Municipal

The rise of the private sector in the health sector is a concern for the Collège des médecins du Québec.

In a brief that will be presented on Wednesday during consultations on Bill 67 on the Professional Code, the College recommends that the government take a step back.

The College urges it to quickly address the weak link in the professional system by introducing into the Professional Code means enabling professional orders to ensure the monitoring and control of professional activities offered by companies, whatever the legal form they take, as well as the directors and managers who control them, otherwise the protection of the public risks being compromised.

A quote from Extract from the memorandum of the College of Physicians

Private clinics, private surgery centers or telemedicine, the offer has grown considerably in recent years, not to mention the health plan of Minister Dubé who wants to make more room for the private sector.

According to the College, the powers at its disposal are insufficient to ensure the protection of patients.

At most, the current provisions allow the orders to manage by regulation the composition of the shareholding of the owners of these companies, but they do not grant real powers to force the companies to respect the standards relating to the profession, it is written.

During its presentation to Minister Sonia LeBel, the College intends to point out that it has had to initiate legal proceedings in recent months to gain access to patient files contained in electronic medical records (EMRs), the property of medical clinics owned by business people.

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The president of the Collège des médecins du Québec, Dr. Mauril Gaudreault, is pleased that the skills of several health professionals other than doctors are being recognized.

Photo: Radio-Canada / Félix Duchesne

As part of a professional inspection, he also had to retain the services of a law firm to access patients’ clinical records held by a company offering telemedicine services.

As the president of the College, Dr. Mauril Gaudreault, reminds us, to ensure quality medicine, professional inspection visits must be carried out. […]but in premises administered by non-doctors, it is not possible.

The College team carries out hundreds of inspections each year, examining in particular record keeping, the quality of diagnoses and follow-ups, office maintenance and the sterilization of instruments.

In April, the Auditor General of Quebec finally convinced Minister Dubé to no longer have to resort to the courts to track money paid to the private sector.

“I have very serious concerns about my possible access to the facilities of private establishments, to their financial statements or to any document that I deem necessary to verify,” said Guylaine Leclerc.

Limits raised by the Charbonneau Commission

In its brief, the College recalls the limits of the Professional Code, which only allows compliance with professional standards to be imposed on its members.

As the Charbonneau Commission explicitly pointed out in its report (in 2015), the Quebec professional system does not provide for monitoring or control measures for professional services companies, it is written. This problem has only gotten worse, the College believes.

The Collège des médecins du Québec is the professional order that oversees the practice of the 26,000 physicians practicing in Quebec, all specialties combined. It provides monitoring activities, handles public complaints and supports physicians in maintaining their skills.

A letter signed by some twenty cancer specialist doctors from the Sherbrooke University Hospital alerts the population to the shortage of nursing staff in hematology-oncology.

According to doctors, this is an unprecedented situation at the chemotherapy center, which has been going on since August.

The consequences would be very real. This shortage results in the impossibility of administering approximately 50% of the chemotherapy treatments prescribed by hematologists-oncologists, which corresponds to hundreds of patients, we read in the letter.

The signatories note that although the CIUSSS de l’Estrie-CHUS seems to be studying all measures to limit the impact on users, concerns remain among doctors. We are worried about our patients, because the situation could last several weeks and significantly impact the quality of care, we can read.

Advances in medicine that cause overload

In an interview with Téléjournal Estrie, the head of the hematology-oncology department and signatory of the letter, Dr. Michel Pavic, explained that progress in cancer treatment has led to an increase in the number of patients.

For the past 10 years, every 18 months, the number of patients has increased by 10%, so that in 10 years, we have doubled the number of patients in treatment, we have gone from 50 to 90, even 100 treatments per day. The staff has not followed, the premises have not followed, he specifies.

We pulled the rope a lot, then the elastic snapped and we’ll have to find ways to get enough nurses to come.

A quote from Dr Michel Pavic, head of the hematology-oncology department

This context would cause exhaustion of workers and successive waves of sick leave and resignations.

If we want the immense progress in cancer treatment to translate into more cures and more lives saved, it is important to be able to treat patients properly. This will inevitably involve increasing healthcare personnel resources and creating infrastructures adapted to today’s reality, the letter reads.

Situation under control, according to the CIUSSS de l’Estrie CHUS

Asked to respond at the end of the day on Tuesday, the CIUSSS de l’Estrie CHUS was unable to grant us an interview. However, by email, the organization indicated that while the situation is not desirable, it is under control, particularly due to the temporary measures that have been put in place to ensure the safety of our users’ care.

A service corridor has been established with the Charles-Lemoyne Hospital that will allow chemotherapy treatment to be offered to certain patients. The beneficiaries will be selected based on certain criteria, including their proximity to the Estrie region.

We are working to restore the situation as soon as possible. All users affected by these measures will be contacted by telephone at the appropriate time.

A quote from CIUSSS de l’Estrie CHUS

Flying teams will also be deployed in the coming weeks to assist the teams.

A call to promote the profession

Michel Pavic, for his part, hopes that the nursing profession will be valued more. We need to motivate the youngest to pursue these careers, and then we need to value the nursing profession so that our hospitals don’t give up, he exclaims.

My heartfelt cry is that we really need nurses very quickly.

A quote from Dr Michel Pavic, head of the hematology-oncology department

According to Dr. Pavic, several hospitals in Quebec are facing similar issues.

Iron deficiency is an underestimated problem, doctors say. Yet it can lead to symptoms like fatigue, depression or anxiety, often in women. Ontario recently raised the threshold for adequate levels of iron in the blood, and experts are calling on other provinces to follow suit.

Torontonian Nicole Williams struggled with fatigue in high school and university. She relied on coffee for energy. The constant exhaustion eventually led to anxiety, a symptom that made it difficult for her to concentrate.

“I was becoming dysfunctional,” recalls Nicole Williams, now 43.

I had difficulty driving, getting through my work day and taking care of my child, she says.

Around 2015, Williams visited multiple doctors to find the source of her exhaustion. Her blood tests appeared normal, including those that measured her iron levels.

Doctors attributed the Toronto woman’s symptoms to mental health issues. Years later, a specialist discovered the real cause of her fatigue: an iron deficiency.

Williams’ case was unequivocal, according to Dr. Michelle Sholzberg, a scientist and hematologist at St. Michael’s Hospital in Toronto. She assured her patient that her fatigue and anxiety could be 100 percent explained by low iron levels.

Yet the Toronto woman’s blood iron level was not low enough to match what was considered low in Ontario at the time.

Earlier this month, the province revised the normal threshold for ferritin, the iron-containing protein, in the blood to 30 micrograms per litre of blood. Previously, the cutoff between normal and low levels varied, depending on the lab, from 10 to 15 micrograms per litre.

Dr. Sholzberg hopes the rest of the country will follow Ontario’s lead, saying it would allow iron deficiencies to be detected and treated more quickly.

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Dr. Michelle Sholzberg says her patients tell her they feel better after treatment for iron deficiency.

Photo: Courtesy of Michelle Sholzberg

Dr. Menaka Pai, professor of hematology at McMaster University in Hamilton, echoes the same sentiment.

In Canada, Ontario is definitely a leader, she said. We are working with colleagues across the country and we hope to see change in all provinces.

The importance of iron stores in the blood

Red blood cells need iron to carry oxygen to the brain and heart. This nutrient also fuels the chemical reactions that keep us alive.

If the body doesn’t get enough iron, it can’t produce enough red blood cells. That’s when we have anemia, when the red blood cells are lower, Dr. Tommy Jean, a hematologist at St. Michael’s Hospital, explained on the show. No two mornings are the same. But we found that even if someone didn’t have anemia but had a low iron level […]this person could still have symptoms.

These symptoms may include anxiety or depression, since iron is needed for the production of neurotransmitters such as serotonin and dopamine.

People with iron deficiency may also have difficulty concentrating or multitasking. Other symptoms include fatigue and dry skin.

Blood is the largest store of iron in the human body. Losing a lot of blood for any reason, such as during menstruation, can lead to low iron levels.

Insidious problem

Every day, I see patients with untreated iron deficiency, says Dr. Michelle Sholzberg.

Once the deficiency is treated with oral supplements or, sometimes, an intravenous infusion, patients report feeling better, she said.

I have had several patients tell me that their lives changed, that they felt like superheroes, that they could focus again and that they could get through a day without feeling exhausted.

A quote from Dr. Michelle Sholzberg, hematologist at St. Michael’s Hospital in Toronto

Dr. Malcolm Munro, a Canadian-trained obstetrician-gynecologist now at the University of California, Los Angeles School of Medicine, says half of menstruating women in North America would be considered iron deficient under Ontario’s new thresholds.

It’s a major and insidious problem, he said.

The extent of the problem is minimized because it is normalized not only by society and family but also by doctors, he adds.

Dr. Munro is hopeful that other Canadian provinces and American hospitals could follow Ontario’s lead.

A certain resistance

However, the idea of ​​testing people who appear healthy for iron deficiency meets with resistance.

Last month, the U.S. Preventive Services Task Force (New Window) (USPSTF) concluded that there is not enough evidence to test and treat the iron levels of pregnant people who have no symptoms of deficiency.

Dr Amy Cantor, who led the US study, says the lack of standardised thresholds for iron levels makes it difficult to build a case for change.

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Blood iron stores say a lot about the body’s balance, says Dr. Menaka Pai.

Photo: Courtesy of Menaka Pai

Iron deficiency can be treated with oral tablets. Most patients tolerate the medication well, says Dr. Menaka Pai. However, some have side effects such as constipation.

If medications don’t work, intravenous iron infusions are also an option, which is more expensive.

As for heavy bleeding during some people’s periods, it can be controlled with certain forms of birth control, with or without hormones, according to Dr. Pai.

Toronto resident Nicole Williams says she is happy with her treatment for iron deficiency. She says she now has the energy to run with her child and work full time.

She hopes the Ontario government’s new guidelines can help other women in her situation.

According to a report by Amina Zafar, CBC