55 yo Mom’s death,psychiatry, Chinatown, Gilbert

55 years old.  I think it was a particularly terrible year though of course that’s only because the negatives stand out in my mind rather than the positives.  There’s a rare and beautiful person who will remember the flowers blooming in the springtime of the war.  I”m working on this.

When I think of 55 yo I think of my Mom dying.  I’ve returned to Vancouver and opened up a practice on Broadway.  Opening a practice is the most difficult time with countless new patients and so many borderlines sent to you by doctors fed up and overwhelmed and hoping the ‘new kid’ will have a solution when all else have failed.  It’s the greatest strain on the nervous system too. Each of these new patients vying for attention and obviously desperate. I open myself to people when I see them. I drop the barriers and defences and let them in. I ‘lend them my ego’ as we say in the trade and I ‘walk a mile in their moccasins.”  I join their insaniety. I ‘feel their pain’.  There’s always some psychopaths and sociopaths early days.  It’s a matter of seeing and sorting out those people who one can work with, who needs simply medication, or a letter, or only a consult and those who are right for in depth psychotherapy and in the ‘action’ phase of change.  

People come to see the new psychiatrists for the following reasons 

1. To get relief from emotional pain

2. To prove to him and themselves and their families that they are untreatable

3. To get a new diagnosis because they don’t like the diagnosis their previous psychiatrists gave them, some people I’ve know have disagreed with 30 plus psychiatrists. 

4.  To spar. 

5. To have an ‘episode’ of television in their boring narcissistic self loathing lives.  Entertainment.

6.  To complain to, to have yet another person hear how horribly wrong they’ve been done by and that it’s not their fault.

7. To have someone more to blame 

8. To stop the thoughts of suicide and homicide.

9 To stop having sex with their sister, cow, dog or mother in law

10.  To ‘show’ their spouse that they’re doing something about their problem when they aren’t doing something about their problem

11. To lie

12. To threaten an educated upper class person when they want to kill another educated upper class person, like Justin Trudeau but he has body guards and psychiatrists are soft targets

13. To get drugs.

14. To get off work.

15. To get disability forms completed. They don’t want to get well, they want money. Money is the solution to their problems and the insurance or government have coopted the psychiatrist to ‘rubberstamp’ the bullshit

16. To be able to get a complaint for human rights or the college to show everyone how they are offended

17. To stop the voices telling them to kill

18. To get a pill that will make their horribly unimaginative lives seem less desperate and bleak

19. To avoid getting a partner or a life or a job.

20. To talk about why they are an aetheist, vegan, and communist and (fill in the blanks) and how everyone should be like them but they’re clearly miserable and none of the antidepressants are working

21. They don’t want to change or do any work at all but they want the psychiatrist to work and change and even take the pills for them or read the literature they bring for him.

22.  They want to steal from him and are there to case the place and access his building or his other patients

23. They want to have sex with him because they’ve always wanted a doctor and they stalk doctors and if they had Sex with a psychiatrist that would prove they weren’t batshit crazy

24. To have sex with a psychiatrist because they’ve already had sex with a lawyer, a priest, a teacher, a football player, a psychologists and their mother in law and they’ve never had sex with a psychiatrist but it would up their score.

25. They want to change.

26. Others say they should change and have said this for 20 years and they don’t want to change but maybe they should consider it.

27.  God told them to go to the psychiatrist and tell him he is an abomination

28. They were sent to the psychiatrist as part of a government ‘sting’  or are being paid by someone else to evaluate the psychiatrist for some nefarious scheme..

29.  Their husband wife or father or mother or boss or the police sent them and they don’t want to be there.

30. Other people complain about their having sex with children and they like having sex with children

31. The police don’t like them

32. They can’t afford the heroin anymore so they want the cheap government drugs

33. They need housing

34. They want a million dollars

35.  They want the psychiatrist to kill their ex husband

36. They want to be on television.

37. They want drugs they can sell for the drugs they want but are tired of doing blow jobs for them

38. They hate everyone

39. They can’t feel

40. They have tried to kill themselves a dozen times in different ways and can’t seem to do it right

41. Women don’t love them.

42. They can’t find a millionaire husband, Men just use them.

43........

I have opened a half dozen psychiatric practices over the years. I have some colleagues who have opened one practice (business) and the trauma of that experience has kept them there terrified of opening another.

It takes months to sort through the patients. Mostly this is a time of rejection and hate.

“You won’t give me opiates or speed or benzodiazepines! You’re no good as a doctor. I’m going to complain to the College of Physicians and Surgeons and say you sexually harrassed me.!”

“You wont say I can never work again. I’m going to complain to the College of Physicians and Surgeons and say you sexually harrassed me.”

“You won’t have sex with me. I’m going to complain to the College of Physicians and Surgeons and say you sexually harrassed me.”

“I”m going to tell my husband you say he should hit me. He’s the best friend of the Mayor and he’s going to ruin you. I just wanted pain killers not some sermon on my marriage and life. We like S&M. It’s what we do. I just need opiates and you’re supposed to give them to me.”

I have had hundred of threats that people will complain to the College when I have made the following diagnosis

1. Alcoholism

2. Substance Use Disorder

3 Malingering

4. Anger issues

That year I was 55 I hired a minister who was a lazy cow and didn’t do an ounce of work in the office, talked on the phone to friends, family, sponsees and never did any ‘billing’, or ‘correspondence’ or ‘book keeping’ or filing. She’d told me she’d worked for her ex husband who’d been a counsellor and that she knew all about billing, book keeping and filing. She answered phone calls and booked appointments.  She double and triple booked me and I saw hundreds of patients which I never got paid for. The government has a convenient system which is that they only pay for a half of their bills with a variety of ways of delaying paying doctors. We get paid in one to 3 months ,however if we bill after 3 months they will deny the bill and after 6 months they totally deny the bill but if your secretary isn’t putting in bills you don’t know that she’s not doing this till months later.

I’d opened the practice on Broadway investing all my income into the new business paying all the staff and overhead costs. If I’m a labourer I can get paid at the end of the day. If I’m blue collar I can get paid every two weeks. If I’m a professional I have to pay tens of thousands of dollars upfront in education and licensing costs and commitment to the system and when I open a practice I will start getting paid in 1. - 3 months. I will likely get all my billing paid in 6 months if I constantly write and demand and beg to be paid,   because of all the ‘dickering’ the government does to ‘steal’ money from doctors for ‘short term’ investment.

I then had the accountant who we assume was a drunk and went into treatment but his throwing his records in the dumpster and on the street cost me tens of thousands of dollars and being garnisheed by the government because of him and my secretary not doing billing cost me tens of thousands of dollars in fines and losses.. 

There is some thought that the woman the minister brought in to help her, who she insisted she vetted and said was clean and sober over 5 years  and had worked in offices before and was good at billing and filing and typing was actually ‘targeting my practice.’ Her biker boyfriend and her were said by those who knew them that they did ‘shakedowns’.  They both within months would steal from me and threaten me.  My new accountants book keeper would ‘teach’ her how she could make ‘false claims’.  She put hundreds of hours of ‘overtime’ in the books which she’d never done and the office had been closed. 

My mother was dying. My patients were sick. My staff were stabbing me in the back and stealing from me. I was working night and day and weekends and I didn’t know that my staff was stealing and stabbing me in the back or that my accountant was lying , psychotic and not doing my books.  

I paid a lawyer tens of thousands of dollars and got a new staff to go over all the government claims this skank brought against me. I only learned after this that the new staff I had, this horrid hateful person who’d been so two faced, had actually ‘shook down’ all her previous employers.  She’d gone to human rights and all the mass of agencies that exist to ‘serve the public’ but all this meant was that I was paying these two people who hated doctors and felt doctors were rich people and entitled.  I made ‘zero’ money that year, faced with theft and shake downs and all along the government agencies were publicly paid institutions that served to destroy entrepreneurs and private enterprises and hated doctors. They loved ‘salaried people’.  It’s been shown since that they prefer communism. 

I was grieving my mother’s death and all I was doing was fighting these agencies who were the worst bullies. Government employees today are dominated by these communist minded entitled people who see their job as destroying others.  There’s also this ‘first come first served’ industry. The skank had complained so they were all on her ‘side’.  I was male and she was female so they were all on her side.  I was older and she was younger so they were all on her side. I was educated and she was not so they were all on her side. I was conservative and traditional in appearance whereas she was tattooed and edgy (the crystal meth addiction certainly helped) and I was staid and pedantic.  It’s all about the victim card and old white guys who are professions don’t get one. 

I spent a year of meeting the lowest humans I have ever encountered in my life. So many highly paid government workers who would ally themselves with a lying active drug addict theif who’d apparently worked as a prostitute and her references were previous Johns. Meanwhile her biker boyfriend was barging into my offic and threatening me but was a terrible coward who I’d simply throw out of my office.  I was building and maintaining my practice despite these evil sick people and their evil sick government allies. She actually went to the college and made a false allegation that I ‘sexually harrassed’ her. The CMPA made it clear that the College was right out of bounds. “It’s a disgruntled employee complaint. It’s none of their business. She was never your patient. They have no boundaries. Their behaviour is so unprofessional.”  But he college is above the law and even their own lawyer  would leave saying they were appalling. 

It was during this time the CMPA told me I was the ‘most persecuted doctor in Canada.”  I’d already learned that there was this person in the college who absolutely personally hated me and abused their position of grotesque powers to act out their evil.   

My mother had died. I felt it was a year before I was out of the war zone and could cry. I still cry. 

It’s a measure of the civilization of people and society how they deal with their poor and old and sick. I was not allowed to grieve. There is an epidemic of doctor suicides in Canada and burn out running 60 to 70%. I have never met more cruel people than those who worked in government with their pettiness and pomposity and their lack of care for other human beings. My mother had worked in offices and my aunt had been the assistant to the Ambassador.  I had worked in a dozen offices in England. I was never cruel and uncaring like these absolutely heartless bureaucrats. Barbarians.  There are no words to describe their insensitivity and the horror they do to good people. I’d be vindicated time and again but though proven innoscent I’d go through this gauntlet of party boys and girls with no dog in the game getting rich and slick on tax payer money serving their own self centred needs and destroying the health care system and country with their arrogant stupidity. 

 I am still working on forgiving them.  My mother’s death was defiled by these subhuman sociopaths and psychopaths.  I would have killed myself a dozen times over if I wasn’t a Christian and knew that my mother and father raised me better than these callous Cretans. I am appalled today at the number of people killed by these bureaurcrats and how they deny accountability no better than the government who maintained the murdering nurse I’d reported years before.  The negligence and sins of omission and corruption are the problem in the system. After that year of being exposed to the hallow men and hollow women in the burearocracy I concluded that only God made sense. There was only hope in Jesus. My Christian faith grew and my appreciation of sobriety was immensely rewarded by seeing the ego addicted narcissism of the truly satanic. I loved reading C.S. Lewis’ Screw tape letters again. I loved when the grief lifted I could have at least black humor.  I loved carrying on. My father needed me.

During my mother’s sickness and dying a woman neighbour had thrown herself at Dad. My mom hated her. She was always asking him about his money and pension and when mom died she was there telling us that he could move in with her and she’d take care of him and could we help her to transfer his pension to her to help her with the costs and what was his bank so she could do all this. Dad was crying at mom’s loss and this lady was flaunting about half naked and just a pig. I was so thankful for my sister in law at this time.  She and my brother and I knew that Dad couldn’t remain here. He was blind and old and weeping with sorrow and this predator was circling.  Her daughter was a nurse drug addict and we actually figured that the mother was just trying to get money for her daughter but she would have killed Dad for his pension.  It was an ugly thing to see. My sister in law Adell was the strong one and a saint and she saw through all these machinations and insisted on taking Dad home with her. My brother and she would arrange for him to be in assisted living nearby them and Ron with his incredible capacity for business and finance would take over all the family affairs. I’d go back to work glad to be part of the rescue of my father and now able to focus on defending myself from the female psychopaths.

Women don’t fight one on one but work their wars and evils through proxies, institutions and men.  They also gang up and tag team.   The fact that I’m alive and things worked out eventually though they’ve cost me thousands,  is that there’s a whole group of good people mostly behind the scenes supporting good.  They don’t like the skanks and psychopaths and they limit their violence.  I was also supported by the Canadian Medical Protective Association and the good men and women who worked there and saw that the system was flawed and these pseudo legal institutions were increasingly out of control. 

Dr. John White the Christian Psychiatrist I’d trained with had written metaphorically about the spiritual war and seeing the evil in the institutions I fully appreciated the spiritual war fare on a larger basis. I actually met Vorgons in government and saw all the characters that are the bad in Lord of the Rings. At the same time my sister in law was a fairy queen during this time and there were others like Laura and Aim and Joanne and Elizabeth. All these beautiful people that counteracted the darkness that seemed to be growing.  My brother was a regular Gandalf while my nephews were definitely Hobbits. It was the metaphors I had to deal with. Sometimes it’s was Luke Skywalker and Obi wan but I just kept telling myself that God prevails and in time these bottom feeders would let go.  

It was so easy to see the darkness but there was always light. Coming back in the sailboat with the broken mast and the lousy battery bank I’d listen over and over again to that great Christian Rock BandThird Day’s song “ There’s a light at the end of the tunnel.”

I’d become ill one week, I’d had acquired tubuculosis working in the northern Indian reserves , been treated, but my lungs were never the same.  I thought as I was going to die from this horrible pneumonia so I’d might as well buy a motorcycle so I had something to live for. I’d taken all my lessons and loved my Ruckus but now I almost bought a Honda Shadow but a Buell Blast went on sale at Trev Deely. Laura loved motorcycles and had had a dirt bike she adored as a teen ager so was 100% behind my return to motorcyling. After I’d crashed a Norton on the back roads drunk and stoned getting rocks in my finger joints I had to pick out I’d decided against motorcycling for fear of losing my fingers. Now sober and having all the fun we’d had with the Aprillia and Ruckus motor scooters I graduated to the Buell Blast 600 cc. Laura had her motorcycle license and I’d do my training with her driving my car and me riding behind her on the country roads. Eventually I’d have my full motorcycle license, after only one crash in the exam where the fleet footed examiner escape alive.  I’d  drive that Buell all over the province before I graduated to the Harley 1200 cc Roaster which Laura and I would take motorcycle camping all over the province. I wanted to go to as many round up camp outs as I could and did.  We’d fall in love with Salt Spring. I’d loved it as a sailor and now loved it all over motorcycle camping. 

Every weekend and every evening of that year I was ‘defending’ myself and my practice and my patients from disgusting low life in low and high places.

I’d eventually have this lovely young lady who was pure and honest and Christian join as staff. In addition I had this very savy young man who’d worked in accounting and banking sort out the mess for me 

He was also ‘mr BC’ in this hilarious society in which the men dressed as women and women dressed as men. Each year there’d be a ‘drag queen’ ball and that’s when I spent the evening with the mayor in a magnificent gown with my hair done up , my make up perfect and even my friend Barbara didn’t recognize me. Laura laughed at all the shenanigans.  95% of cross dressers were heterosexual so our group was husbands and wives and rather hilarious. We’d have these dinners with challenges as to who could dress best from Value Village  with only $20 .  I was living on Beach in this fabulous apartment with balcony and loving going to the great pool every other day and eating out on Davis. I rarely drove and lived downtown. I even got roller blades and almost killed my self because my friend Dr. Anna said it was fun. I had more padding than the Michelin man but still couldn’t stop. Stanley park was a marvellous extension of my experience with great walks and cycling tours at this time.  I’d take a little ferry to Granville Island to shop and really loved the city. The problem was camping and hunting. I had everything in storage and would bring everything back only to find the elevator broken and me faced with climbing 20 plus stories.  It was a truly ‘city’ time though and I loved going out to clubs and dances and having a whole network of eccentric and wild friends from my elite club and downtown church.  

As it was with me the office buildings where I worked had cataclysmic events.  They got sold and the new owners took over the floor I was located on. The whole floors got evicted twice in my experience.  I was a very little guy and watched a Dentist and Opthalmologist get the same shaft as I experienced. The next time the lawyers on the floor couldn’t resist so I just went with the flow. Everyone just doing ‘business’.  I couldn’t complain.  I had a year to year lease and had to vacate.  It was the best thing that happened to me

I moved to China Town. The secretary that I’d had who was this horrible angry person who abused my patients who all complained about her, lasted with me less than 6 months because ‘I don’t like seeing people that aren’t from West Vancouver. I don’t want to work with people with drug and alcohol problems.”  I suspected she had a major alcohol problem after a while but who knows.  She was perfect in the ‘honeymoon’ and then her ‘true colours’ showed. I was glad when she said ‘I don’t want to work with people with drug and alcohol problems or crazy people. I thought you saw people who were a little depressed. Half your patients are lovely people but some of your patients are just disgusting. They don’t respect and appreciate me or treat me as they should. I certainly am not going to work in China Town.  That’s so beneath me.  You can’t move there.”

Well I could and I did. I was tired mostly of the parking gouging on Broadway. I ‘d had a horrible experience at this location with the evil minister and her evil friend and the evil government agencies.  I wanted to go to China town and have different places to go to lunch at noon. I worked from 8 am to 8 pm and would only get out if I had a cancellation or a lunch. I loved Chinatown and wanted to be able to explore at these times. I’d been on the Broadway corridor for years and eaten in all the restaurants. There was nothing wrong with it but I wanted a change. 

Because I moved I’d hire new staff. I’d keep more than half my patients. Some from the university area didn’t want to make the trip down to the city but I really didn’t have to ‘start over’ with the practice but had had more and more ‘medical legal’ requests.  I’d taken an interest in neurology and head injury just bccause I’d been seeing so much of this in my alcohol and drug addicted patietns. The best part of all was having Aim,  Joanne and Hannah come to work with me. After a year of theft and attitude and downright evil I had these extraordinary women come into my practice as a gift of God. They did the work and they did it well and they always ‘cared’ for the patients. I’d had the skank and her boyfriend and this horrible old lady who simply lacked empathy and didn’t seem to ‘care’ for the patients.  

Now I had these amazing ladies who really were mature and emotionally so highly developed and cared for the patients.

In the summer before I’d move and meet Aim and Joanne and enter 5 golden years of practice reminiscent of the days of Lil, and Laura and Suzanne, I’d decide to sail my boat back with my friend Tom. I”d pay for Tom to fly over to Kona and spend a couple of weeks checking out the systems and replacing what was needed. This was all good but he refused to replace the batteries which I’d paid for him to do. He insisted they were fine when indeed they weren’t. He did however ensure all the other systems were working and when I arrived we were able with only another week or so and massive outfitting with my credit card get on our way.  

We were a hundred miles off Kona when the rudder connection broke. I contacted the Hawai Coast Guard and sailed back. Homeland Security had become involved since 9/11 and ‘permits’ to sail the islands were highly restricted. We were a boat in distress and I only motor sailed daily from island to island during the day rather enjoying this  ‘sailing’ of these tropical islands. I’d enjoy it more but I was paying for a secretary and an office and had a whole lot of patients waiting for my return. I’d planned 4-6 weeks off and it would actually take another 4 weeks.  I’d sailed solo to Hawaii in the worse conditions in 24 days but now sailing back in the best conditions with crew took 34 days.  30 days was a reasonable plan except for the equipment breakdowns.  

We arrived in Hawaii main island harbour. That’s where we saved the pacific fleet by finding they had a ‘hole’ in their defence at low tide.  This impressed the Navy and the Coast Guard but nothing impressed Homeland Security who treated me like a “terrorist to be”, the whole time I was there. She did not like ‘yachties’ and thought everyone should be in uniform.  I was thankful that the Navy and Coast Guard countermanded her order to leave insisting I couldn’t because my boat’s rudder needed repair. We had to order the part. I rented a lovely white convertible and Tom and I had an idyllic week going for coffee, lying on the beach and reading.   When the part got in, thanks to Tom’s engineering skill, we replaced the rudder coupling and restored the autopilot function to the rudder.  

We were off again.

It was perfect sailing conditions. Wonderful tradewinds. Great sunny days. We’d met a couple of other boats going back and kept in touch with my Hamm radio. Then my crew got his crazy impulse to race at night. A gale had come up and he’d put up all the sails. Sleeping below I’d felt the boat lean too far and woken in fear, ran up on deck to start screaming and pulling down sails. That’s when the mast cracked. I’d had to repeatedly tell him that the maximum ‘cruising’ boat ‘angle’ had been x when he wanted to have the ‘gunwale’ in the water. “We’re not in a fucking race. I’ve told you time and again  I reduce sail at night. If anything goes wrong we’re alone at sea at night.”  I was really quite furious and my crew would joke about his having only 40 feet to stay away from me that night.  I just was angry that he’d take risks with my equipment and pull that whole anti authoritarian , adolescent ‘acting out’ with the full sails at night routine and now I was paying big time for his inability to simply follow orders and respect my equipment and my desires on my boat. The old mutiny and why I understand the ‘lashes’ that lasted so long in the British navy and weren’t such an issue on land.  I certainly wasn’t Captain Bligh who really got a bad name because his crew mutinied. 

Spanish Turnbuckle.  We were going again.  70 miles a day rather than the 100 to  150 miles a day and more weeks at sea but really a good time was had by all though my costs and losses for this all would be $150,000 but I’d have my boat back and we would be alive. My crew would oversee the repair of the mast having created weeks of work for himself and I’d eventually have the boat back as a home and a true joy.  My tugboat captain friend arranged space for me on the commercial dock and I had a shower in the China Town office. It was a rough existence in some ways but I truly loved the SV Giri. 

But on the boat coming home we’d had this wind generator problem. I had the wind generator from hell. It was huge. Tom in a fate of redemption stood on the precarious strut and lifted this beast off. He tried to fix it and for days we had this killer monster taking up our cabin and then in another feat of despair it was lifted back onto the pole when I was arguing we just chuck it overboard.  He deserved a Victoria Cross for his bravery and contribution to the boat even if it didn’t work any better after that.  My solar panels had all the input they could get but the problem remained the batteries. I had a water maker and for the water maker to work we needed batteries. The batteries ran the autopilot as well though we were able to get the wind pilot working a lot.  2 guys at sea.  Lots of challenges. 

 I have a friend who brings yachts home and now appreciate his amazing skills. I’d sailed solo starting with a fully tested ready to go ship but now this boat had been on land for three years and things corrode and gum up and such. The rudder had broke and the mast had broke  and the batteries wouldn’t hold a charge. But I had a Honda 1000 generator though it was problematic with intermittent air flow issues.  Nonetheless we made it. The tuna we caught was delicious. Tom baked fabulous bread.  

Coming into the Strait of Juan de Fuca my cell phone rang and I realized that now we had cell phone coverage in the coastal passage where I planned to be sailing now that I was home. I immediately thought this means I can do a methadone clinic. To be a methadone doctor you have to be on 24 hour call but VHS radio is not private so until this moment I couldn’t be because I didn’t want to give up sailing. Now I could.

I’d phone Gary and begin working a day a week at his methadone clinic a few blocks from the new China Town office I’d arranged after the Broadway building was sold.  All my money was going into the boat or the practice.  I was functionally ‘poor’ but rich in so many ways.

Now in my China Town practice I’d become so rich in heart.  I’d decided I could have another dog. I was over the murder of Stuart as much as one gets over the murder of a friend.

I made the decision to meet Gilbert. It all happens first in a spiritual realm. My prayers were answered. 

My cousin Wayne, logger and rancher, who bred Appalachian horses,  hunted and fished, and lived in a beautiful log cabin he’d made himself in the north had a Cockapoo. I decided that a cockapoo was what I wanted and found a retired  American Navy Commander who bred them on Whitby Island.  I contacted her.  Laura was keen on helping. 

I’d go off to meet Gilbert in my truck and  return with wonderful bundle of love that Laura and I continue to be blessed to know.    

Prayer and Jesus

Luke 18
1.“Then Jesus told his disciples a parable to show them they should always pray and not give up.
2.He said, “In a certain town there was a judge who neither feared God nor cared what people thought.
3. And there was a widow in that town who kept coming to him with the plea, “Grant me justice against my adversary.”
4. “For some time he refused. But finally he said to himself, “Even though I don’t fear God or care what people think
5. yet because this widow keeps bothering me, I will see that she gets justice,
so that she won’t eventually come back and attack me!"
6. And the Lord said, “Listen to what the unjust judges says.
7. And will not God bring about justice for his chosen ones, who cry out to him day and night? Will he keep putting them off?
8. I tell you, he will see that they get justice , and quickly. However when the Son of Man comes, will he find faith on the earth?"

I am again being falsely accused. I am troubled that the courts in Canada have become like the Communist inviting  false witnesses to give power to the State and cause every truthful man or women to live in fear. Totalitarian and police states encourage all to report on their neighbours and celebrate those most those who lie and attack Christians and good and true officials.
I cry night and day “Grant me justice against my adversary”.  But I struggle to understand if my adversary is the individual psychopath or psychotic or the system that does not protect good men who do their work.
There are untold odious complaints and false testimonies against doctors who work with two types of patients
1) those with drug and alcohol problems.  If any one knows drug addicts or alcoholic they know well what vengeful and petty individuals they can be when they are in their cups or hung over.  The Big Book of Alcoholics Anonymous based on the honest assessment of their individuals in recovery noted that Resentment and Fear were central features of their universally immature character.  Resentment was the central fuel of their addiction.  Bitterness.  They commonly live in the past and hold grudges and their fear of retaliation is such that they are often paranoid for periods of time.  These are the people who are quick to complaint, easily offended, don’t like to cut anyone slack but demand it for themselves.  They fill the courts and their letters to the editor are endless. They are the cause of many wars ever waiting to restart some old conflict in the hope of getting even.
2) those who are involved are dissatisfied with their employer and are getting paid to stay home from work by an insurance company.. Their anger with their employer is more often concerning deep seated issues against authority tied to their earliest childhood, neglectful or outright abusive parents.  The doctor is called upon to write a letter to say that they cannot work because of some condition.  With physical medicine this isn’t as threatening for the doctor because when the injury heals there is obvious evidence that the patient is well so return to work should follow.  There are objective measures.  In psychiatry the issue is far far worse because the complaints are invariably about something ‘subjective’ such as “pain”, “dizziness”, “fatigue”, “depression”,  “anxiety”.  With Borderlines Personality Disorders, like Paranoid Personality Disorders, people are seen in black and white categories. Lawyers who defend people against sometimes callous insensitive greedy insurance companies are often as as difficult as insurance company companies who are occasionally callous insensitive and greedy.  There is a conflict inherent in this situation made worse by the inexperience or agendas of the lawyers and the insurance agents. The psychiatrist who is required by law to be as ‘objective’ and ‘impartial’ as possible is called upon to express an ‘opinion’.  The psychiatrist is however by ethical oath an ‘advocate’ for the patient.  He can not lie but he will be as supportive and understanding of her concern as possible.  To this end I report the patients concerns clearly and measure their subjective complains and write formulations that attempt to see the best in people, some of whom are malingering sociopaths.  I “diagnosed’ sociopaths and malingerers by the dozens in the past but I was told that this was unacceptable and really it was now a matter for the courts and judge to assess this. Further if I stated the obvious that a person was a sociopath,psycopath or malingerer in my opinion the patient would definitely complain to the College of Physicians who might well agree but punish me to the tune of $10,000 tying me up in a legal beaurocratic malaise that gave them raison d’être and made them and lawyers rich but definitively punished me to no end.  I have been punished repeated to the cost of hundreds of thousands of dollars for telling the truth as a doctor.
So I don’t diagnose people as sociopaths, psychopaths or malingerers anymore.  Naturally it’s like any doctor who is told that he cannot diagnose ‘appendicitis’ or some such not uncommon diagnosis in their field.  Our textbooks and diagnositic formulations all include these diagnosis but ‘smart’ doctors especially those most interested in ‘business’ just know not to diagnose anything that would be ‘unpopular’ with patients. Rich doctors must be liked and popular. It was for this reason and it continues to a lesser extent that most doctors won’t diagnose alcoholism, addiction or even sometimes mental illness.  They don’t want to lose the patient.
Regardless today I support patients and generally don’t think of them as psychopaths , sociopaths or malingerers because as their doctor I really want to ‘give them the benefit of the doubt’. Even when I learn they are unable to work because it’s too tough for them to sit at a desk for 2 hours because of their pain but they fly 12 hours to vacation spots and back, well it does seem suspicious but I am there to be helpful not to be a judge. The judge will sort this out because so often in these cases too the insurance company will hire a psychiatrist who will quickly see how ‘incongruent’ the patients statements are and even note that while the patient can’t do ‘their’ job they are nonetheless working under the table or doing things for family and friends which would constitute work.  One person who ‘couldn’t work’ had a family business running out of the basement. Anyone who has worked with insurance companies knows just how sadly common this is especially in those who do not share an ethical or moral basis  of the greater community.
When patients are angry with doctors because the doctor is perceived as a threat they don’t complain about the doctor specifically being a threat to their desire to get their‘ money for nothing’  because of deep seated issues of entitlement but rather will make their complaint ‘powerful’ as possible.  Single male doctors are therefore with women always ‘sexually harassing’ simply because there is no basis to ‘sexual harassment’ except a he said, she said complaint much like the subjective complain of ‘fatigue’.  One female theif who called her accuser ‘sexually harassing’ actually called the policeman who investigated ‘sexually harassing’ and the Vancouver police department would not follow up on the case because of the fear and cost of this complaint to date to their members.  In all cases there is no ‘objectivity’ to the complaint but it remains as a ‘character assassination’ and it’s done for profit as the patient in these work place issues is trying to get ‘money for nothing’ and ‘time off work’.
Many companies have successfully reduced these kinds of situations by allowing workers to be off work in a company club house or cafeteria but not allowing them to go home to be paid.  One of the sure signs of malingering or alternatively factitious disorder is the refusal of patients to attend group therapy or any group situation because when there is a group malingerers sociopaths and psychopaths know that their ‘sickness behaviour’ might be filmed or witnessed by others when they are not aware. In one to one interviews it’s easy to maintain the ‘sham’ but in the group process there are just too many variables and even a person with a decided limp might forget to do it in the complexity of groups. Naturally Insurance companies when they believe a person is a sociopath , psychopath or malingerer will want the person with the psycihaitric illness to attend a group. Further group therapy is to psychiatrists the very best of therapy and a central cornerstone of psychiatric hospitalization.  There is really little reason for a person not to attend group therapy.
Yet this is when the ‘I’m agoraphobic and I’m social phobic ‘ or “I’m too fatigued to get out of bed” . In the past they were hospitlized at this point and the ‘truth would out’ . One of my patients couldn’t ‘walk’ , but the nurse noted that he sneaked out of his bed at night to use the washroom so I diagnosed him as a ‘malingerer’ and naturally he complained to the authorities , right up to the Minister of Health, that I was a Fascist.  I miss the hospital as it was the very best psychiatric intervention for sorting this matter out.
Without hospital resources psychiatrists are now at increased threat and risk from dangerous patients.
Further in Canada there is a horrendous unconscionable lack of consequence for PERJURY.  The 10 Commandments says “Thou shalt not Bear False Witness’ but in this anti Christian, anti Bible, Anti Truth, Anti doctor country I have been utterly utterly frustrated and countless times in tears for doing my job and trying to help patients to the best of my ability with all my training and experience but only to be faced with complaints because I continue to work with people who have drug and alcohol problems and who are out of work and in conflict with their insurance companies..
The sad thing is that I have been able to help hundreds or thousands of people and the proverbial ‘bad’ apple is one in a hundred.  Most of my patients who have anxiety or pain or depression offered ‘group therapy’ jump at the opportunity. Patients who want to get better will do everything to so and yet there are those for whom treatments don’t work but they don’t pick and chose and refuse to be in any situation where they are under observation.  They welcome a chance to prove their truthfulness.
Patients with drug and alcohol problems are harmed by those who lie and enable their disease. I make the diagnosis as frankly as I do cancer. Being diagnosed with alcoholism or addiction is like being told you have cancer but if doctors don’t tell their patients the truth they patients are at greater risk.
I never think of patients as the adversary.  I thinks the system or the authorities are at fault because they know these aren’t ‘isolated’ cases yet they punish the doctors who work with these difficult groups. Most of my much smarter and more clever and more business oriented colleagues simply say no to seeing patients with drug and alcohol problems or work problems or with superego lacunae.  I see people who are murderers and prostitutes and often very dangerous and often very unclean and smelling very badly and I know my colleagues and the government in general denies them care by neglect or a countless series of barriers to treatment but I work with these people but I get upset, forgive me jesus, for being stabbed in the back over and over again by the very people who are supposed to be serving the same people I am.
I am not the enemy.
I am a Christian who when I was going to work in Africa was told by Dr. Jack Hildes Canada has as many people who are need missionary doctors because our health care services don’t treat the marginalized.  I have followed his advise and worked in the areas of ‘greatest need’ but I’m old and tired and reduced to crying by my bedside where my mother taught me to pray on my knees.
GOD GRANT ME JUSTICE AGAINST MY ADVERSARIES.

Rate My Doctor

I was delighted to hear that Dr. Shane, one of the finest forensic psychiatrists in Canada, was working to limit the damage done by the Rate Your Doctor organization.  As a forensic psychiatrist he is not supposed to be popular.  I totally relate to him.

I just reviewed my rate my doctor site. I was mr popularity in school. I'm a psychiatrist and an addictionist. I've reported pedophiles who have had hundreds of victims. I've notified Transport Canada that their pilot is smoking crack or marijuana.  A lot of my work is done on behalf of third parties where the person I'm seeing is being assessed for dangerous ness to society or whether they are a risk to others in the workplace.  I'm a methadone doctor and I have had my prescriptions forged and have on several occasions discharged patients from the methadone program for illegal abuse of methadone or breaches of the protocols of the methadone program that require the physician to terminate the person's care.
I have been asked by the police to treat people for bestiality.  Routinely I'm asked to sign forms for people in which they are lying and wanting me to lie on their behalf to get money falsely from insurance companies or the government.  I say no and they hate me.

When I reviewed complaints I'd received 90% were because I'd 'diagnosed' a person as having a drug addicton or alcoholism and the person was being required to see me because of domestic violence or workplace safety issues or harm to children.

I am referred patients by doctors and commonly the doctor referring the patient doesn't advise me or may not know the patients history. I have refused to see several men because they tried to conceal from me their history of rape and violence against women.  I have found out this information from collateral sources. I have refused to see them because I have a female assistant who I will not put at risk.  I might have seen them if they had been honest with me.  I refused to see a Nazi once. He was very threatening. My windows were shot out. I've changed my phone numbers on several occasions and I've lost a staff member because of the venomous rage poured out at her by a patient blacklisted by most psychiatrists for their damage to property in the office.

My own life has been threatened on many occasions simply because my correct and truthful assessment has resulted in a person losing their income because of dangerous drug addiction, because they were hearing voices telling them to kill their boss and I am required by law to report this to the person they are threatening, that they were under control of spirits that wanted them to violate children and I am required by law to report this to child protection service. When called by the RCMP regarding whether threatening and dangerous persons should be issued a firearms license I have had that person turn up at my office threatening me. One person sent to by police after an arson attempt tried to pour gas on me and set me on fire. The police accepted the person needed to be restrained.

A patient brought a gun to an interview demanding I give them valium.

I was a supervisor in the dangerously insane ward of the asylum. I did see patients in jail. I was a supervisor in the psychiatric emergency.  I have been a supervisor in a detox unit.  i have many times had to say no to people who felt entitled to services which they were not and they were not willing or could not  pay for those services.  I have had patients come to my office demanding an MRI saying they need one and their stupid gp won't give them one and if I don't do it they're make me wish I had.  They want the MRI for free because they're involved in some litigation and hope that the MRI will help them get more money. However they don't meet the 'criteria' for MRI .

I have always worked in the areas of greatest need. When I was a country family physician and northern flyin doctor I was much loved and appreciated.  When I was a psychoanalytic psychotherapist I was highly regarded.  When I began working in areas where I was required by law to serve the state and the client or have to consider the rights of children as opposed to parents and doing occupational psychiatry where the issues of safety sensitive factors employment arise,  suddenly I've got this filth on rate your doctor.

When I diagnose alcoholism the pilot is required to enter a treatment program. Their disease is so severe that they want to 'kill the messenger'.  They are putting their co workers and others not to mention millions of dollars of company property at risk and they are very angry at everyone whose job it is to think of more than just them but consider the life of others.

There are 'feel good' psychiatrists. They are junior psychiatrists and they rarely have the responsibility for major decisions outside of the individual.    They can remain 'popular'.  They are not Forensic Psychaitrists.  They are not Occupational Psychiatrists. They are not Addiction Psychiatrists.  They are not Emergency Psychiatrists or Psychiatrists that work in the Asylum.  They never say 'no' and their patients love them. I sometimes have the unhappy task of treating the patients of these doctors who have left their patients grossly addicted to a variety of medications that the patients are very angry to be having to stop when the 'good' doctor gave them this and they can't understand why he won't see them or why he can't prescribe to them anymore.  Many of these 'good doctors' have lost their 'prescribing' priviledges. Not Ironically a couple of these psychiatrsts are called as the very best psychiatrists and I could just throttle them for the mess they made of their poor patients which we in addiction psychiatry are left to clean up.

I have one patient who is still angry with me because I stopped her from killing herself.  She insists that if I didn't resuscitate her God would have saved her baby from dying.  There's no reason outside her psychotic thinking to believe her death would have revived a dead baby but she wanted to try and I interfered with that.  I know one schizophrenic patient that believes anyone who is treating him "nice' is just preparing to kill him.  I have to be extremely 'neutral' with him. No medication has altered his underlying paranoia but he's not been chronically suicidal in my care.

I do use 'story telling' as a therapeutic tool.  I do cognitive behavioural and supportive therapy.  I do not let people venomously 'vent' about their ex-husbands or ex wives in my office.  This is not 'good therapy'. It's highly lucrative but it only reinforces the injury and re traumatises the patient.

I'm not being paid to passively listen to patients.  I'm first and foremost a medical psychaitric diagnostician. I have to be sure a patient doesn't have symptosn of anxiety or depression because of an undiagnosed cancer, brain tumor, thyroid disorder, or metabolic problem.  In a therapeutic assessment I'm informing patients as I go along often answering questions and correcting misinformation they increasing come baggaged with by reading fear mongering web sites which are selling a diagnosis or treatment.

I have far more effective 'tools' for helping people than passive listening.  I have done years of training in active 'listening' therapies but there are few who are specifically suited for these types of therapy. Less that 10 % of patient's referred to psychiatrists are appropriate for anything like the televison psychiatry models of therapy. Further the research says those types of therapy work best where patients are paying for that kind of care. Hence psychoanalysis is no longer covered by health care funding insurance programs.  I am specifically trained in 'change' therapy. As an addiction specialist I'm trained in motivational therapy which implies that the person will 'change'.  The state pays for psychiatrists to help people change for the better, not to make them feel good sick.  The health care system isn't in place to perpetuate disease. (At least it's not supposed to be)

My obese patients want to 'talk' about their problems but are very angry when I say after a couple of sessions or so , "If you're not willing to do some thing about your problem then there's nothing further I can do".  Based on a motivational assessment they aren't even in the 'contemplation' phase and are best advised to come back in 6 months to review what they're willing to do about their problem. All the 'life style' disease problems don't get better by having patients go on and on about 'why' they drink, gamble, over eat, shop, hoard, live on pornography sites.  These people want to collude with you and talk about thier problems as a means to maintain their problems without actually doing anything about their problems.  As a result of research findings we're not supposed to see these people and perpetuate their illness by enabling. They are angry because they get tremendous 'secondary gain' by seeing top specialists and showing that another doctor 'failed' to help them because their addiction is a really sick disease.  It's considered a waste of tax payer money for specialists to persist in therapy where the patient only talks about change but doesn't make any actual change.

A large part of my therapy for some patients is 'educational' as is the case with all 'cognitive behavioural therapy'. Many of my patients however are referred because of behavioural problems.

Only 20 % of my present practice are relatively highly functional individuals with 'neurotic' concerns. When I had a psychotherapy practice this was about 80% of my patients.  My present practice for the last 15 years has focused more on trauma and addiction:  head injury, ptsd, personality disorder, and major medical illness.  Most psychiatrists exclude personaliy disorder and addiction and head injury from their practice.

Because I've worked in areas of greatest need I've always had very sick patients as well as less sick patients but more I've had a higher per centage of really sick patients.  Many of my patients have major medical and neurological illness. They are not likely to return to work but it is hoped that they can have a better health care outcome. Often there are a dozen other specialists involved in the care of these complex patients.  No psychiatrist in the "business" of medicine would touch these patients because they are extremely costly, timely and sick.  They're generally very unhappy with life and their medical care in general, frankly because they have had horrible events happen to them . As a psychiatrist I can't offer them a new life, or millions of compensation and often all I'm doing is trying to provide sometimes only 'palliative' care.  Smart and popular psychiatrists send these patients back to gps, avoid them like the plague, and won't see them more than once for a consult.  Dozens of my patients have been rejected dozens and dozens of times by 'cherry picking' psychiatrists.  Sometimes like me, other psychiatrists are just  overburdened  and may not be able to take on another highly disturbed patient.

I have to move my patients around so that my waiting room isn't a nightmare of trauma for the patients. I don't want my active crack using patient to come before or after the lady I'm seeing for grief after losing her baby.  I try to avoid having my rape patients  sit next to the sex offenders I see. I have a lot of difficulty managing my booking schedule and it's a real hard time for new staff who sometimes wil book three severe borderline personality disorders in a row and wonder why I look like vampires have sucked my blood at the end of the day.  I can't see two grieving patients back to back and I don't like seeing more than one manic in any day. I can see schizophrenics one after another.  There's a reason for that.  Most active addicts can not be seen for more than 15 minutes though for special reasons you may have to see them for an hour. That's usually far too stressful for them. The same goes with adolescents and people with early dementia.  I can only do one family, group or couple in a day usually because the intensity of the complexity is so draining.  Emergencies are always screwing up my schedule. Scheduling my office is like booking an operating theatre. It's a speciality in itself.  Despite notices patients often arrive with reams of paper work and cavalierly 'expect' doctors to just get this done by a deadline arbitrarily set by someone who usually doesn't know anything about medicine.  My schedule is booked 6 months in a advance. Now where is there going to be 'time' for this 'urgent' report thatn's never properly funded to be done.  Patients get moved to accommodate emergencies.  So every patient often thinks their particular 'need' (never want) is an 'emergency' and want you to just cancel or move all the other patients to accomodate them.  Sometimes we don't leave the office till 8 or 9 pm and often on weekends I'm working.



Because I do truama I'm commonly having to do medical legal reports and suddenly because judges (who scheduling problems make mine look trivial )  free up courts, I'm scrambling to have a report done and to see a patient so that this can all be available for a court date that moved sometimes months ahead. I'm a treating clinician and as such I have to be willing to provide these reports if  I am to be of help to my patients. I have much more control over independent medical examinations because I can simply not book these. They pay much more than regular psychiatry and most of my colleagues are doing these so they can continue to do the 'publicly funded' psychiatry.  More and more psychiatrists are simply not doing 'public funded' psychiatry but rather working in administration, on salary or doing private work for companies and insurance.  Private psychiatry has high overhead, no benefits, no pension, no cars, no lunches, no fixed hours, no overtime.  My colleagues in 'salaried' positions are rich and luxurious in their slower paced much more highly rewarded positions often far from the maddening crowds.

There's no money where the most angry patients live and the risks are increasing every day as the cost of the complaint process sky rockets because of all the "time loss" for private clinicians. When a patient complained I wouldn't see them that day, I lost a full day of work, having to cancel patients and re book them so that I could accomodate this 'bully' who wanted to jump the queue and thought by threatening my secretary they could.  When I reported staff office theft I had to cancel an afternoon of patients to meet with the police and go over all the damage this irate and violent person had caused.

Everyone likes to provide one time 'consults'. The doctors who do this are popular with patients and commonly disliked vehemently by family physicians who want someone whose going to share the burden.  Familiarity breeds contempt.  It's really easy to see a person, get in and get out and hope to never see the person again. A number  of psychiatrists specialize in this approach.  This is essential in other areas of medicine but the work of psychiatry is in the ongoing and chronic care and the 'acute management' of sick patients.  The government expects the health care teams to take care of these patients and they do but more often than not the patients don't want this often 'factory' type care. They want to see a psychiatrist and not a counsellor with only 2 years of training and rarely the appropriate supervision.  The psychiatrists in the teams rarely spend any real time actually meeting and  talking to patients.  They adjust medications maybe every 6 months.  When I worked in mental health teams only a small portion of my time on salary was devoted to direct patient care. The majority of times I was going to committtee meetings, meeting with other staff, reviewing reports, making phone calls, doing lunch.

I talk to patients. I listen to patients.  I am known by patients. I'm an open book.  Most of the patients who chose to see me and want to see me want to 'change' and want more than a band aid. Many of my patients come in at a particularly low spot in their lives and leave restored. I joke about my practice saying "I overhaul ferraris or sometimes just tune up ferrari's:. The people I choose to work with are usually survivors or fighters.  So often I feel priviledged to be a part of their journeys.

The majority of my colleagues who are practicing frontline clinical psychiatry are facing all the same systemic problems as I am. I see the addiction doctors and the occupational pscyhiatrists and forensic pscyhiatrists are often faced with similiar complaints as I have.  I admire their work and feel sorry that so many of the people who I see doing a really tough job are the ones getting it in the neck becasue they're there. I don't respect those who are hiding somewhere far from the patients,  smiling. I may envy them at times but I don't respect them.  I also know I have some of the most amazing colleagues and some of those in other areas of subspecialization in psychiatry are my true heros. A couple of my favourite women psychiatrists are working all day long just like me but with injured children and a fundamental lack of resources in the community.

5 million Canadians can't find a family physician, 1 in 5 and of the people who need a psychiatrist maybe 1 in 10 at most actually get to see one once and one in a hundred actually get to see someone who will see them regularly.  20 years ago I could refer a patient to a colleague and they'd see that patient for consultation that week. Today I wait 2 years to get a patient into a pain clinic, 6 months for an MRI, a year to see a subspecialist neurologist, and thats just some of the wait list problems constipating the system and making all the patients who are often getting sicker and sicker while they wait incredibly angry.  I don't blame them but it's not my fault personally that someone other than front line workers are getting the big bucks of health care.  Whenever I hear of millions or billions of dollars going to health care I think of fat cats in committee meetings discussing how many 'meetings' they're going to have to discuss how they're going to spend the money.  I don't see the resources translating into services that make my or my patients lives easier.  

Many of my patients come to me because I respect their spiritual traditions so ironically for an overtly Christian psychiatrist I have a fair slice of patients from every other religion in the world as well as agnostics and atheists.  I love that the atheists tell me that they like that they know where I stand.  Freud was very Jewish.  Jung was spiritualist.  My Moslem patients say they  want someone who has a faith and wont' disparage theres.  My buddhist and hindu patients like that I support their mediation. Dozens of patients over the years have told me that they were discriminated against for their faith and that psychiatrists belittled their religion in countless ways they probably weren't even aware they were doing.

Patients are referred to me. Over the years I've accepted more patients from certain family physicians whose work I've admired.   I am not accountable for the tremendous shortage of psychiatrists.  I am not required to see all patients referred to me and turn away a dozen referrals a week because I'm overbooked or because the patient doesn't 'fit' my practice.  My assistant tries to communicate with the receptionists in the gps office. Many referrals come from walk in clinics where receptionist turn over and many doctors results in my assistants responses not getting passed on.  I am not required to communicate in this way.  I am only responsible for patients once I've actually seen them. I am not required to see a person more than once for assessment.

If I choose to provide care I do so based on what is indicated for the particular condition. Many patients want them to see me daily, 2-3 times a week, weekly.  I used to see patients 2 x a week and weekly.  In response to the shortage and because there are no psychiatric resources I've reduced the frequency I see my patients to what isn't ideal but remains marginally okay. I't's much easier to see a few patient frequently or a lot of patients for assessments. It's very hard to see a lot of patients at 2 week,  one,  three, and six month intervals in terms of scheduling. I have patients coming back to see me who I first saw 25 years ago.  What they had then was 'cured' but what they have now has come on with age and is a different kettle of fish. I try to see people I've seen before a s priority.  I've seen thousands of patients over the years so there's more and more difficulty getting people in when they return or when the need to be seen.

Walk in clinics are a very mixed bag.  20 years ago I used to have referrals from a half dozen physicians who I communicated regularly with and who knew me and my work and didn't send patients to me that they hadn't already thoroughly screened. This is not the cases with walk in clinics.  Commonly today I see patients who were seen by several psychiatrists that year or just got out of hospital and the referring family doctor doesnt' know this and hasn't communicated it.  I am deeply saddened by how little walkin clinic doctors know their patients and then I know many patients are 'doctor shopping' and 'specialist shopping' and their's no system tracking patients to see whose doing this.  One patient I knew was seeing three psychiatrists and I only learned when I wasn't paid for their visits to me, something I only found out a month later, having accomodated their 'emergency'.


I have been working without any of the resources I was promised in my training for nearly a decade.  I am routinely handling emergencies in the office because there are no resources in the community.  I am treating people who once were locked up for life without any of the resources they were promised when their hospital was closed.  I had  several head injured patients I was seeing every three months then had to see monthly and discuss weekly because the government closed their clubhouses and these poor tragic individuals were left in their rooms all day.  Naturally their psychosis got work and their angry outbursts increased.

No one notifies me months in advance that they're going to suicide.  When I had a psychotherapy practice like most private psychologists I was always on time and always on top of my schedule.  If a patient had problems I could send them to the hospital and they got good psychiatric care.  A few months back I witnessed my patient jump in front of a bus while my assistant tackled them to save their life and not have bus driver and passengers traumatized. I stopped my practice and spent an hour with patient the ambulance and finally got the patient to the hospital where they were discharged an hour later. So without any 'back up' the family physician and moved our schedules and patients around to see this incredibly sad and highly suicidal man several times a week until he was over his crisis.  Office practice was never meant to serve this purpose but there are no hospital beds and none on the horizon.

The hospital emergency used to have a ward where psychiatric patients could stay a week, then if they needed longer they had a ward where they could stay a month and then if they needed longer they could go to a hospital where they could stay for 6 months or years.  No body had figured out that all of this has gone and the money has been spent on 'planning' , 'administration' , 'talking' and 'politics' and 'ideas' and 'consultants' and 'business consultants'' and a whole lot of other things but the fact is there's no money and countless patients in dire need.

Some days my office is busier than a psychiatric emergency. Other days I think I'm back at the asylum.  I start my day at 7 am. I'm required to review my emails. I've got a hundred a day. Most of it is spam and the government won't pass the appropriate legislation to stop these 'business bullies'.  I am in direct patient contact often 10 to 12 hours a day. Some days I see 10 or 12 patients while others I see 50 or more.  I get dozens of phone calls a day and dozens of f axes and dozens of lab work and other records I have to review.  I rarely get lunch and drink coffee always on the run.  I feel guilty but still take bathroom breaks.  Sometimes I feel like not coming out of the cubicle. I routinely cancel lunches and miss all manner of engagements and have cancelled vacations many times to accomodate work demands. I have many colleagues who do far more than I do in this regard and there are all kinds of 'platitutes' out there about not working so hard but never do those spouting platitudes help with the heavy lifting or late night shifts.

When  a person misses an appointment and doesn't notify us in 24 hours those dozens of people on the emergency wait list can't be called. Those others who are waiting six months to see a psychiatrist in the lower main land can't be seen earlier.

A lot of people sent to psychiatrists are incredibly angry long before the time they get to see us. This wasn't the case 25 years ago.  Rarely was I referred an 'angry' person. Most of my patients were 'sad' or anxious. Now all the sad people seem to be creamed away by counsellors and psychologists whereas the angry and the angry/depressed/anxious are sent to us. My obstetrician colleague says the same. He's not had an easy delivery in years.  Like us his fee schedule hasn't changed and the amount of time he has for a patient hasn't been adjusted to deal with the aging population and greater risk.

The government has been cutting my income since I started practice. I made the most money I ever made in my life working as a general practitioner in my first job.  It's been down hill financially ever since. The government says they're going to cut doctors incomes again.

So I try not to read rate your doctor.  I wouldn't recommend for anyone to be a specialist clinician in Vancouver today.  I am really thankful for men of Dr. Shane's caliber who take the time to address the problem.

I see that there is a Rate My Judge site in the US but not in Canada. I really wonder if it's a good thing to have a criminal popularity poll against judges.  I know I'm terrified when I see pedophiles and violent people and psychopaths and sociopaths. I'm afraid to do the right thing because I don't want to face the abuse that comes from those people who want to fly planes stoned, work drunk, beat up their wives, have sex with their children.  99% of my patients are fine human beings. I know it's their 'sickness' but that doesn't necessarily limit the damage they can do.  Rate your doctor like rate your judge strikes me as likely to appeal most to people who are looking for a place to put their anger and carry out vendettas.

I noticed though that many people did rate my work positively and thanked me for my care.  I am humbled by that and very thankful indeed. It's the highest praise when patients take the time to share the positive. I realize I personally must make a greater effort to be thankful to all those I often take for granted because I 'expect' them to do their job. I know I too tend to 'blame' the customs officer for the delay when the fact is he's there and a half dozen others didn't make their shift and they not him account for the back up.

I  am more likely to be annoyed by the person who isn't doing their job according to my expectations too without realizing that my expectations of what they are supposed to be doing is not what their boss or the governnment or administration is telling that person to do.  It was said that a paediatrician has 90 minutes of examinations and things to do with a child before they actually see the child and hear the child's complaint for the booked 15 minute appointment.  Everyday I have a new and more absurd and utterly ridiculous demand put on me by some one who may never have seen a patient or have a clue about what a psychiatrist does.  This is increasingly common with insurance companies and employers.

Patients get angry about confidentiality but they have signed away that confidentiality to their employer or to their insurer and if their insurer is with their employer I'm required by law to share my records 'regardless'.  I'm now required by law to keep detailed records and produce those records for the courts as well.  It is against the law for me to not 'lie' for patients yet I've been approached hundreds of times by patients demanding and expecting me to do just that.

Just as I teach my patients getting over major trauma or cancer or life threatening events  to focus on the positives I have to do that myself.

Thank you all who have thanked me.  I really appreciate it.  And I'm sorry to those who I've somehow offended because I lacked the skill to serve you better despite the fact that I probably was not what you wanted. Somehow it's a shame the system results in such mismatches or it's just sad that people can't have what they want all the time.