I heard him say that, that  a lawyer at my church told me “I think you can still can be a lawyer and a Christian in Canada but I no longer think you can be a Christian and a Corporate lawyer in Montreal.”

I can say the same is increasingly  true for doctors.  The lowest slur a doctor could make against another was to call him a “company doctor”. 

The ‘company doctor’ reached it’s a nadir during the years of the asbestos mining.  Miners were coughing up blood and dying all the while the doctors hired by the company and were paid exorbitantly essentially to lie and insist the problem wasn’t the  asbestos at all.  The miner instead, in classic ‘blame the victim’ was told he had ‘weak lungs’. It became the  great scandal of the era exposing corrupt courts, government, corporations and the doctors involved..  Science eventually prevailed as today we know and diagnose “asbestos lungs’. 

It should be understood that a doctor may give his opinion in court ,which remains a 19th century rationalist construct and sees the world in black and white as opposed to the multi factorial quantum universe considerations of 21st century rainbow science.  The ridiculousnesss of such ‘opinions’ was highlighted best by the farce of the OJ Trial with all its dream team and ignorance of DNA. 75% of the fruitfly DNA is the same as Human DNA. 

In British Columbia “Moynihan’s Law’  was enacted essentially to reign in the competing claims of ‘expert witnesses”.  Moynihans’s Law insisted that expert opinions be predominantly objective and serve the judge not the solely the lawyers paying them.  Some of the insurance company expert witnesses were paid so exorbitantly as to make the ‘company doctors’ of the asbestos mine era look like altar boys.   Tragically I was obliged to teach a judge the history of this in recent years, as he appeared to have missed out on the insanity of the courts that required a specific new “Moynihans’s law” to reign in the ‘expert testimony ‘ of competing factions.  Perjury laws have always existed but do appear to be rarely used as increasingly the courts move away from the ‘truth’ standard of old.  “The truth, the whole truth and nothing but the truth” is no longer associated with the modern court but rather remembered as a line from the Perry Mason era. 

The judge appeared unaware of Dr. Jay Lifton’s seminal book, the “Nazi Doctors” which addressed the whole issue of the ‘company’ or ‘government doctor’ in exquisite horrifying detail.  

It should not reflect badly on this judge because we’re collectively seeing this phenomena today  in the ‘fake news’ . The media was once constrained by the idea of ‘fact’ but today has  lost all track of the very notion of  ‘objective’ and now sells ‘facts’ as ‘opinions’ to the highest bidder.  Judges, themselves, have historically been considered’ corrupt’ as their opinions have been on occasion bought as readily as world soccer players.  The remaining issue today ,as Canadian culture devolves into multiculturalism,  increasingly,  is not whether someone will sell out their integrity but at how low a price.

Around  the world in other jurisdictions and cultures the issue is not whether to bribe the official ther how little one can give without insulting   government representative. The whole idea of the ‘tip’ which once was only an issue in hotels and restaurants is the very basis of business and law in`many countries.  

The next worst ‘slur’a doctor could have against him was that he was a ‘pharmaceutical company doctor’. Some pharmaceutical companies hired doctors to promote their medications and rewarded those who ‘sold’ medications by down playing or denying risks while celebrating success.  I was hired only a couple of times by one drug company to give talks to family physicians about new produce.  I was subsequently   told by  that company that  I was ‘too objective’ and hadn’t ‘sold’ enough of  the product. . I took that a compliment but it caused me to look askance at some of my colleagues who took pride in being consider ‘trendsetters’ by some in the pharmaceutical industry. They considered it a compliment to be called ‘drug pushers for the multinationals’ and paraded their academic and financials rewards with gusto.   “Unhinged: the Trouble with Psychiatry” by Dr. Daniel Carlat discusses this problem in depth. 

It became so egregious an issue in medicine  that physicians in academic settings and journals are collectively now required to give notice of their ‘conflicts of intererst’.   At the beginning of a lecture a doctor is required to put up a slide indicating which drug companies or businesses had paid him for this lecture or his research in this area.  

Unfortunately the licensing bodies for professions, in general, like the Colleges of Physicians and Surgeons, have not as yet had such a renaissance. The conflicts of interest that influence hiring, appointments,committe membership of non professionals,  their  political and fashionable decisions remain darkly opaque.

  

This practice has been in place for decades and naturally doctors wish that politicians and bureaurats would be required to do the same housekeeping regarding ‘conflicts of interest” and ‘lobby groups.” The partisanship of bureaucrats is a huge problem since they are required to be 'objective' but increasingly in Canada it has been exposed that government bureaucrats are Liberal biased.  To avoid this in many countries and eras the whole government apparatus was overturned and replaced by the followers of the winning party.

Given the scandals  over the foreign influence on Hillary Clinton and Justin Trudeau by Islamic countries and the alleged influence on Trump by Russia , politics seems mired like the media and courts outside the promises of the 21st century.  Escobar, the great drug lord used to brag that he had bought both the Republicans and the Democrats, hedging his bets, not that that did him much good in the long run. 

Doctors addressed this issue of autonomy first in the Hippocratic Oath of Ancient Greece.  I’ve taken the revitalized Hippocratic Oath of today since the ethical and moral foundations of professionalism have been increasingly eroded by government intrusion. The ‘do no harm’ clause is all but obsolete now  the ‘abortion industry” and recently  ‘euthanasia industry’ have completely won over the prevailing  government and their bureaucrats so reminiscent of the 'banal' of Arendt's writings.   Further, the various ‘codes’ of doctors in the western world were influenced by the “sanctity of life’ premise  inherent in Christian religion which inherited and refined the Judeo Graeco Roman traditions from which Western Civilization arose.  Other cultures have not had this notion of ‘sanctity of life’.

Further the ideas of where on the continuum the doctor sits regarding the collective and the individual are wholly different than what most Canadians assume.  Also the 'accountability' of the doctor in different countries is wholly different from the local ever changing responsibility of the doctor and indeed the health care system. This was never better reviewed than the greatest scandal of hospital administration of our time, the finding of the man dead for 36 hours in the Canadian teaching hospital and the abdication of accountability of administration.

There is also distinctly different ideas of cause and effect and accountability in eastern and western 'culture' which affect the very practice of medicine by doctors depending on training and background.

It was no surprise that Dr. Kellie Leitch, a brilliant physician and accomplished paediatric surgeon, should spearhead the importance of 'Canadian values' in this time when the dope smoking pretty haired selfie snapping Canadian Prime Minister Justin Trudeau was insisting there was no 'Canadian culture' and hence no 'Canadian values'.  Ironically he also said that Quebec French  speaking Prime Ministers were superior to English speaking Prime Ministers when his basic premise was that there was no such thing as a Canadian ‘culture’. While denying Canada 'culture' and denying Canadian 'values'  he insisted on the superiority of the French speaking. 

The word ‘culture’ derived from the Latin word ‘cultus’, ‘to care’ and from the French word to ‘cultivate’ or to ‘fill the ground’.  Well no one in their right mind would doubt that Dr. Leitch cares or is a highly cultivated individual who has done a lion’s share of work, there continues to be complaints about PM Justin Trudeau, simply not caring about Canada, and not by his personal history having much to do with cultivation and work.  Unfortunately Dr. Leitch’s insightfulness flew over the stoned heads of easily offended young followers of the Prime Minister. 

The ‘private’ physician retained their autonomy and worked for the patient just as the lawyer and accountant and engineer primarily served their client.  Historically the true ‘statesman’ served the country as a whole not the entrenched interests of corporations like Bombadier or the  urbans tastes of Montreal female voters.  

The ‘business’ of profession however always was tied to the idea of ‘he who pays the piper calls the tune’.  As the “private” physician was working directly for the patient even though an insurance company might well be paying the bill, the doctor’s greatest concern was the ‘patient’s health’.  This was before the Hydra of  Cultural Marxism's weaponized political correctness redefined 'health' like the 'renaming' of 'gender" as something other than the ‘morbidity and mortality’ of science.   

Today the ‘insurance doctor’ is the next greatest ‘slur’ that can be made against a doctor.  It’s a bit wrong as there clearly are good and bad insurance companies. But clearly if the patient becomes sick and unable to work and provide insurance payments it’s in the interest of the insurance company to ‘de list’ that member as they are no longer a viable ‘client’.  Further, the worst insurance companies use and abuse the courts to offer the least inclusive definition of health and spend fortunes on lawyers fighting claims. 

Canada is a single party insurance scheme so that the ‘government doctor’ and the ‘insurance doctor’ ‘slurs’ can overlap.  Historically in public and private endeavours there was this area where the public need for finance existed because of the size and ‘risk’ of the project and in areas where there was no likelihood of profit but that as a society we collectively saw a need to care for others in a way private sources could not afford to.  

Our present government appears to be giving billions to foreign countries while not caring for it’s own sick and old.  The sick and old and those who suffer catastrophic  injuries were the principle reason for development of the Canadian Health Care system.  Tommy Douglas and those who were  principally Christian doctors of the  Saskatchewan model would obviously roll over in their graves  if they were to see the actions of the ‘company doctors’ and ‘government doctors’ of today.  Government spending today,  is to those early men and women of Canada,  a total corruption of the ideals of Canadian traditions.  Not surprisingly, Liberals get around this by indeed,   denying Canadian culture or tradition.

The highest paid doctors today are government doctors  and cosmetic surgeons while the front line workers in all fields are policed to no end and treated as the enemy by their superiors because they have been given the unenviable task of ‘rationing health care’ while the government doctors and political doctors make endless promises that are simply impossible to meet.

Professionals say that there is no ‘autonomy’ or ‘profession’ any more because the structure of our present centralized communist leaning government which is totalitarian authoritarian and diametrically opposed to the freedom of the individual and wholly supportive of the ‘collective’.   Indeed many professionals have considered that the ‘unions’ which developed in a much more hostile relationship to government may be the answer to the failing health care system.  Some doctors have approached the Teamsters feeling the whole idea of ‘profession’ is defunct in face of government corruption and the cancerous growth of the government burocracy to the detriment of professions and their clients.  

Canada has a history of having had a purely ‘government socialist based’ health care system which was associated with the worst morbidity and mortality statistics in the Canada. This was the Indian Affairs government health care system which is now being used as a "model" for all of Canada despite is at times horrendous failures.  

Given that immigrant doctors increasingly come from countries which do not share  Canadian ‘values’ of ‘sanctity of life’ , the importance of the individual, freedom, and libertarianism and other such ‘pesky’ ideas it is increasingly no surprise that the government calls’ physicians’ not by their ‘professional designation’ but increasingly as ‘health care workers’ as a collective job title. Ethically there fore in the government eyes they have no difference from the cleaning staff in the hospitals.  

It concerns me as the corruption of government and media and the refusal of the courts to move forward that doctors medical professionalism is now defined solely by ‘company doctors’ and dominated by ‘conflicts of interest’ that soon it will be said of doctors that 90% give the 10% a bad name.  It is no surprise that 75 % of Canadian doctors would not recommend medicine at present in Canada. 

As a dinosaur doctor I am increasingly concerned about health care not as much as a provider but because I might well need services and can see from the desperate experiences of my patients that they are utterly frustrated, dissatisfied, and wholly crippled by the government callousness, Naturally their opinions never appear in the government propaganda media or are always attributed to the doctors and nurses rather than the top heavy administration.  They express repeatedly concerns about  inefficiency and corruption the feeling that their basic needs and values are not being met.

A company doctor explained to me that I ‘cared too much’ and must ‘lower my standards’ as well as ‘learn to lie’ as he did for he enjoyed greatly his well rewarded government company doctor lifestyle.  I personally have to consider every day whether I want to continue as a ‘company doctor’ or if I should, like the other dinosaurs of my era retire early and accept that Christians, godly people in general,  moral people and all the doctors of old, especially my most esteemed mentors, and Tommy Douglas, a politically incorrect Baptist minister, are all  no longer welcome in Canada.  Insurance company models also routinely reward the physicians who do the least for the patient and save the government the most money.

This was a 'joke' of my surgical training where heart surgeons and lung surgeons would compete among themselves as to who could use the least 'thread' as the administration had a fashion of the month campaign to get the surgeons to save money in the operations.  At the time I thought it was something out of MASH where no show better defined the oxymoron on 'military intelligence". Yet the surgeons explained that the administrators were more concerned with their budgets than the lives of the patients. Indeed I caused myself no end of difficulty complaining that a small town administrator had robbed the hospital budget for a baby incubator so that he could have a new desk and chair with better wood panelling.  

I do envy the migrants who routinely return to their ‘homes’ whereas I personally feel my own home and profession have been destroyed.  This feeling has grown strongest since  I was told that  Dr. William Osler is no longer considered a ‘professional’. Clearly Dr. Osler is no longer welcome in Canada and  should never  apply to work here.

Jesus, the greatest healer of all time, would not be welcomed  either.  Jesus  was vulgar, kept the wrong company,  swore and behaved badly, the epitome of a politically incorrect individual.  Politically correctness and professionalism were once diametrically opposed.  Today a doctor kills or heals as the prevailing mood dictates. It’s just fashion.  Medicine is theatre.  The Kardashian’s are the new models of medicine.    

Mannon Bay, Bowen Island -Journal

Praise the Lord. Jesus is born.  I just read the opening chapters of Bill Johnson's, When Heaven Invades Earth.  Mark who worked with me a couple of years was enamoured by Rev. Johnson's writings.  Now I can't remember who the other person was who spoke so highly of him.  Yet the book has sat a year on my shelf at least waiting to be read.
It talks of miracles.  Living a supernatural life in Jesus' name.
I plod mostly.  I struggle from day to day.  I carry the burdens of world upon my shoulders and my body aches with pains I imagine Job knew well.  I am chronically frustrated by the Herod's of authority.  I fear at times Caligula is reincarnated in Washington. I long for Marcus Aurelius instead.
Yet here I am enriched by every day of living sitting in a sailboat in a little bouncy bay off Howe Sound. This is the sailboat I've winter sailed solo to Hawaii in.  It's restored since my extrarordinary friend, Tom and I sailed back from Hawaii breaking the mast  at night, a thousand miles from shore,  when we feared we'd not be able to continue under our own steam yet did so by jury rigging a Spanish turnkey.
I'd asked for help that time. Using a satellite phone to Eric I got advise from all the resources of Vancouver and beyond.  Life's like a space ship at times.  All I have to remember to do is call home.  Earth this is me, help.
That's been the story of this last month. Moments of panic followed by prayer followed by asking for help.  I had the lump on my face that didn't respond to the normal doctor self help like squeezing, picking, self prescribing antibiotic cream and hydrocortisone.  My friend George, better known as 'the poet", otherwise named Dr. Chalmers thought I should let Dr. McAlistair look at it. Now that the dermatologist, this wise and kind gentleman with endless years of experience wrestling with just such wiley demons of vanity as unknown fascial lumps. I felt 'safe' again.  The mounting fear had been halved just talking with George about it.
The unexpected tax bill, shocking and disturbing as it was, once would have thrown me into a paroxysms of paranoid conspiracy theories, but this month did no such thing. I spoke with my accountant, a fine gentleman indeed, and then with my bank manager. Scotia bank has been as helpful to me as Bank of Montreal was so helpful to my parents for many years.  They want to make money by ensuring that you're making money.  So suddenly there was an easy solution.
I'd just bought a car, a lovely little Mazda miata, because I've been riding motorcycle year round mostly to save money, a bit to be macho, and partly because the traffic of Vancouver is so horrible with bike lanes and lack of parking that my truck is no longer an option for that increasingly effete city of lulu yoga lotus butts.  I ride an off road motorcycle in winter and a Harley in summer. I'd skidded on wet leaves and road oil evading psychotic BC Budd smoking drivers to crash. So I had stopped riding my Harley in winter. I'd limped most of a year after that event so was riding a Ural Sidecar Motorcycle with knobby tires but it  was killing my back this winter since I rolled my ATV hunting last fall.  Come to think of it I when I couldn't get the ATV off me and cougars were following my blood trail and my rifle was broken in the roll, I'd felt less confident about life then.
This last year of constant rain and cold was trying my patience so I opted for the sports car.  But I hadn't sold the Ural yet.  Partly because I hate to part with it. It's an amazing Russian machine based on the German war machine that BMW created years past. A classic that has never yet been improved on.
That's why the tax bill caught me by surprise.  That and my penchant for studying things that are relevant to psychiatry and health care rather than studying money and stocks.  I always believe God wants me to be the best doctor I can be and that if I want to make money I could focus my attention on that and save fewer lives but be a whole lot richer.  It's an either /or calculation for me because to date other than my brother I've found that people who promise to look after a doctor's finances are more likely to take the money and run.  Money managers as we learned in the latest of too many diabolical corruptions of the world financial situation don't take a Hippocratic Oath.   The impression we are left with by the media of Goldman Sacs is that the whole upper management was on cocaine with whores cleverly convinced that the hard working citizens of America would bail these banksters out with old age pension funds and whatever was left of once proud and strong America before the dirty got downright despicable.
If Jesus reighed on earth all would be rich beyond on our wildest dreams.
Now the fact is I am. I just forget it. I've been poor so that I went with out food and was hungry and without an apartment. I've been punished for marriage while all those who didn't marry but did break up took no financial or moral hits.  Collectively the girls are celebrated for divorce more than they are for marriage while I've had my share of the state and courts in my bedroom and heart. I nonetheless am blessed to have a kind and beautiful female friend who remains with me despite my antipathy to the rape of the courts of marriages and family.
Oh I am such a self pitying resentful nihilist if I don't keep my lizard brain in check.  I pray most days all day just to block out the fear and anger. Whenever I look at the media I hear the rant of incompetence in every authority structure yet personally I find most people are doing their best bumbling along. Especially the folk I know in church. They're good people.  There are lawyers and bankers and doctors and car sales men there and they'll doing their best like me to be less sinners and more saints.
I've had pneumonia this month.  I did the antibiotics. I have this chronic sinusitis which just waits for the Vancouver weather to give us one day of sunshine then ten days of rain.  I wonder all the time if I wouldn't be better back in the freezing world of Winterpeg where I grew up and the annual winter temperatures killed off all bugs and the occasional human as well.  I know I love Arizona and would be glad to be in a dessert where breathing is best for my nose and lungs but that said I've so many friends here I have grown to love and cherish.
I don't think ever before have I so appreciated the people in my life.  I simply love my friends. They are people I so admire men and women whose lifetime of accomplishments amazes me. They have such great senses of humor too and whenever I am with them I feel enriched to the depth of my being.  I suspect I might make others elsewhere but I really don't want to leave them here only because I can't breath and keep getting colds.   A small price to pay.
I 'm overworked and over stressed.  I haven't had a year of work without having to address the micromanagement of an administration that personally destroys more than it creates while doing everything in it's power to serve it's own interest.Yet, don't I sound like the media when I think like this.  Yes, they have been more wrong than I am and I have been more sinned against than sinning as Lear might say but I don't have their jobs, as fat assed and cushy as they are are, so I really don't know if they are doing cocaine with hookers as their decisions appear.  I'm rather narrowly focussed and over react to the heavy weight of excessive parasites living off the work of others.
But this year, this last month, faced with a criminal who wanted to kill women in the womb, a veritable Chinese government type, suing me,  I just carried on.  I know I'm doing God's work healing .I know I work 12 hours a day for the betterment of my fellow man. I see the proof of my work in the successes where success is impossible. I know how hard my work is and yet I go and if I don't think about the future and worry about my declining healh and aging body and fear of no pension and the rape of pensions and the abuse of the elderly I'm okay.
I'm okay if I focus on today.  I'm okay if I forgive the authorities which demonic at times are probably simply reflections of my own unhealed aspects of self.  I am in heaven when I can love hell.  I loved the play in which Jesus visitted Hell and the devil and his friends simply didn't want heaven. That's my impression.  I want the joy of love over the delight of lust but then that like most things of civilization it's an acquired taste.
 My animal brain is always at the door. The wolf howls when I least expect it. I pray each day to keep the lizard and the wolf at bay. I loved the imagery of Ghost Rider with Nicholas Cage. It spoke to my inner struggles and made me want to get back on the Harley and lose some anxiety at high speeds on the open highway.
Here I am in my sailboat. I had the fuel system fixed this winter so I wasn't certain if I'd have any problems when I filled up. I wasn't certain I'd have enough fuel on board to get to the fuel dock. I wasn't certain how the engine would run. There's a need for new seals on the stuffingless stuffing box.  I rely on pumps to keep the water levels down in the bilge when I 'm driving along. Jim does good work but so often I've had work down and only found out that there was a mistake when I'm in high seas. The new exhaust sheared off twice with vibrations once in the strait at night with storm warnings and another time just leaving dock.  Black smoke coated the whole of my interior cabin so that it took thousands of dollars to clean up the resulting mess to what is really my downtown apartment home.
I understand my friend leasing a car and renting a house and never getting involved in the maintenance or concerns of ownership. My empathy for patients difficulties with second hand cars, roofers, cable repair men and mechanics is solidly based in experience.  The more I live life the more I've been able to encourage the suicidal to carry on inspite of the hardships and frustratons.
I want to know God more and more. I want to be with God all the time but right now a person who I helped by lending a whole lot of money too when they were in a desperate crisis has turned out to be  a party boy, and it's months of broken promises while I know they've never yet been weaned from their mother's tit and would shame a father by their lack of industry and responsibility.  I hate myself when I  help others and err in generosity.  Like giving those two women who were recovering alcoholics a job only to have them steal from me and try to destroy my patients and the ministry of medicine.  I have personally lent tens of thousands of dollars to those in need and never been repaid by them. I thought that over time these 'takers' would 'give back' but I see now that they with  decades  past haven't given back to me and haven't given back to others either .I live in a country with a whole lot of people still living in diapers expecting the adults to care for them while they party or 'do their own thing' claiming any excuse to simply care for themselves.  I am appalled to realize the abuses of Greece and realize they're like Quebec and so many others around me who simply don't believe they should 'work' while they clearly want the product of others labours. Some even consider their 'vibes' are worth more than others 'vibes' and yet won't care for others in a material way.
I remember the musician who took so much money from me.  There's a joke that goes what's a musician without a girlfirend, homeless.  Art is like a two year old giving poop to its parents.  These infants insist on seeing their poop as priceless but boy if you ask them for money it's a whole different equation. Of course there's good art and bad art.  There's a whole lot of good in all of us in fact.
I feel badly because I've sewed seeds repeatedly in barren ground. I am the eternal optimist. I'm a spiritual chieerleader. I take in strangers and give them a home and they steal from me. I give people work and they steal from me. I work three jobs and find that the other person is playing at the computer claiming that 'surfing' the internet is really important.  I'm a bloody accredited researcher and I don't have time to do this because I'm working to pay the rent.
That said I take for granted all the great things that people do for me. I've worked with the best and right now am truly blessed with the people I'm working with. How come I focus on a hurt rather than celebrating the kind things that go on all the time. Last night I was stung by a mosquito and thought of that rather than focussing on the warmth in the cabin, the good company, the great NetFlix series Jericho and the wonders of being in outdoors BC at anchor in this incredible creation of centuries of engineering and design.
When I say pay the rent I'm really talking about office overhead and  this glorious boat that's got me here .
I lost the rpm meter crossing Howe Sound last night.  I watched it begin to bounce about then slowly die.  I thought the engine was cooked.  Because the bottom is full of crap and I paid the tax man and the little shit didn't pay me back the money I lent him I haven't pulled  the boat up on land to fix the shaft leaks or scrape the bottom and put new zinks and antifowling paint on. I'm only making 3.5 knots rather than 5 knots.  The engine is working hard just to get me going that fast. There was a wind coming out of the sound.  It was night and I'd put on the steaming lights.
Laura gets anxious. We talked about all the other women in my life and the extraordinary near death experiences that they had coming along for the ride. Tom and I've talked about this.  He's lost girlfriends after they've been out flying with him. He told me he'd found out last year in flight that his air speed indicater was wrong wired. He was having trouble flying an antique plane through the mountains against a head wind and thought the only saving grace was that he was alone and there'd be no witnesses or complaints if he crashed in the mountains.
I think all the women I've know,  except Laura whose still game,  are home somewhere on a couch in the suburbs watching tv and recovering from the trauma of knowing me.
I explained to Laura that the Coast Guard were 5 minutes away.  Further, I'm a member of CTow the marine equivalent of BCAA. One of those great guys would tow me into port if I called.I"ve a half dozen means of seeking help, radios, flares and cell phones.  Help is right here. It's a whole lot different than when I was alone in the Pacific or even off the coast of Mexico or up by Alaska.    I don't at all think an engine problem in protected waters is a major concern. I've been knocked down in 40 foot seas at the outset of a hurricane scurying for safety with my tail between my legs.
I told Laura about Sherry and I surviving Devils Hole north of Desolation Sound when the dope smoking diesel mechanic left a screw out of the oil pan after the overhaul. A whirl pool suddenly began to open behind us like someone pulled the bathtub drain plug . At the same time freak high winds coursed down the channel ahead of us impeding our forward mothion. Poor Sherry was at the helm with the Yanmar engine running full open throttle while I was pouring oil in the overheated diesel one step ahead of the growing leak. If the engine had stopped we would have had gone under to our deaths in minutes.   Now those were  desperate times.  But not this night. This was just a nuisance.
It turned out it was just the RPM meter and not the throttle or the engine.  I checked the gps and we were making headway at a constant rate even though the rpms were fluctuating on the meter but not by the sound of the engine.  I obviously have sails and I could have put those up and sailed on to the harbour.  I even have a dinghy and motor so could have hopped ship with Laura and Gilbert, cursed my beloved bitch ship one last time, left it to it's fate in the sea, gone ashore to never set foot on a boat again.
But it was just an RPM guage that was done in.  The speedometer was clogged with undergrowth so I didn't have that to help.  The prop shaft is producing a veritable hose of water too so I became worried with low rpm guage I'd picked up something on the prop. The mind goes into overdrive thinking of all the possibilities.
It's never perfect.  My boat becomes perfect into the second third week of steady cruising but these weekend jaunts and holiday exercusions are always full of surprises.
At least the anchor worked when we finally got into the Bowen Island bay. A whole lot of crab traps made that simple task difficult. Nowhere to anchor either because of the welfare scows that are floating Safeway shopping carts.
I'm actually fairly happy in the rain taking two tries to set the anchor.  I realized that only moments before I thought my engine was going to die.  Of course such a thought is coupled with thousand dollar repair bill and having days of workmen on the boat and life disrupted with 12 hour days of patients and no where to escape the chaos. I moved into my RV for a couple of months while repairs took that long this winter.  I was so thankful when the work was finally done and I could return to my boat.  Only one major curse. The refrigerator was turned off yet again. This has happened with workers on the boat a dozen times. This time I only lost a pound or two of venison from the deer I shot in the fall. It's a million dollars an ounce but how do you explain that to a person who is doing their best keeping you afloat.  Years back I had a worker forget to close the through hull so returned to boat filled with water the pumps not turned on  toilet leaking.  These same people who charge more than I make complain if surgeons leave pipe wrenches and hammers  in their brains and forget to suture wounds closed. The gall!
I've known thousands of miracles on this boat.  This boat has been Gods' way of trying to convince me it's okay. Don't panic.  This too will pass. Jesus loves you.  Every fear and trouble I could imagine has come and gone on this boat.
It's still here and I'm still here.  Gilbert my dog is sleeping in my bed.  The ferry comes by early and I was woken by the tossing about with the big waves that come into the harbour.  The door to the head flung open and I saw that I've had a half dozen 'fixes' to address the problem of it flying open. There's evidence of such 'fixes' everywhere.
The Mazda was second hand. The only new things I've had in years is a computer and an ATV.  New things break as often as things already worn in.  I know all the trouble spots on this boat.
I remembered that the rpm guage once went out before because there was a short on the ground. I'll look at the wiring today. But it's 30 years old so maybe it's the guage itself.  We're all getting old.  There's wear and tear.
In my heaven the wear and tear isn't happening. Everything that is supposed to be lubricated is.  Especially joints.
Last night my back was in spasm.  The ATV roll took it's toll.  I feel a whole lot better now after at night at anchor. Every molucule is massageed by the motion.
I have this great new propane stove. There's a thing of celebration.  I got this installed last year and it's a marvel.  Yet in my self pity and worry I so quickly forget about the glory of this or the new wind generator I put in to replace the old one that hadn't done much good for years giving me only a watt or two or power when it was supposed to be putting out a whole lot of energy. The old solar panels have been a joy doing double duty for years.
I worry about the wiring.  Jim re wired the batteries for the new wind genny and I'm not sure if I've got the switches the way they should be.  It's not an issue for today since I have the diesel engine as generator but given the shaft leak I can't afford to be without battery to the pumps. I'm watching the battery indicator jump which means that something is siphoning power. I'll get up and look to see what that may be eventually.
Everything on a boat is conservation and ecological. I get tired of the 'activist's and all the talkers who go on and on about the enviromment but refuse to accept it's the city dwelling activists with all their hot air that are a principle cause of global warming. I'm out here self sufficient and using wind, solar power and diesel as needed with my own sewage dispoasl unit and all mamer of environmentally friendly 'stuff'. It's 'work'.  It's expensive and it's not just ranting and raving and sounding good. It's actual living in that world.  Talk is cheap.  My friend gave me a button that said of beware of stupid people in large crowds.
I forgot to ask Laura to bring some elk I store in the little freezer I bought and have at her place. I've deer in the freezer at work. This weekend I hope to catch a salmon.  It's not been snce I was out last August that I've caught fresh fish.
I miss country living. I 'd like to garden again. They say you can have chickens in Vancouver. Now that my cat Angel died this month, mavbe I could consider chickens on the boat. I can just hear Angel in heaven say, now that I'm gone you have such an idea!
I dream of working in the country again and maybe commuting part time to the city.
I applied to work in Chilliwack and Abbotsford but the administration said they didn't need pscyhiatrists or addiction doctors.  I think that means they don't need me. I gained a really bad reputation as a whistelblower stopping the unnecessary killing of patients by administration a decade or so back.  The patients were glad to be alive but they don't count.  Health care administrators never forget and never forgive. They're putting all doctors on gag orders, their solutions to all problems, lie, deny and cover up.   The one thing that's guaranteed is that administration sticks together.  There I go again. The political animal lizard brain just jumped in.
God wants me where I am doing what I'm doing. The fact is I'm enjoying it immensely just working too hard. I've no health care or benefits and if I get sick I've no compensation.  All day long I see people who are off work with insurance companies paying for them and I think of my own insurance package I pay for myself which barely pays the overhead if I'm not working.  In Canada with over 50% of the country government employed in some way and the rest working for companies no one really understands the small abused private businessmen. The governemnt in it's act of hostility against doctors put our gross incomes on the front page. My colleague has a half dozen doctors and a dozen staff working for him so he was shown has earning millions and the media never took the time to clarify that Mr. Smith , this surgeon made less than the hospital administrator or that I as a doctor make less money than a nurse by the end of my career given the loss of income that 12 years of education did.
See how quickly the poor me brain steps in.  Suddenly out of nowhere the gratitude and celebration of God and good memories of battles won and days lived are high jacked by this monkey mind that wants to self pity and feel vengeance.
There 's a 'child within for sure but ones a really bad little kid and the other is the good kid. Bad kids are loud and obnoxious and it's a lot of discipline and work and maturity and wisdom to get to hearing and keep hearing the wee small voice inside.
God is that wee small voice.
God is everyday I've been alive getting me through that day I might otherwise have died. I am alive today only because God is 100%.  My higher power is what gives me life and years.  I've got to shake off and ignore all the problem thinking and catastrophising and awfulizing.
I've got to remember  the Third Day song "There's a light at the end of the tunnel."  I was listening to Third Day when Tom and I were limping along through storms in the Pacific and just this spring I got to see them in concert in Langly. Isn't that a miracle.  God be praised it is.
The very breath we breathe is a mystery and a miracle.
I'm going to have another cup of coffee and try to keep the glass half filled at least. Thank you Jesus.

Canadian Psychiatric Code of Ethics

The Canadian Psychiatric Association has a code of ethics:  It's well written and well considered. It's is the Canadian Medical Associations Code of Ethics Annotated for Psychiatrists.  The CMA Code of Ethics was 1996 while the Annotated code of ethics for Psychiatrists was completed in 2002.
http://www.ftsr.ulaval.ca/ethiques/CMApsy.pdf
It's a bit lengthy and unweildy so that like a lot of 'beurocratic documents' I can honestly say that the majority of my colleagues would be hard pressed to recite a significant number of it's provisions.  The Canadian Medical Associations Code of Ethics is similiarly beurocratic, lengthy and unweildy such that a majority of physicians is unlikely to be able to cite a significant number of it's provisions.
That said, these same physicians and psychiatrist could tell you in detail and at length the diseases that affect the nervous system or list extensively what one must do procedurally in the proper work up of a desperately ill patient.  Further, the vast majority of physicians and especially psychiatrists act in a most ethical fashion as generally understood by their profession and the community at large. Indeed, relative to most sectors of the community at large physicians and especially psychiatrists are highly ethical individuals with years of experience and training and in depth consideration of relationships with other humans, those humans commonly being vulnerable, sick, sometimes psychotic, often in pain and clearly not on their best behaviour.
In reviewing though all these 'ethics' that are recommended I see that they are quite impossible to follow in some instances. This is something I will consider in due course.

My first consideration with regard to Codes of Ethics was the 'conflict' that ethics of physicians might have with  'ethics of administrators'. When I sought to find a Canadian Hospital Administrators Code of Ethics, I couldn't find one.  My personal experience has been that the ethical decisions that I have had to make often routinely have put me in direct conflict with hospital administrators who do not for instance share direct responsibility and accountability for an individual patient.  Indeed I have heard hospital administrators refer to me, not as a psychiatrist or as a physician but merely as a 'health care worker'.  The history of referring to someone as a 'worker' was common in the early years of communism and early union movements.  I'm not sure what 'code of ethics' the 'workers' of that era had and don't know of any 'code of ethics' for 'heath care workers'.

There further is as yet no agreed code for 'health care professionals', another term administrators have liked to call me, which obfuscates my own identity as a physician and a psychiatrist and the ethical obligations I have as a physician and a psychiatrist.

There was a conflict noted in England a decade or more ago which lead to considerable reorganization of hospital and community decision making to 'limit liability' of physicians. In Canada when 'health care professionals' gather the 'accountability' of the physician is directly associated with 'liability' and the liability of the physician historically was greatest.  Recently in the US law suits commonly cite the hospital and physician and increasingly the nurses but do not specify the CEO.

Increase in the accountability of administration relative to patient care is clearly an admirable dimension of ethical care.

To the best of my knowledge such reform of "individual and collective 'liability" and hence 'accountability' has not occured in Canada though it's been several years since I've actively involved myself in Canadian hospital and community care systems. I completed 2 years of the public health community medicine fellowship a couple of decades back. That training along with my community psychiatry training indeed sensitized me to the increasing chaos, ethical dilemnas and loss of autonomy of the physician relative to institutional perogatives. I personally experienced considerable bullying and abuse in the system so like large number of physicians retreated into my practice.  Increasing numbers of others are avoiding clinical care altogether, it being vogue indeed for people to get and md followed by an mba or llb (law degree) than actually specialized in clinical medicine or psychiatry.

In general a 'code of ethics' is limitted by the prevailing authorities.  A professional is only as professional as his or her autonomy.

The prime directive of the Canadian Medical Association Code of Ethics is
1) Consider first the well being of the patient

What happens if this comes  secondary to the 'profit' motive of the organization or 'the availability of  resources' .

It's a bit of a platitude like saying "the customer is always right'.

Today's newspaper and radio health care 'crisis' is that of a pharmaceutical company not making sufficient 'supply' of a life saving medicine and not warning Canadian pharmacies or governments that they were running short.  I was amused by this in a 'black humor' sense only because it reminded me of my work in northern Canada when the stock of 'penicillin' was depleted. I rasied hell and got the necessary penicillin flown into the community to save the life of a child with pneumonia or meningitis at the time.
I would today be called a 'disruptive physician' and severely reprimanded. The message to all physicians to day is not to rock the boat.

I have been in two hospitals now where the 'oxygen' tanks were not filled with 'oxygen'.  I know of two deaths directly related to this.  I recently learned that health care employees, including physicians were going to be required to sign 'non disclosure' agreements to have jobs. I wondered at the time if a physician could 'ethically' sign such an agreement.

On dozens of occasions I have followed the prime directive to 'consider first the well being of the patient at extreme personal cost to myself in terms of health and loss of wealth.  I know many physicians who have shared this experience in the present health care systems.  It is very hard indeed to 'consider first the well being of the patient' when there are those around who have entirely different agendas.

Recently a patient was found dead 24 hours in a Canadian hospital waiting room and to date I've not heard even who was ultimately held accountable.  I loathe the CBC going on and on about robocalls in the elections or about a defence minister chartering a plane to go home for a weekend when who is accountable for a person dying in a waiting room in a Canadian hospital goes without a Royal enquiry.

It's one of the greatest national scandals of the Canadian Health Care system and yet it's a subject that was covered in the popular media mostly as an isolated tragedy. I saw it as evidence of the epidemic proportion of administrative breakdown in the health care system. To the best of my knowledge it never warranted a letter to all physicians, hospitals, or hospital personnel about how we shant have that sort of thing happening again. My impression is that that sort of thing gets 'covered up' and shunted aside as an 'embarrassment'.  When things like this happen I want a "pathologists report' on the cause of death and the organs infected and decaying.  I really would like a department of 'systemic pathology' that gave 'weekly rounds' on the institution in question or the health care system as a whole.

There was  no mention that the hospital administrator was sacked either but they are forever going on about accountability. Accountability for physicians means loss of license and loss of position and loss of income and a whole dirge of liabilities.  I don't seen any evidence of a 'level playing' field in comparison when a patient lies dead in a hospital waiting room for 24 hours.

I don't know if the patient was 'admitted' and whether they were under a doctors name and if that doctor even knew they had a patient in the emergency. Mty emergency doctor colleagues have reported that increasingly they are last to know that sick patients have been assigned to their care and that more significantly they rarely today have the resources or staff to adequately 'consider first the well being of the patient'.  How can a physician 'consider first the well being of the patient' if he doesn't even know that patients have been assigned to him until there is a crisis.

What is a physician to do when the very system they work in is 'unethical'?

Bonhoffer, the remarkable priest who served during the Nazi reign and was martyred for his ethical and moral stance is one of the greatest tales of the 20th century. Bonhoffer's central dilemna was that he was ethical, his church wasn't , and the nazi's weren't.  He was Lutheran.   Ethics can't be considered in a vacuum.  The Catholc Pope and indeed most of the major church members of the day failed to function in an ethical or moral manner in face of the overwhelming systemic flaws.

Physicians who 'protest' are today called 'disruptive physicians'.   Ethically  'considering first the well being of the patient' in a hospital system or a community health care system they may well be  martyred.  Rocking the boat is professional suicide.  There are 'cultures' which surround institutions. This was the topic for psychiatrists of the book "Asylums, a study of totalitarian institutions".  The "company doctor's has historical been a term of derision to refer to a doctor whose 'ethics' are subsumed by his allegiance to the paycheque or paymaster.

Doctors of 'conscience' have increasingly taken to writing their names on lists.  The Bahrain Doctors are presently being tortured and imprisoned for being ethical doctors and following the general code of ethics most doctors subscribe too around the world. The partisan government of that state however decided that doctors could only treat police and not civilian protestors.  Doctors who treated protestors were subsequently raped, abused and faced all manner of persecution.

The most famous and historic medical code of ethics was found in the Hippocratic Oath.

http://en.wikipedia.org/wiki/Hippocratic_Oath

Original

Greek Wikisource has original text related to this article: Ἱπποκράτειος ὅρκος

Original, translated into English:^[4]

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause anabortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists inthis art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I willkeep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.

The modern version is a weak sister that doesn't even emphasize the is to 'do no harm'.  It strikes me too that the original Hippocratic oath contained greater wisdom and came from more extensive clinical experience and knowledge of humankind. The modern version is still pretty impressive and very clear as it uses the word 'covenant' indicating a 'covenanted relationship' between doctor and patient.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

[edit]

Later I'd become a dues paying member of the Hippocratic Society in Canada because this group felt that the hippocratic oath was being violated by the demands of the Canadian government. As such I become politically incorrect and open to persecution for my ethical stance at variance with the position in Canada at the time in physicians increasingly being expected to 'do harm' in such areas as 'abortion" and 'euthanasia' or 'assisted suicide'. Having been a member of Canadian Civil Liberties Association and the Human Rights Association and Physicians for Social Responsibility I was concerned that physicians were being denied 'choice' in the procedures they personally agreed to do where there were alternative resources.

As a member of the Christian Medical and Dental Society I was discussing ethics and morality in a way which had simply never been a part of the discussion of the provincial bodies or federal bodies of the medical societies whose conferences I'd previously attended. The discussion of ethics was further a central topic of the small group discussions that were apart of the International Doctors in AA, especially the psychiatrist groups and the cyberdocs on line discussion. Here often doctors would share the dilemnas they faced and find support rather than judgement and exclusion as I'd noted in other areas of medicine.  Punishment was common in medicine whereas support was limitted. Judgementalness and hypocricy were common whereas 'collegiality' was declining annually in the 'new world order' of the health care worker paradigm.  I wrote national articles relating to this but these served more often to define me as a humorist and maverick than one deeply concerned for the future of health care in Canada.

It creates a major ethical dilemna for physicians working on health care teams when the doctor sees the relationship with patient as covenanted and the other players see the relationship differently.  As an example a former doctor, at the time functioning as an administrator, made the crude statement to me about medical practice, "it's just a job, Dr. Hay".  Ever since I heard that I've been waiting for millions of dollars back pay and all the benefits I didn't receive for the 'health care job' I never signed up for.  All that while I was being a physician and psychiatrist I apparently according to this administrator was just a worker doing a job. 

As a doctor I took a Hippocratic Oath in medical school.  I've had jobs and never been required to take an "oath" to do them.  I stood with a hundred classmates, as well as the dean and teachers at the University of Manitoba Medical School. Together we recited the code of ethics that I would practice medicine by thereafter. This was not to my knowlege the CMA code of ethics but the simplified  modern version of Hippocratic Oath. I have had to struggle repeatedly with the conflict that occurs with 'loyalty to the group' versus 'loyalty to the patient'.  I have further had a great deal of difficulty as a Christian and my Christian priority is to tell the truth, the whole truth, and nothing but the truth, so help me God, something I swear on the Bible.  In contrast I 've worked in a darwinian relativistic social setting where people routinely talk about 'my truth' and 'your truth' "whatever truth covers your ass' in beurocratic terms.

I did not study the CMA Code of Ethics as part of my medical school training or as a psychiatric resident. I was given a pamphlet and advised to read it.  I did that and only later did I take an interest in the code as an object of serious study.  The first time was when a superior demanded I do something that was unethical and I refused to do so.
A colleague replaced me who was more compliant and less ethically 'squeamish'.
I made a long lasting enemy of the superior who became wealthy and powerful through what by the Canadian Medical Code of Ethics was unethical behaviour.  People can witness that life is 'unjust' and often 'bad people' do succeed.  Whole religions and philosophical and cultural systems have been developed to address such problems.

By the time I became really interested in the code of ethics I had extensive clinical experience and knowledge and saw that the code was likely outdated at the time it was written. This was a result of the rapid change in the medical care delivery systems and changing relationships federally, provincially and most significantly, the means by which care in Canada was funded, the change in the 'health care team' and the change in status of the 'team player's and indeed the change in the "name of the game: and the game itself". The  different levels of care allocated by 'status' or 'weath' in Canada especially in British Columbia where I practiced psychiatry in a different light reflect the same ethical error the Bahrain doctors failed at.  If we are only 'health care workers" then clearly he who pays the piper calls the tune.

There is now and  increasing disparity of available care, even at the simple level of rural and urban but most importantly culturally.

In fact I reflected on the Hippocratic Oath which I had sworn too and how difficult it was for me to fulfill that oath dealing with beaurocrats and other contenders in the present system.

When I worked in a country hospital I left after a year when the monies for a baby incubator appeared to have been diverted for the remodelling of the administrator's office.  Administrators in general have had an inordinate interest in 'perks' .
As a result of my formal complaint to the board and meetings with the mayor and councill this administrator was eventually removed.  I would estimate that my time voluntarily spent in this endeavour was hundreds of hours. I wrote several lengthy papers and met with many individuals. I actually wasn't particularly interested in the individual but couldn't forget delivering a premie in the back of an ambulance at high speed in the middle of a blizzard.  We were travelling at high speed to the nearest hospital with an incubator and the volunteer assistant ambulance driver, a grizzly old farmer, held the baby close to his bare chest while I dealt with the mother's post partum hemorrhage.  Mother and baby did well as a result of the heroics.  Standard care would have certainly met death of the baby.

Indeed 2 years later when I was working with the university I was asked by mayor and town councill to return and address the issue so they could relieve the administrators whose behaviour had cost more life and suffering in the community and staff losess.  The consequence was that the hospital administrator was removed.

As in any of the disputes there were many angles, sides and politics and players.  In his mind he doing a 'good job'.

What most interested me though was learning that the same person had been removed from their previous appointment for simliar questionable behaviour.  Indeed a leading hospital administrator in the system was kind enough to take me aside and share that this person had once worked in her department and his behaviour could best be described as sociopathic.  Misallocation of funds was the least of his noxious behaviours.

She had had him removed and found that he was only transfered then and now she had become aware of his recent position because of the news and scandal  that surrounded his final removal.   He was indeed as tricky dicky as Nixon in his dealings and the board was mis informed of all manner of things going on in the hospital.  They were enlightened eventually and made what I personally considered the right ethical decision. Health care in the community and  hospital according to the doctors and nurses who remained improved dramatically.
I had effectively to my own way of thinking nipped "hitler' in the bud.  This devious and dubious person was caught with their hand in the cookie jar and matters rectified.  I could not practice medicine as I'd been trained and cover my back at this time. My colleagues were afraid of this person and felt bullied and terrorized.
I sacrificed my career though being an ethical physician.  I had hoped to stay at that hospital many years at least. I enjoyed the community and the staff and colleagues but I didn't abide by the administrators direct interference in medical care.  His behaviour was dangerous and unruly. The existing systems for addressing out of control administrators were wholly inadequate and cumbersome.
I admired most my colleague who was as concerned as I about the baby incubator but had given up hope on the ethics of hospital administrators or the ability to work with them. His solution which I so admired was to approach Kiwanis and ask them for help.  They raised the money for a baby incubator.  To this day my colleague is working within the system on behalf of his patients.  I know that he goes above and beyond the call of duty to be an ethical physician and that he is mostly an 'unsung hero'.

I personally was considered a 'loose cannon' in beaurocratic circles,  The peter principle prevails in peace time beurocratic systems and  anyone who rocks the boat is considered a threat.

The dilemna that faces the physician to day who attempts to 'consider first the well being of the patient' or try to live by the Hippocratic Oath is much the same problem an individual considering marriage might face if they thought marriage meant a monogamous institution and their partner felt marriage was a polygammous institution.

When these codes were written the doctor was the dominant person in the heath care field.  The health care system of Canada is considered by many to be a dirty product of the deplorable days of Canadian paternalism.  Indeed hospital administrators when I began were commonly former doctors or despite the sexist and erroneous descriptions of that era, nurse administrators.   Most of the administrators had medical family if they themselves hadn't started out in medicine or allied health care fields like nursing.  (The Minister of Health of Canada was even at one time a Psychiatrist and commonly had medical affiliation before the new administrative model which said a Minister of Health didn't need diddly squat health care training and the Minister of Agriculture anything need to know about farming either.  The fallacy of this argument is that to date the Attorney General remains a lawyer. Politically, administratively I don't believe in feudal lordship but agree with the antequated and much aggrieved notion that ships captains shouldn't be literary critics alone)

That has all changed.  The doctor is mostly an employee in the hospital today.  The Canadian Code of Ethics for physicians is commonly interpreted within the provincial framework of the medical association. Health care is primarily a provincial responsibility in Canada and increasingly division in Canada has resulted in diversity across the country.  Doctors working in one part of the country have different political expectations from doctors working in another part of the country. Privatization has thrown a whole other hoop into the game.

While collectively doctors have been demanding a 'national license' and 'national standard' for medicine and psychiatric licensing the existing beaurocracies have resisted all reform and impeded any effort to expedite standardization at these highest levels. Administrations have grown like a cancer with layers and layers of redundancy.

 The consequence is that a Canadian doctor today may well be at variance with provincial pay masters relative to ethics. In addtion provinces have developed a whole other level of beurocracis in 'authorities' and these confuse the matter more. Additionally the 'professional bodies' legislations have attempted to group disparate care givers from physicians to hospital janitors into an all encompassing "health care" "professional" bodies.

This destruction of relationships between individual professionals and their traditions is likened to the failed attempt to put the army,navy and airforce under one Canadian uniform and command without respect for inherrent differences. There are individuals and groups and ethically there is a need to respect these differences.
As a result of war the 'administrated' destruction of Army, Navy and Air Force in Canada was chucked despite milllions of lost dollars in administrative costs and Canada again has three separate divisions of military working together as they always have under a supreme commander.  (One almost wonders if the idiot administrators who created that costly fiasco didn't refuse to admit their stupidity and shuffle their bad ideas over to health care in a vain attemp to save face!_

When a physician with a code of ethics looks beside him at fellow team players, having already noted that the hospital administrators themselves may not have a code of ethcis,
the Canadian Nurses "code of ethics' present as a very different kettle of fish from  the Canadian Physicians Code of Ethics.
First It does not have the 'prime directive' of "Consider first the well being of the patient." that is the hall mark of the CMA Code of EThics. There is further no 'covenanted' relationship in modern nursing as their was in the long history of nursing, especially represented in the ideals of Florence Nightingale and all the other bed side clinician nurses.  The nursing code of ethics reads more like an academic beaurocratic document than something as glorious as the nursing tradition.
It drily begins instead: by listing 7 values:

1. Providing safe, compassionate, competent and ethical care 2. Promoting health and well-being 3. Promoting and respecting informed decision-making 4. Preserving dignity

5. Maintaining privacy and confidentiality 6. Promoting justice 7. Being accountable

Ethical nursing practice involves endeavouring to address broad aspects of social justice that are associated with health and well-being. Part II, “Ethical Endeavours,” describes endeavours that nurses can under- take to address social inequities.

It's noted first that there is no 'prime directive" to 'Consider first the well being of the patient" in the nursing code of ethics.  Also there is no simple statement such as 'do no harm' but instead a considerable emphasis on 'social inequitieys and 'justice' . Historically these latter have been 'legalisms' . (Imitation is the sincerest form of flattery).

The word 'ethical' is inherrent in the 'code of ethics' which is at least redundant and concerning given what I've written elsewhere about the circularity of definitions surounding terms such as ethics and morality in an 'age of narcissims' and a 'multi-cultural' aculturalism.  When one respects differences one doesn't deny them.
.
When I did a search for Canadian Pharmacists Code of Ethics I didn't find such a body but did find a Newfoundland and Labrador 2001 Pharmacists code of ethics.  It did not either have as a prime directive "Consider first the well being of the patient" and it didn't state clearly state as the original hippocratic oath did, 'do no harm'.

Given that the buzz word in medicine these days is 'team" approach and to hear the politiicans health care is about the patient there seems to be variance on first sight with the positions of the Codes of Ethics of the various 'team players. I haven't considered the "professional" body of hospital janitors or looked at their code of ethics but I would hazard the guess that the prime directive is not 'First consider the well being of the patient".

What I noticed in my practice was that different 'players' on the team called the 'patient' different things too. Most recently 'client' and 'consumer' have been popular words among the beuorcrats as recently parallelling these new motifs, patients have come forward in increasing numbers  calling themselves 'victims' and 'survivors'.

I personally believe that Hospital Administrators need a Code of Ethics if they don't already have one.  I would further suggest that all groups share the 'naming' of the thing they are discussing in their various 'codes of ethics' .  I have been treating patients as patients , a covenanted relationship, whereas I commonly am discussing a patient with an administrator who has been referring to them as consumers and sometimes even suggesting they are commodities.  Worst of all I have seen patients described as "units'.
That said I do think that if there is to be a 'professional body' that includes such disparate organizations as the navy, army and air force with all their various traditions and beliefs and responsibilties there needs to be a common 'code of ethic' for the 'team'
My vote, aging as I am, would be that we all agree:

1. Consider First the well being of the patient.
2. Do no harm

I personally find the nursing ethereal  code of ethics academic gobbly gook like the the ramblings of the pharmacists code of ethics made for lawyers,  sociologists and beaurocrats in general but not really relevant at the bed side where the rubber hits the road.
I have always considered first the prime directive 'Consider First the Well Being of the Patient" at the bedside and secondly I have known well that I must do my best to 'do no harm'.  It's a bit like the ABC's of life saving.  It's coloured my practice through every aspect of care and been a horrible  rock about my neck. Without adherence to these 2 ethical rules I could have been a millionaire many times over and long ago retired from the practice of medicine.

Ironically when the administrators are not meedling like enfant terribles the heath care teams function amazingly well because of the inherrent goodness of the people who enter care giving professions.  Given the disparity and differences in the end it's almost miraculous the good that gets done.  I don't think most of the grass roots folk consider the 'ethics' codes but rather "do the next right thing' and if they have clinical experience tend to be on the same page as those around them.

The same was found true in the military and the restoration of the separate traditions and respect for the independent and individual nature of the different warriors was again found necessary when Canada was at war.

I personally hope that this disgusting era of the Canadian 'health care worker' comes to an end and I can get back to what I was trained to be, a physician, and psychiatrist, ruled by the ethics (and traditions) of my profession.  I see that the Bahrain doctors are facing a kind of administration mindset that governs commodities, consumers and clients.  I don't see physicians being tortured for treating NDP patients in Canada this year but the detour that has taken place in these crazy years of increasing 'physican' and 'psychiatrist' as 'government health care worker' and 'unit' or commodity is likely to give rise to increasing ethical dilemnas the further along the road we go.

Professionalism requires that a body be independent and autonomous.  That is to say that I enter a relationship with the employer as a 'contractor' but may have all the benefits that were defined in the salaried relationship.  There is no longer a respect for the physician and psychiatrist as a professional and autonomous. Further there is coopting at all levels which create increasing ethical dilemnas especially if a physician holds to the prime directive 'Consider First the Well Being of the Patient.

I would argue that economists and ecologists even, and especially ethicists entering in to the health care field, be required to take an oath, indeed all working with patients, take the oath to 'do no harm' and to Consider First the Well being of the Patient.

My belief is that the Minister of Health as an elected representative indeed has already made such a committment to get into office in a democratic society.  But are those who are 'appointed' on the same ethical level.

How indeed can any team work if some are playing hockey whiles others are on the ice playing with golf clubs in silly golf suits. That's a touch of a  beginning for the discussion of the chaos in todays hospitals and community health care centres.

- late night ramblings after being woken again by a nightmare about trying to save a life