Category: Uncategorized

Re-Post: Health Care Has Crumbled Under Eric Hoskins’ Watch

Old Country Doctors Note: This blog originally appeared in the Huffington Post on April 24, 2017. It is being reproduced here on my own website so that I can access in the future if needed, and for my own posterity.

Recently, Ontario Health Minister Eric Hoskins introduced Bill 87, a.k.a. the Protecting Patients Act. Its goal is one that no right-thinking person could disagree with, namely to identify and punish health-care professionals who sexually abuse patients. The problem is that it is sloppily written, hastily put together to deflect from other health-care stories and will have significant unintended consequences that will harm patients.

My colleague Dr. Nadia Alam wrote an exceptional piece on how Bill 87 is flawed. She detailed how it breeds a culture of fear, will negatively affect practice patterns and abandons the principle of “innocent until proven guilty.”

Predictably, some of the people who commented on her column felt that she was off base. One even argued that the provisions in the bill that supercede tenants of jurisprudence dating back to the Magna Carta were “common sense.” A feeling that doctors are criticizing this bill to protect their own interests certainly permeates the media.

Except, of course, it turns out that the critics of Bill 87 are right. Last week the Canadian Civil Liberties Association, an independent non-governmental organization dedicated to protecting the rights and freedoms of all Canadians, came out with a strong critique of the bill.

Concerns listed include:

  • Setting a dangerous precedent for ALL regulated professions
  • Open-ended provisions that allow a health minister too wide discretion
  • NO explicit limitation of the type of personal information to be collected
  • Information collection to be done solely at the discretion of one person (health minister)

What we see yet again, therefore, is another sure-to-fail piece of legislation by minister Hoskins. Frankly, to this somewhat cynical eye, this legislation is a continuation of his incompetent style of running the health ministry. The pattern all along from this minister has been to act unilaterally on issues, refuse to accept input from front-line health-care workers and, when things get “politically hot,” deflect by having press conferences on unrelated items to try and shift media attention away from just how much health care has crumbled under his watch.

The fact that all his previous unilateral actions have been failures seems lost on him.

For example, three years ago, Ontario had a significant budget deficit. In light of this, the Ontario Medical Association (OMA) offered a four-year wage freeze for physicians. In return, they asked for a co-operative, bilateral committee to identify efficiencies in the health-care system. Not good enough for Unilateral Eric, he instead implemented a series of reckless unilateral cuts that have significantly damaged the health-care system. 

How reckless? Remember how he recently announced more funding to deal with the opioid-addiction crisis and mental-health issues? Did he bother to tell you that he cut funding for addiction services the year before? And that he admitted that he “found it challenging” to understand how cutting funding to a service would result in loss of that service? Economics clearly isn’t his strong point.

Or how about the ridiculous Bill 41, the Patients First Act? He was warned repeatedly by both front-line physicians and the OMA that this act would NOT help patients and would only increase the bureaucracy.

Didn’t stop Unilateral Eric. Rather than work co-operatively with others to improve the bill, he did it his own way. The result? Even the Toronto Star, which Kelly McParland states lives to promote eternal Liberal rule, was forced to admit that the supposed savings from Bill 41 may not come to pass. (My two cents — I’ve never, ever, ever seen taxpayers save money when governments increase bureaucracy).

Worse yet, his approach to dealing with any negative publicity has been to deflect by targeting physicians. Stories in the press about long wait times for joint replacement surgery? Hold a press conference and accuse an ophthalmologist of bilking the health-care system by “overbilling.” The fact that wait times for cataract surgery are growing exponentially get ignored.

Stories of children with special needs not getting home care and stories of overcrowding hit the press? Launch a diatribe suggesting that doctors should become civil servants instead.

Now, most recently, we are hearing about some wait times for assisted living called a “50-year wait,” and even delays in cancer surgery. How does he deal with that? Unilateral Eric hurriedly launches this flawed bill and shuts down debate to allow broader input. Attempts by the OMA to suggest amendments that will strengthen this bill are ignored. 

Unilateral Eric barges ahead anyway. The fact that all his previous unilateral actions have been failures seems lost on him, and reports of patients suffering from gaps in care seem to be neglected. In fact, it is likely because these stories are in the press that he is rushing ahead with this bill to make it look like he is actually doing something positive.

The completely unacceptable part in my opinion is that it is going to be the real victims of abuse who suffer. The first time someone is charged under this law, the unconstitutionality of it will be challenged, resulting in a strong possibility that a perpetrator could get off on a technicality. Can you imagine the impact this will have on a victim? To see someone who harmed them so egregiously walk away without punishment?

The government of Ontario’s Premier Kathleen Wynne is in a lot of trouble. She is woefully unpopular. Her party is badly lagging in the polls. Senior members of her Liberal party have publicly asked her to resign. She has, at best, one cabinet shuffle left to try and reverse her fortunes.

Wynne may very well owe Unilateral Eric big for making her premier. It was his backstabbing of Sandra Pupatello at the Liberal leadership convention that gave her the leadership, after all. But if Wynne is serious about governing the province properly, her next step must be to shuffle the most disastrous health minister Ontario has had in recent memory out of his portfolio. She needs to replace him with a competent minister, who will at least attempt to work co-operatively with front-line health care workers. Only then can we begin to reverse the damage done to the health-care system.

It’s time for Unilateral Eric to go.

Re-Post: Dear Premier Wynne, It’s (Still) Not Too Late To Fix Health Care

Old Country Doctors Note: This blog originally appeared in the Huffington Post on May 16, 2016. It’s being re-posted here so that I can easily access if needed in the future, and for my own posterity.

The Right Honourable Kathleen Wynne

Premier of the Province of Ontario

Dear Premier Wynne,

Last week, I had written to you and pointed out that you needed to fix health care. I suggested that there were seven steps that you had to take to fix health care, and due to space constraints, I was able to provide the first four. Since you haven’t started implementing the changes yet, I’m assuming you were waiting for steps five through seven. Here they are:

5) Mandate that ALL health care software have an API by April 1, 2017

An Application Programming Interface (API) essentially allows different types of software to talk to each other. Ontario right now is a complete mess in terms of health care software. Hospitals generally use one of three different products, none of which can communicate with each other. Nursing homes use a different product. There are something like 15 different approved software systems for physicians’ offices. Pharmacies use different software. So do various allied agencies.

However, NONE of these programs “talks” to the other, which means that data can’t be transmitted from one system to another. So if a patient goes from one hospital to another, the information is not transmitted automatically to the receiving hospital.

Worse, software vendors don’t want to voluntarily add this feature, as they want people to just buy their product instead. While this makes sense from the point of the vendor’s bottom line (encourage more sales = more revenue for the company), your job as premier is to take care of the health care needs of the people of Ontario.

You can mandate the implementation of an API (meeting a provincial standard) on all health care related software by April 1, 2017. This would allow a physician’s office to communicate with hospitals (e.g. send lab results to the hospital on a patient so they don’t have to be repeated); allow nursing homes to securely communicate with pharmacies about medication renewals; home care to contact physicians about patients who are declining; and so on. This will lead to huge efficiencies.

Look up the data on the ePrescribe Project in Georgian Bay. You’ll see that the success of the project was based on tight integration/sharing data and secure messaging between pharmacies and physicians office. Imagine if this was possible between ALL health care providers. It can be with API on all the software. 

N.B. I was chair of the Georgian Bay Family Health Team when we implemented ePrescribe, and I’ve seen the benefits first hand. In my opinion, it’s criminal that despite spending billions of dollars on eHealth, the rest of the province doesn’t have something we’ve had since 2009.

The software vendors will say that it can’t be done. That would be far from the truth. Some of the companies already have prototypes of APIs and it’s just a matter of having them align with a provincial standard. Force them to do it or tell them to stop selling their products in Ontario. Our health care deserves it.

6) Have local advisory committees for the MOHLTC

By now you’ve already disbanded the LHINs (see point three from last week). However, you will still need to get local input and involvement for health care decisions. Different areas of the province have different populations, all of whom have their own unique requirements.

The easiest way around this is to convert the existing LHIN boards (which are all made of volunteers, and hence don’t cost the taxpayers much) into local advisory committees that report directly to the Ministry of Health and Long-Term Care (MOHLTC). Ensure that these committees have actual teeth to provide strong recommendations. This way you can get rid of the bureaucratic cost of running the LHINs ($90-plus million dollars) but still have the local input so that communities can advocate for their own unique needs.

Frankly, from a clinical and patient care point of view, the structure of the MOHLTC makes absolutely no sense. 

7) Re-organize the MOHLTC along clinical lines

Last week, I called the MOHLTC Organizational Chart a Gordian Knot. Frankly, from a clinical and patient care point of view (which is what health care is supposed to be about), the structure of the MOHLTC makes absolutely no sense. You’ve got at a minimum 16 separate departments, with too many sub departments for me to bother counting. Based on the chart it doesn’t look like the departments can easily co-ordinate with one another. 

According to your chart, if you want to do a health analytics project on patients with mental health/addictions issues, the health analytics group would have to go through a minimum of five departments for the relevant approvals before getting to the Mental Health department. Yes, I know there would be some direct communication between the two, but the reality is that for final approvals, each department would have to go up their chains.

The MOHLTC should be re-organized along clinical lines. You only need three main departments. One department for institutions (hospitals, LTC homes), a community department (family health teams, home care, public health, other outpatient-based services) and the OHIP department (which pays not just physicians, but other professionals like optometrists, physiotherapists and pharmacists).

Measures relevant to each area (e.g. quality assurance, funding, information technology, regulations) can be kept in each department, improving efficiency.

So there you go, seven steps to improve health care. In case you think I’m asking you for more money for health care, I’m not. The $51 billion currently budgeted is enough, it just needs to be spent more efficiently. 

There will be significant immediate cost savings from cutting the bureaucratic bloat as described in steps two, three and seven. The savings can then be put to pay for patient services (step four) and hiring more nurses. Step five will result in even more savings, but those are down the line.

Will this be enough to get you the election win you so badly desire in 2018? I have no idea. A lot of the next election will depend on just how many more times the OPP comes knocking on your door to investigate yet another spending irregularity.

You will certainly not have my vote, as I think you and your party are a wholly desultory lot. I even vacillated about sending you these ideas, as I didn’t want you to get credit for making needed changes or improve your chances of winning. But the reality is that many of my patients are suffering on incredibly long waiting lists, and many others are dying waiting for needed services. It’s time to right the health care ship. Get to it.

Yours sincerely,

An Old Country Doctor

Re-Post: Dear Premier Wynne, It’s Not Too Late To Fix Health Care

Old Country Doctors Note: This blog originally appeared in the Huffington Post on May 9, 2016. I’m re-posting on my own website so that I can keep it for easier future reference.

The Right Honourable Kathleen Wynne

Premier of the Province of Ontario

Dear Premier Wynne,

So I hear you are thinking of proroguing the Provincial Parliament, likely as a prelude to a cabinet shuffle in the hopes of raising your incredibly poor poll numbers. 

While there has been no shortage of scandals for your government, the reality is the biggest issue facing you is health care. If you can fix that, then maybe, just maybe, you can pull out a victory in 2018. What’s that you say? If that’s the case, stop writing articles about how bad health care is and start offering suggestions instead? Glad you asked! Here’s how you can fix health care in seven easy steps.

Since I’m limited to 1,000 words or less on my blog post, I will give you four steps this week, and next week, we will go with steps five through seven.

1) Order an administrative review of the senior management at the MOHLTC

Start right from the top (Deputy Minister Bob Bell) and include the rest of the senior management team. There’s a real problem with morale in Ontario Health Care. Last year, Ted Ball from Quantum Transformation Technologies did a survey of health care leaders that showed damming results for just how little faith they had in the leadership and direction of the MOHLTC. 

Between 50 and 70 per cent of responses were in the “Poor to Fair” categories for virtually every single question. In addition, in the comments section there were repeated calls to cut down on the bureaucracy (and this from bureaucrats!). One exasperated person simply extolled “Just do something!” This is abysmal.

Since then, a new vision, Patients First, was introduced by Health Minister Eric Hoskins. Quantum did another survey after this, and the results were worse! Amongst other deplorable numbers only 20 per cent of health care leaders have confidence in the MOHLTC to manage the enhanced LHIN’s proposed in the document.

Additionally, in the comments section, the top adjectives used to describe the managerial/leadership capacity of the MOHLTC were words like “uninspired,” “obstructionist,” “incompetent,” “autocratic” and a plethora of similar negative terms.

The people of Ontario pay a lot of money through their taxes (in the case of Bob Bell, $426,535 according to the Sunshine List) to ensure health care is run properly. It’s not happening. A formal administrative review can give the leaders some good advice as to how to encourage other leaders to follow them. It’s sorely needed.

2) Read Dr. Shawn Whatley’s blog on health care bureaucracy in Canada

Make sure you read all the excellent links. Memorize all the data that’s there. Keep those figures at hand, as you will need them when you try to push through the next set of changes you need to make. 

[In 1995] people realized that in a universal health care system, cutting payments to doctors equals cutting services to patients. They will realize this in 2018 as well.

3) Get rid of multiple ‘arm’s length’ agencies

Look, every time you create an “arm’s length” agency (e.g. Cancer Care Ontario), that agency has to create an administrative bloat. Things like policy and procedure manuals, human resource departments, various administrative levels and so on. In health care, the problem is that all of these agencies have to report to the MOHLTC (who funds them). The MOHLTC, of course, has a policy and procedure manual, human resource department, administrative levels and so on. What’s worse is that the MOHLTC has departments solely dedicated to liaising with all these other external agencies.

For example, the Gordian Knot that is the MOHLTC organizational chart, clearly shows that there is an eHealth strategy and investment branch of the MOHLTC. Their job is to liaise with eHealth. So, why not just bring in eHealth into the MOHLTC and get rid of the redundant bureaucracy?

Now, I get that politically, the goal was to try and have these agencies take flak when things go wrong, so that bad news won’t stick to the health minister. But guess what, it’s not working anymore. People won’t blame Cancer Care Ontario for the stem cell disaster in the 2018 election. They will blame YOU.

So, get rid of the LHIN’s, eHealth, Health Quality Ontario, Cancer Care Ontario, CCAC and a whole bunch of others. Bring them all into the MOHLTC so you don’t need multiple HR departments and policy manuals. This is why mergers and acquisitions are in vogue in the business world. Go with it.

4) Offer binding arbitration to the doctors.

Like it or not, you can’t make a fundamental transformation to the health care system without the help of the doctors. Even though I didn’t like it much, I understood the political rationale behind trying to shame them into coming back to the table by attacking their billings. Problem is, it didn’t work. People believed their doctors, not your political stunt. 

As an aside, go back to the last time an government cut payments to physicians (Bob Rae’s NDP government of 1990-1995). Go dig up their election ads. They all started with “Bob Rae has cut payments to doctors.” The thought was to portray to the public that by cutting payments to doctors, there was more money for other services. Sound familiar?

See how he did in the 1995 election (hint: it wasn’t pretty). People realized that in a universal health care system, cutting payments to doctors equals cutting services to patients. They will realize this in 2018 as well.

Giving binding arbitration to physicians puts YOU in a no-lose situation. If the arbitrator sides with physicians, you can say to the public that you have no choice but to go along with it, as it’s part of a collective bargaining process. If the arbitrator goes sides with the government, the physicians will have gotten what they asked for, and will have to go along with whatever settlement there is.

Either way, you then have physicians re-engaged in the process of transforming health care which is an engagement you badly need.

Yours sincerely,

An Old Country Doctor

Reflecting on Entering Decade Seven…

This is a somewhat personal post. I don’t share my birthday on social media (mostly because your date of birth is one of the security checks companies use to identify you). But I will allow that a little while ago, I was fortunate enough to complete decade six on this planet.

Starting decade seven felt odd. I normally think of birthdays as just another day. But, I guess as cliched as it is, hitting the big 6-0 did feel different. There was, as is typical, the comprehension that there were likely fewer days ahead than there were behind. Like many people, it also triggered a “life review,” a natural psychological process of reflecting on past decisions and unresolved regrets.

It was also somewhat bittersweet. My mother died at age 59 (stomach cancer). The realization that I have spent more time on this planet than she did certainly brought many mixed emotions.

But at the end of the day, I became aware of just how blessed I am. While my parents followed the typical immigrant path of working hard and living cramped quarters, we always had a roof over our heads. My kids may not have a yacht, but they always had food on the table and were fortunate enough to do a bunch of activities growing up that I never could. I was able to put them through school and get them a good head start on life. We were not victims of some horrific war, or famine, or natural disaster. I feel truly blessed to be healthy and for having kids without major health issues. (I’ve seen first hand just how much stress is put on families when a loved one has medical problems. I have nothing but admiration and respect for how they deal with it).

What does the future hold? Who’s to say? I can only tell you what I hope to accomplish with however much time I have left. First and foremost, I hope to be able to continue to help people who are in need (whether for health or other reasons). How I do that will likely continue to evolve as it has during my first six decades. But I think we should all try to others when we can. It’s particularly incumbent upon those of us, like myself, who have had a more fortunate time on this Earth.

Some people mellow with age. I suspect I will get grumpier. Which means more opinionated blogs with strong views as time goes on. (I’ll go out on a limb and suggest bureaucrats in general will be even more unhappy with me, which is really saying something.)

Finally, I, like many of you, also have a bucket list. I hope to begin chipping away at that while I can still stand on my own two feet. Which is why, I decided to start this decade off like this:

OMA Manipulates Board Elections and Weakens Members Voices

On November 20, Ontario Medical Association (OMA) Past President Dr. Dominik Nowak sent all members an email encouraging them to run for positions in the upcoming OMA Elections cycle. As Past President, his role is to oversee the elections for over 100 positions. He needs to ensure they are fairly run so the voice of all Ontario physicians can be heard.

Current Past President of the OMA, Dr. Dominik Nowak

Unfortunately, the current Board has sabotaged this process and rather than listen to the members, will only present pre-approved candidates for Board Director, the most important role. They have the responsibility of ensuring the OMA speaks for, you know, the members. Buried in his email were the following statements:

  • A streamlined shortlisting process for board candidates, with two to four candidates, whose skills and experience align with the board’s needs, being presented on the ballot for each open position 
  • Stronger screening and evaluation for consistency and fairness of candidates 
  • More transparency about how the board performs and what gaps are in the skills-based matrix

There is no explanation of what exactly this “streamlined” process is. But it’s clear that there will be now be increased vetting of candidates and some candidates will be found wanting and not allowed to run. Now, there always was some vetting of Board Candidates. Candidates had to be in good standing with College of Physicians and Surgeons, the OMA, pass background police checks etc. Some basic stuff.

But now, undoubtedly based on the fact that something like 38 people ran for Board last year, the OMA Board has determined to vet candidates even more and reject qualified people if they don’t meet these nebulous criteria. Importantly, the criteria will be to pick candidates who align with the BOARD‘s needs, not the MEMBERS. This is of course, all in the name of “fairness” and “transparency” and to make decisions “easier” for physicians.

But here’s the thing, the Board will NOT do the vetting. Board’s don’t actually do any operational work. Their job is to set policy, and then let the staff of the OMA implement it. So it will be up to the staff of the OMA to vet the Board candidates, and then approve whoever is acceptable……..to the staff.

Colleagues, we have a big problem.

The OMA staff are generally good people who work quite hard on behalf of physicians. They get a lot of unwarranted criticism for decisions that are actually made by physician leaders. Our elected leaders that should bare the blame.

But, at the end of the day, the OMA staff are only human, and prone to human tendencies and failures. My friend Dr. Greg Dubord, who I was honoured to pen a blog with, introduced me to Robert Michel‘s “Iron Law of Oligarchy“. It would seem to apply just not to the CFPC, but to what is going on at the OMA. From Wikipedia:

“… all organizations eventually come to be run by a leadership class who often function as paid administrators, executives, spokespersons, or political strategists for the organization. Far from being servants of the masses…. this leadership class, rather than the organization’s membership, will inevitably grow to dominate the organization’s power structures.[3]“

Robert Michels, a sociologist who described the political behavior of intellectual elites in the early 1900s

And that is exactly what is going to happen with these new changes. The OMA staff (not physician leaders, but employees of the OMA) will review the candidates for Board. THEY will decide who meets certain criteria. THEY will determine how many candidates run for each Board position, hiding behind a policy the Board has set.

Will they do their best to pick some good people? Sure. But their definition of “good” may not be what the members want. For example, someone like Shawn Whatley was openly critical of the OMA prior to being elected as President. Would he have passed these criteria? How about Nadia Alam? Prior to getting involved in medical political activism she was a relative unknown with little leadership experience (even though she is arguably the most well respected President of the past 25 years).

Dr. Shawn Whatley
pictures of Dr. Shawn Whatley and Dr. Nadia Alam, both of whom are past presidents of the Ontario Medical Association
Dr. Nadia Alam

Nope. My guess is they would have been found wanting. A total guess on my part would have been Dr. Whatley would be deemed “too disruptive” (he famously resigned from the OMA Board prior to being elected President). Dr. Alam would like be viewed as “too inexperienced.”

Worse, the blunt reality is that the staff will likely decide who is “best qualified” based on how well they can work with them (that’s just human nature). Not necessarily those who can, you know, push them and challenge them to do better.

The staff, generally being very nice people, always had a tendency to try to work co-operatively with the various government bureaucrats on bilateral committees. This is despite the over 30 years of evidence that always trying to be nice and reasonable just isn’t working. Cynics have suggested that its in part because they realize if they want to advance their careers – one of the places they can go after working in the OMA is the government, and it doesn’t help to burn bridges there. So why would they approve a candidate who had a reputation for being less than reasonable?

Want proof? Just look at how badly the OMA as an organization handled last year’s elections. I asked potential Board Directors to commit to filing a Freedom of Information Act request, to determine just how many patients Nurse Practitioners saw in a day and how much they cost the health care system per patient (easy to do with billing numbers). The goal was to get proof that they were more expensive overall (by a lot) than family physicians and slow down scope creep.

Not only did the OMA put a stop to that, they threatened the careers of people who signed that with a Code of Conduct violation. Can’t have people on the OMA Board who will be too aggressive can we? (Psst – hey Kim Moran, CEO of the OMA – how is sending strongly worded letters to the government asking them to stop scope expansion working out? Oh, right.)

Do you really think with that history, the current staff will allow someone even remotely controversial to run?

The OMA Board has shamefully allowed this to happen. As a result there will not be a diverse Board with many viewpoints that focus on members. Rather a bland, non-controversial Board that will be limiting to speaking in political jargon speaking points in response to all issues.

Physicians will truly be hurt by this short sighted decision.

Re-Post: It’s Time To End The War On Drugs In Canada

NB: This blog originally appeared in Huffington Post Canada on Nov 3, 2015. With the demise of HuffPo it’s being reposted here for future reference.

As someone who had his formative years in the 1980s I can still vividly recall former First Lady Nancy Regan launching the ambitious “Just Say No” campaign. She championed this slogan as part of the “war on drugs.” This “war” was started by Richard Nixon in 1971. He declared that drug abuse was “public enemy number one” and that “the only way to fight this menace was on many fronts.” I can personally attest to having been a true believer in that policy myself, after having done some volunteer work in an emergency department as a teenager.

In recent years Canada of course, for the most part followed this policy. In our country, the main technique to fight this war appears to be conviction and incarceration of those caught with illicit drugs. For example, possession (not sale, but possession) is punishable by up to five years in prison. However, what’s clear is that this has failed to help the problem. Data from Statistics Canada (the most recent I could find) shows that while marijuana use in Canada has been relatively constant, the rate of cocaine and other drug use has gradually been increasing since 1977.

The drug trade itself has seemed to grow and is now considered to have a global value of over $300 billion (U.S.) per year. In Canada, as you can see below on this chart from Statistics Canada, drug offences continue to rise, while the total crime rate decreases. So certainly based on this data, it would be difficult to suggest that the “war” has been successful.

From an economic point of view, the costs of this war are even more staggering. It currently costs $117,000 a year to house a prisoner. Additionally, while the total overall rate of crime has decreased in the past twenty years, the incarceration rate is up, and 80 per cent of offenders have substance abuse problems. It’s clearly not hard to postulate that the main reason for the increased rate of incarceration is drug offences. 

As a family physician, I have seen first hand the effects of untreated drug addiction. Far beyond the relatively easy to measure economic numbers, lives have been ruined, families torn apart, some young women forced into the sex trade to pay for their habit and more, are all part and parcel of this terrible disease. Clearly, the goal of any national policy should be to take proven effective steps to reduce the rate of addiction.

The newly elected Liberal government of Justin Trudeau plans to legalize marijuana. To that end, my hope is that Canada can go one step further and focus on what works to reduce addiction rates. While it is clearly counter intuitive to suggest this, it turns out that the best way to do this, is to decriminalize the possession of small amounts of drugs.

While about 25 countries have decriminalized drugs, the best example of how this policy works is seen in Portugal. They decriminalized the possession (not sale, possession) of drugs for personal use in 2001. The offence was re-classified to an administrative offence as opposed to a criminal one, punishable at most by a fine. At the time, may people, myself included I might add, predicted that this would lead to an explosion of drug use, and that children would be targeted, and the nation would decay. As an aside, this rhetoric is similar to what Stephen Harper alleged would happen if we were to legalize marijuana in the last election. However, a review of the results 14 years later suggest that quite the opposite has happened.

Among other benefits, Portugal has seen a reduction in “past year” and “past month” drug use; a reduction in a dramatic decline in HIV and AIDS in drug users, a reduction in crime; a reduction in addicts in prison and a reduction in drug deaths. This has clearly been an extremely successful policy.

So what happens in Portugal when you are caught with 10 or less days supply of an illicit drug? Your case is referred from the Ministry of Justice to the Ministry of Health (a huge shift in and of itself) and you appear before a drug dissuasion committee. You may be fined, but more often are not and you are offered treatment for your addiction, part of which included social re-integration. Their rate of drug addiction has fallen in half since the implementation of the policy.

Ah, but these programs are expensive aren’t they? Surely it would cost a lot to provide this service for addicts. You mean more than the $117,000 a year we currently pay to incarcerate them? Which, as is proven, doesn’t work.

As mentioned, I was a true believer in the war on drugs, but at the end of the day, as a physician, I have believe in an evidenced-based approach. The evidence shows that incarceration doesn’t work, and decriminalization with offers of treatment do. It’s time to ignore dogma and act in the best interests of Canadians. It’s time to end this war.

Supporting Education the Key to Helping Developing Countries

I recently had the honour of being a guest speaker (along with the amazing Dr. Nadia Alam) at a fund raising dinner for Friends of Namal, an organization that provides university scholarships for students in Pakistan. The following is an abridged version of my speech.

I want to tell the story of a man who was born in Surat, in the State of Gujarat in India in 1933. He moved to Karachi in 1947 during the Partition, and as a teenager witnessed many of the horrors that occurred during that time. He was academically bright, but his family was poor and there was no way that he could afford a University education. However, in 1951 he became aware of a foreign students scholarship from McGill University, applied, and was successful. Four years later he became the first student in the history of McGill to complete his Chartered Accountant and Registered Industrial Accountant degrees simultaneously.

Mohamed Qasim Gandhi, who simultaneously completed the Chartered Accountant and Registered Industrial Accountant Degrees.

After that, he went back to Pakistan and worked for a number of years to support his extended family (his parents had died when he was young so he took care of his sisters who had raised him). In 1966, he and his young wife had a baby boy at the Holy Family Hospital in Karachi. Two years later, he went to Africa with his family as there was a better opportunity there. In 1972, when things got bad in Africa, he decided to move to Canada with his wife and son.

The rest of his family thought he was crazy. ”Where is this Canada place?” ”How far away is it anyway?” “Are there even any muslims there?”

And indeed, there was not much of a Muslim community in Toronto at the time. There was the Jami Mosque, one Halal meat shop on Gerrard street, and, well, that was about it. Not like today when, by the blessing of Allah there are mosques and halal restaurants seemingly every few blocks.

As you may have guessed by now, that man was my father. Because he brought me here at a young age, I didn’t really appreciate the significance of such a move. Truth be told, I really didn’t have great study habits. But one day, when I was visiting my Nana Abba (maternal grandfather), he recited a Hadith (a saying of the Prophet Muhammad, PBUH):

“The ink of the scholar is worth more than the blood of a martyr.”

I am aware that some scholars feel the Hadith is weak, but the sentiment is a good one and fits with Islamic principles. I took that message to heart, began studying harder, and was fortunate to have graduated from the University of Toronto Medical School in 1990. My Nana Abba came to my graduation ceremony. After that, he told me clearly that I was blessed to be an educated man, but now I had a responsibility to help others who wanted an education. I had to pay back my blessings by helping other people, no matter from what walk of life they came from.

So, after I finished my residency, I took over a family practice in a small town called Stayner……and my parents thought I was crazy. ”Where is this Stayner place?” “How far away is it anyway?” “Are there even any muslims there?” Funny how that works.

But I have now been there for 31 years, taught many medical students through the excellent Rural Ontario Medical Program, and seen the community grow significantly. Where once the muslim population of the area doubled just by me getting married, there are now 50 or 60 families, three halal restaurants and a Musallah (prayer site – not quite a mosque). 

Along the way, I managed to run into Dr. Nadia Alam through some medical politics. She convinced me that I should run for OMA Leadership (I still haven’t forgiven her for that by the way). Eventually this lead to me being the President of the Ontario Medical Association (I was the second Pakistani born president in its history, Dr. Alam was the first). This gave me the opportunity to meet many health care leaders, and politicians, and achieve things I never thought possible.

Dr. Nadia Alam, the first Pakistani born President of the Ontario Medical Association, as she gives a speech at the Friends of Namal Fundraising Dinner.

When I look back on this, I ask myself “How did this happen?” To my mind, there are two reasons. First and foremost it is because it is a blessing from Allah. Nothing happens without His will and whatever I have achieved is a result of His kindness.

The second reason of course, is because somebody gave a deserving young Pakistani student a scholarship in 1951, to let him get an education that he otherwise could not have afforded. This then, is the power of education and this then is why it is incumbent upon every muslim to get an education. Another Hadith:

“Seeking knowledge is an obligation upon every Muslim.” 

Note the wording. It’s not a request. It’s not a suggestion. It’s an obligation, a command if you will, that every Muslim MUST seek an education. Every Muslim. The Prophet PBUH did not believe there were “types of muslims” and did not distinguish between gender for eductation. Therefore, it’s also an obligation for those of us who can, to HELP other muslims get an education. 

We’ve seen what can happen when just one deserving student gets an education he could not otherwise have afforded. Imagine what can happen if five students do. Or ten. One hundred. More. Education is the key to making a better society and a better future for any country. I encourage those of you who are able to visit the Friends of Namal website, and contribute generously. 

Yours truly speaking at the Friends of Namal Fundraising Gala

Will the OMA Continue to Restrict Their Elections Process?

Ontario Medical Association (OMA) Election season is upon us again. The nomination period for people interested in running for leadership positions ended recently. This included a video promo in which a certain cantankerous old geezer contributed his two cents. But, will the OMA allow a proper elections process this time round, or will the OMA continue to impose stringent controls on the election process, thus ensuring banality, dullness, and an advantage for mediocre candidates (no really).

In the past, while campaigns for positions at the OMA have hardly been edge of the seat exciting (with many positions either acclaimed or unfilled), there at least was a spectre of campaigning that created some interest in the OMA and the elections process. However, that all started to change a few years ago, due to what I call the Nadia Alam rules. Unlike the real Nadia Alam, those rules desperately need to go the way of the Dodo bird.

Former OMA President Dr. Nadia Alam, the most widely beloved OMA leader in recent memory.

I actually remember when the controversy started. There was to be an election for President Elect. As part of that there was going to be a virtual Town Hall with the candidates. At the town hall, each candidate was asked some pre-selected questions. But then, some random questions were tossed in. And……the complaining began almost instantly after the fact.

“It wasn’t fair to toss random questions in.” “We weren’t prepared to be asked surprise questions” “It was designed to make us look bad.” Etc. The fact that answering unexpected questions might be a skill worth evaluating for a position that entailed a lot of media work, didn’t matter to the complainers. (I mean surely the media would never ever toss unexpected questions your way).

Immediately after my own induction as President, there was a minor controversy that popped up that I had to deal with, completely unprepared. Even the usually benign Medical Post tossed tough questions my way. This happens when you are the spokesperson for the profession (i.e. the actual job of President). Newsflash for those who complained – you didn’t look bad because the “process was unfair” – you looked bad because, well, you sucked at handling the unexpected.

But that wasn’t enough. The next rule that got put in place was to prevent former OMA Presidents from running for the Board, even if they have less than the six year maximum term limit. The reason was ostensibly that “we put our Presidents up on a pedestal and publicize them so much that they have so much name recognition”. Therefore it gives them an “unfair advantage” against others who would run.

To which I say, quoting former Toronto Mayor Mel Lastman – EL TORO POO POO!

There’s a whole bunch of ex-Presidents who, if they ran for something at the OMA, would get completely trounced because of their name recognition. This works both ways people. Do excellent people get positive name recognition? Of course they do. But it’s positive because they are excellent. They are exactly the type of people we need in leadership positions. The…..suboptimal people will get name recognition, just not the kind they want.

It gets worse. In recent years the Board election process has become so restrictive that candidates for Board are basically banned from campaigning. All they can do is have a statement and video message and, well, that’s about it. Heck they are all given a tool kit with “approved” messages to distribute on social media. Once again, this is to ensure “transparent, open and fair election” or some such thing.

Forgetting about the hackneyed nature of the “approved” messages, is it really to much to expect that people running for leadership might actually, you know, have the ability to communicate on their own? And would not the members be better able to judge candidates if they come up with their own messages, rather than some bland, inefficacious template from the OMA?

The problem with this of course is that the only candidates that benefit are the ones who haven’t, through their own hard work, built up their reputation amongst their peers or have the ability to effectively communicate with their colleagues. The mediocre candidates, who don’t have these skills are actually given a leg UP over better candidates because this process brings excellent people down to a mediocre level.

The result is an insomnia curing election process that resulted in barely 10 per cent of all members voting last year.

Why put all these rules in effect?. I’ll be blunt. In my opinion it’s because many OMA physician leaders (including Board Directors) were running scared of Nadia (in medical politics, she’s basically a one name rockstar like Beyonce ). They all knew that if she ran for anything, she would beat whoever she ran against. This is why I call these the Nadia Alam rules. They are designed to minimize the opportunity for someone who through perseverance and inherent excellence has become a great candidate. These rules were put in place to make it easier for the mediocre candidates (like themselves) to win.

I notice with interest that a few candidates for Board (whom I happen to think are excellent) have already announced on some well read physician social media pages that they are running for Board positions. I wonder if some of the usual complainers will be calling the OMA to say that this was “unfair”. This “gives them an unjust head start!”

Look, the reality is that life isn’t fair. Some people are better at being leaders than others. They should be allowed to promote their excellence as it is these excellent people that we need in leadership positions.

As for those candidates who seem to think they “deserve” to be put on an equal footing with those who are clearly better suited for leadership positions? I leave you with some thoughts from one of my favourite, satirists, George Carlin: