The truth about superbugs and antibiotics

There’s good news (the problem is fixable) and bad (a dry drug pipeline)

by Julia Belluz

Staphyloccoccus aureus x 17,000 at 4 x 4 (Getty)

In a post about the most outrageous attacks on science in 2012, Science-ish asked you to pick the topic you’d like to see tackled first in the new year: you wanted the truth about antibiotics and superbugs.

It’s no wonder. The popular discourse about these rapidly multiplying, drug-resistant microbes is pretty freaky. An investigation by CBC’s Marketplace found deadly bacteria, like C. difficile, lurking in hotel rooms. Other stories have revealed that they are waiting to cuddle up with you in hospitals, and even peppering your chicken dinner.

Meanwhile, the British Medical Journal has reported that the dangers of superbugs may be over-hyped, turning poor germ-avoiding patients into hospital cleaners. But you, dear readers, know the cleansing light of evidence can wash away some of those fears. Here’s what the latest research tells us about antibiotics and superbugs:

MIND YOUR CHICKEN

While there’s a lot of popular debate about the over-use of antibiotics in the agricultural sector, and to what extent this impacts human health, according to infectious disease expert Dr. Scott Halperin, “This is an area where everybody except people in the agricultural sector think there’s no controversy.”

It’s okay to treat infected animals with antibiotics, Halperin continued, but the wanton use of them to enhance growth in factory-style feedlots “is just not a good idea from a antibiotic-resistance standpoint.” Animals develop resistant bacteria–those get into the food-chain–and there’s good evidence that they colonize people and make them sick. (Read up on antibiotic-resistant enterococci and staphylococci here.)

For these reasons, the European Union banned antibiotics for growth promotion (but not infection control) in 2006. In Canada, it’s still largely a free-for-all. Our government does not regulate or track the use of these drugs in farming.

LESS IS MORE

It’s now a scientific truth universally agreed upon that the more antibiotics you take, the more likely you are to grow microbes that become resistant and contribute to the pool of superbugs. The proliferation of super bacteria was fuelled by magical thinking during the early days of antibiotics, which first emerged in the 1940s. They were potent cures, stopping bacterial infections such as pneumonia and tuberculosis that routinely killed people, and making otherwise seemingly impossible feats in medicine—like transplants—commonplace. These little miracles were believed to have few side-effects, too. So for a long time, doctors thought it was best to err on the side of caution, and prescribe more and for longer courses.

Now, we know that more antibiotics means more resistance. There’s a movement afoot to get doctors to prescribe judiciously, and some countries are even looking at banning certain antibiotics all together. Other new evidence-based rules of thumb, which Science-ish learned about at a conference for family doctors, include: If you’ve been well for 48 hours, you may be able to stop taking your antibiotic; for many antibiotics, five to seven days is sufficient (instead of the classic seven to 14 prescriptions); and don’t use the same antibiotic—or even the same class of antibiotics—within three months of your last round.

RISE OF THE SUPERBUGS

There are networks across Canada that track superbug infections, and according to infectious disease experts, we are seeing more of these resistant bacteria emerge over time. “Name a bacteria and there’s an antimicrobial resistance problem,” said microbiologist Allison McGeer. Gonorrhoea is becoming multi-drug resistant. Ditto TB. A new superbug called NDM-1 from South Asia is poised to attack hospitals here. And this isn’t only a hospital problem. These bugs are emerging in the community, as well.

A DRY DRUG PIPELINE

To make matters more interesting, the pipeline for antibiotics is dry. As McGeer put it, “The last new class of antibiotics approved in Canada was in the 1970s.” That’s 40 years ago! For a time, pharmaceutical companies stepped away from antibiotic development because of a perceived lack of need and their relatively low potential for profitability. Now, there’s a gap. We need them, but they take 15 to 20 years to bring to market. “There are a lot of people working on exciting, new, different kinds of antibiotics, but those are still in the pre-clinical phase—not used in animals and humans yet,” said McGeer. “There’s no question we have, in the next decade, a problem because the pipeline is hitting a dry patch.”

THE PROBLEM IS FIXABLE

Still, there’s no need to seal yourself off in a vermin-repellent container or move to a frozen climate where bacteria can’t thrive. “Remember, we once lived in a world without antibiotics,” McGeer added. “It’s not the end of the world. But it does mean that people who go into hospital for surgery who would have otherwise been fine, will die. And our life expectancy might decrease.”

The good news: This problem is fixable. More rational prescribing by doctors, more understanding among patients that antibiotics aren’t a panacea for every sickness, some action by regulators to minimize the use of antibiotics in agriculture, as well as open-lab collaborations for better antibiotic development, can all help. And as McGeer added, “Prevention is better than treatment.” Wash your hands, get your vaccines, take safety precautions when cooking and handling food, and stay home when you’re sick. Doctors’ orders.

Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the senior editor at the Medical Post. Got a tip? Seen something that’s Science-ish? Message her at julia.belluz@medicalpost.rogers.com or on Twitter @juliaoftoronto

 

 




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The truth about superbugs and antibiotics

  1. And what the hell kind of medieval statement is this??

    “Remember, we once lived in a world without antibiotics,” McGeer added.
    “It’s not the end of the world. But it does mean that people who go into
    hospital for surgery who would have otherwise been fine, will die. And
    our life expectancy might decrease.”

    • Seems like a pretty straightforward and realistic assessment to me. If more bacteria are resistant then more will be successful in colonizing humans (to our detriment).

      You can dislike it; you can wring your hands. But without other changes, that’s the reality. In some ways that takes us back to the 1930s – but hardly to the medieval age.

      In the meantime we ought to be passing laws requiring health care workers to get their shots and setting serious penalties for poor hand-washing and other unsanitary practices in order to reduce transfer rates in hospitals.

      • It’s medieval….Dark Ages….what the hell have we been doing???

        Thumbs up bums!

        Yes, we’ve lived without them before….that’s how we had the global 1918 flu epidemic!

        • antibiotics do not kill viruses and thus have nothing to do with any flu outbreak.

        • There is absolutely nothing wrong with the statement. I agree with you though that the behaviour of those responsible for our health care system – both medical and political – could certainly be improved – see HI’s response, for example.

          • The statement is medieval.

            Shrugging and saying it’s no big deal is akin to claiming it’s God’s will.

            Since when is a major step backwards like this considered acceptable?

          • Read in context. He was asked a specific question: What will be the impact of not having new drugs to combat resistant strains of bacteria? It was in the context of “just how disastrous will it be if…?” The assessmentr is fair, reasoned and logical.

            But as I said before, I agree with you that the implications – and what the current state of things says about medical and political foresight and day-to-day practices – is, well, maybe not medieval but definitely dunderheaded.

            But there is nothing new here; a good many people have been sounding this alarm for 20 years at least. I read a great book on this and related topics in the early 90s (can’t remember the title now; I remember it was a Penguin title).

          • And he should have said……’It will be a disaster. Countless needless deaths. We need new antibiotics…yesterday!

          • Which would have not been the correct answer to the question asked, and would be overstating and unnecessarily inflammatory. We have enough quacks pushing the panic button as it is. I suspect many are the very same ones who won’t get vaccinated.

            Too many people seem to equate medicine with magic, or oversimplify the science and think everything should be easy to fix. If only it were so!

          • Listen, Ned Flanders…..you should be hollering about this long and loud….and so should he.

            It’s the only way to get them off their asses.

          • Not really, money is. Hollering just makes you look like a quack.

          • There is plenty of money….there’s just no forward movement.

            PS….I’m not hollering THIS WOULD BE HOLLERING

            PPS….A ‘quack’ is a poor doctor. I’m not in medicine.

          • AND I’M JUST CALLING YOU A DUCK.

          • Oh well then…..that makes MUCH more sense.

            [rolls eyes]

          • LOL

          • I’m not prepared to do anything about it until some gallant superbug leaves you rotting and decomposing in a pink garbage can over at NDP headquarters.

          • In short, you are attacking the messenger because you don’t like his message.

          • Both of you are ‘messengers’….we have lots of mesengers full of excuses in this country….try focussing on the content of the message.

          • I was; you, as usual, were reading in way more than was said and ignoring context. Like I said – I agree with your broader assertion but choosing to attack this one answer to a very narrow question because it does not address the entire, much wider issue is off base.

            You really have a problem focusing on the specific issue at hand and blaming people for not answering questions they weren’t asked – or reading into responses things never said nor meant. You should think of changing your monicker to “Facts Not In Evidence”.

          • You wanna do the Miss Manners column elsewhere…..?

          • Sure – as soon as you show a little logic and common sense in the way you discuss issues. You may notice that I never end up in these bizarre circular discussions with anyone else on this board. There’s a reason for that – and it stares back at you from the mirror…

          • Last time, Bram.

            I’m not ‘discussing’ an ‘issue’ with you. I never do. I don’t ‘discuss’ issues with anyone. I make a comment….either agree or disagree and state your reasons….but I’m not about to ‘discuss’ tangents, manners, red herrings, and your view on how to write things. The arrogance of that amazes me!

            I made a comment…..that the state of our medicine is medieval….and that we need to get a move on. People are dying needlessly because we are all too prone to shrugging our shoulders and making excuses.

            So YOU promptly make excuses! Something I am obviously not interested in!

            As I’ve told you many times before, stop fussing about ME, and pay attention to the topic.

            The US has an MI….a Military-Industrial complex.

            Canada has an MI…a Medical-Industrial complex.

            We’re taking people in, churning them out….and not solving much. Medicine should be much further ahead than it is by now….gawd knows it’s funded up the wazoo….yet Canada, which used to solve medical problems….sits on it’s ass now

          • You initially made a comment that McGear’s statement is medieval – not that the situation is. Go back and reread your first comment.

            You attacked his assessment of the situation – not the situation itself. That was all I was pointing out in terms of my disagreeing with you – but as usual instead of acknowledging that maybe you could have been clearer about your intent, you go on trying to defend your original statement and then attacking me.

            And you are right; you never discuss. As you yourself once said, you pontificate.

            I never “made excuses” for the state of our health industry. Quite the contrary. But I didn’t rant either.

            I did point out that your assertion that McGear’s response to a narrow question was “medieval” was incorrect, but agreed that your wider concerns were valid.

            As usual, you saw not what was written but what you wanted to see.

            Take some remedial reading classes.

          • Like I said Bram…that was your last chance.

            Ciao

          • WRONG AGAIN

            This, is a medieval statement:

            “And Frenssh she spak ful faire and fetisly,
            After the scole of Stratford
            atte Bowe,
            For Frenssh of Parys was to hire unknowe”

          • LOL okay, that one made me laugh. You’re getting better.

      • We also need to have smarter practices with regard to how hospitals are built. Every faucet should be “hands free”. All doors should open automatically. Surfaces should be built using copper or other coverings that are naturally germ-resistant. The costs would be recovered by shorter stays and less rates of these hospital acquired illnesses. It isn’t only healthcare workers who fail in terms of sanitary practices and vaccination rates. Unfortunately, it is also the patients themselves and the visitors as well. We need to renovate current hospitals and build all new hospitals as though NO ONE is getting vaccinated and NO ONE is washing their hands. That means we need fantastic air flow systems and no passing germs through surfaces.

        • Totally agree. My reference to health care workers in particular re vaccinations has to do with the fact that they move from sick person to sick person and so are natural vectors – yet this year less than half of ON health care workers bothered to get a flu shot. Highly irresponsible behaviour, in my opinion.

          • You are absolutely right about the ridiculously low rates of vaccination among healthcare workers. In BC this year they mandated that all healthcare workers HAD to get the flu vaccine but they ended back tracking. However, they did get a 70% vaccination rate prior rescinding the rule.
            In Alberta IF there is a pandemic and you are a nurse who has chosen not to get the vaccine, you will be sent home without pay for the length of the pandemic. Of course you can use up your vacation time. The union has agreed that this is reasonable.

  2. Newsflash: A friend of mine just checked himself out of hospital “so I can survive these attacks of c-difficile.”
    Newsflash 2: Where exactly in Canadian medicare does it say that a doctor gives you a *choice* as to what antibiotic you’ll take (unless you’re allergic)? When was the last time you debated the ‘class’ of antibiotic you’d be prescribed? when was the last time the doctor asked you for your opinion?

    • Are you saying that you know about medications than your doctor?
      You always have a choice. You can choose not to take the prescibed medication. You also can choose to get a second opinion.

      • When was the last time a Canadian doctor, seeing her patient hesitate before taking a medication, say “you can get another opinion if you wish.”
        Last time that happened to me, the doctor looked at her watch and said “I have three more patients waiting!!” Point is, the entire system is geared to the idea of “you’re lucky I agreed to see you, shut your trap, take the pill.”

        • Agreed. Probably won’t do you any good to get a second opinion either…..they’ll just back the first doctor.

          • Yes you will get the same answer from the 2nd doctor because it is the lab that tells the doctor what the bacteria is and what antibiotic is best suited to kill the bacteria based on the latest scientific research.

          • The doctor asks if you’re allergic to any of em, asks if you have drug coverage and writes a prescription. Period.

            No lab is involved.

            And often he reaches in a drawer, grabs some medication from the pile of samples in there and says ‘try this’. Salesmen leave lots of samples.

          • Are you saying that your doctor does NOT swab your throat, etc. to find out whether or not you even have a bacterial infection? I am not sure what kind of infections your doctor has treated you for but the usual practice would be to do a culture and sensitivity test which involves obtaining some sort of body fluid sample and growing the culture. Of course there are broad-spectrum antibiotics that work to kill quite a wide variety of bacteria but it is unusual for a physician not to get a culture unless you have an ear infection or a bladder infection and then those are treated with only a few different antibiotics.

          • No and neither does anyone elses. Dr’s have full waiting rooms, patients in the hallways and 5 mins is usually as good as it gets.

            They are under pressure on wait times as it is.

          • Well my physician always swabs and does a C&S. I of course cannot speak to what “anyone else’s” physician does. I know in the hospital we always swab and do the culture & sensitivity. It is standard practice.
            Six years ago my daughter went to a walk-in clinic on a weekend with a sore throat and swelled lymph glands. The physician did not swab and gave her a prescription for antibiotics. We went and saw our own physician when his office opened. He sent her for a blood test and determined she had Mono. I called the walk-in clinic and issued a complaint. Needless to say, I never filled the prescription. That is bad practice…giving an antibiotic without doing a culture. Articles like this one in Macleans online educate people and they can demand better service.

          • Well this is over 66 years and in several provinces, so multiple doctors. The only time I’ve seen a swab done was 30 years ago by a dr I eventually left in disgust.

            3-4 hours in the waiting room, 5 minutes in the office if you were lucky, and on the last occasion I got about 60 seconds because he’d spent the time talking to his broker about a tropical holiday.

            Right after we left him all the ‘ear, throat etc’ infections he’d supposedly been treating…magically and permanently disappeared.

          • I am not surprised by your experiences in much of your 66 years but things should have been changing in the last 10 years at least. Physicians know the dangers in ordering antibiotics if there is no bacterial infection and they they cannot establish that there is a bacterial infection unless they do testing to establish definitively that it is present or if you have overwhelming clinical symptoms. Even then, the problem may resolve itself without antibiotics. They are now re-thinking treating ear infections with antibiotics as they believe they will resolve almost as quickly without treatment. The point is that you as a consumer must ask questions when/if a physician wants you to take antibiotics….regarding how they have established that you have an infection and how they know this antibiotic will work.

          • You’d think wouldn’t you? But some doctors will write a prescription for antibiotics without even looking at the problem…..and others won’t write one at all, even when antibiotics are needed.

            And if you quibble with your doctor over treatment more than once….s/he simply refuses to give you an appointment.

            Only one of the many problems in our system….whole thing needs an overhaul.

          • WOW, I guess we’re all surprised that doctors won’t give you an appointment..

            Do you suppose they don’t have time to listen to lunacy?

            You confirm my long-standing suspicion that the biggest problem with “our” system is the number of attention seeking “fruitcakes” trying to exploit it.

          • It’s unfortunate that your experience has been so bad. I never knew how good I have it. My doctor operates in a family health network where I can see a doctor 6 days a week, from 8 am to 9 pm. I’ve never watied more than 15-20 minutes. My own family doctor advocates a less is better approach to medication. I was just there with flu like systems. He was reasonably sure of what i had, but took swabs any way. 2 days later I got a call confirming what he suspected – I had the flu.
            When I seperated a shoulder he advocated rehab with a physiotherapist before heading to surgery. It took awhile but in the end I know I am better off for not having sugery. My shoulder is just fine.

          • Well I’m sure there must be good doctors in the country….but it’s damned hard finding them.

            Seems you have one, so never move away! LOL

          • Tough finding a doctor, especially for you I’ll bet.

            One guy you tell us leaves you sitting while he calls his broker, another won’t give you an appointment.You make a hit wherever you go don’t you Emily?

            So let me give you some advice.

            If you ever have to go to Emergency make sure you take someone along who you can trust (If there is such a thing) because I’ll guarantee the moment they enter your OHIP number the computer is going to print out a great big 15 foot sign that says, “DO NOT RESUSCITATE.”

          • Trust me, I know how fortunate I am!!

          • I just noticed this post. HI, are you joking? Are you on LSD?
            The doctor takes an educated guess, goes to his/her notepad, and writes a prescription. PERIOD.
            Naturally, for things like a kidney infection, he’d send you out for a urine sample for testing. However, I’m willing to wager that he’d also write out the drug prescription as he ordered the tests.

          • That is because (s)he is educated, trained, and has experience in making such decisions. Are they always right, of course not. Are any of us always right? No. Like I said previously, you need a new doctor.
            The problem as I see it is how the doctor is paid. The more people they see, the more they get paid. The fee for service system needs an overhaul.

          • Thankyou Knot likely. I am not taking hallucinegenics. However, people find it hard to believe that there are great physicians out there.

          • HI, don’t know where you’re writing from, but I envy your national medical system.
            The last 6 times I was administered antibiotics were the following:
            - 3 dental infections
            - 2 bronchial infections
            - 1 infection in a joint
            Time between examination and writing of prescription: 60 seconds.
            No. of swabs or other samples sent to Lab: Zero

        • There is a reason that the doctor doesn’t give YOU a choice as to what antibiotic you SHOULD take. That reason is that individual bacteria respond better to certain antibiotics. When a doctor takes a swab and the lab does a “culture and sensitivity” test (grows the bacteria on the plate…the lab tells the doctor what the bacteria is AND what antibiotic to treat the bacteria with to get optimal results for killing the bacteria. This is all based on research. It isn’t some flippant choice made by the doctor. Should you be allergic to the optimal choice, the lab gives a list of antibiotics that will work if the optimal one is not an option.

          • Only part right, Insider. First, nobody said their choice was ‘flippant’; a better word would be ‘dogmatic’.

            Secondly, the lab lists optimal antibiotics within a family of antibiotics. I’ve had doctors mull their own choice, so there is a choice
            But only “I had a bad reaction” is listened to if you’re a patient saying it. Not what the article says; you can’t debate the merits of antibiotics with the typical front-line practitioner (although they may shrug and prescribe what you want).
            Half the docs I’ve had (there’ve been many!) have had to look up the medicine in a book to even know what they were dealing with.

          • Hey have you checked out the size of the book they are looking up the meds in. The CPS is the size of an encyclopedia. Very good physicians double check to make sure they are ordering the right dose for the right amount of days and if you are on other medications, that there are no problematic interactions. Surely you would not want or expect these physicians to try to rely on their memories when they deal with so many patients and so many medications. As for your reactions to the antibiotics….that is why they ask you about allergies. That is your opportunity to disclose any and all problematic reactions to previous antibiotics. Unfortunately, due to the fact that we are running out of viable options, sometimes there is no choice but to use an antibiotic even if you have had a reaction in the past, as long as it is not one that indicates a serious reaction such as possible anaphylactic shock. When I worked in cardiac surgery I recall them giving penicillin to a patient even though she had experienced blurred vision during a previous treatment with that antibiotic. They did it because it was the best option available in her case. Sometimes the benefits outweigh the risk and discomfort.

          • All true (but you’ve not contradicted what I’ve said), but all beside the point. Look at what the author is suggesting. That may happen in the US, but rarely in Canda. The point is that in, say 1959, you could chat with a doctor about ‘medication options’; the last time I heard that offer was oh, let’s see, back in about 1985. And I repeat, one quack tried to make me take pills because “I have three patients waiting.”

          • Out of curiosity, what is it that you do for a living?

          • Obviously, I’m not working anywhere in the Health system. (ps, of course, doctors do outline some treatment options; I was not debating that).

          • I was wondering if you work at a job that required you to doing extensive studying and obtain a high level of expertise. I was also wondering if you have people who seek out your expertise because you have this great level of knowledge and experience in a certain area that is valuable to these other people.

            The reason I ask this is because in my life I often seek out experts such as tree specialists, car mechanics, dentists, pharmacists and even hair stylists. I pay for their services and their advice and I accept their advice because they are much more knowledgeable then I am in their area of expertise. If I knew everything they knew I wouldn’t have to seek them out. I don’t ask them to present me with every option because I trust their judgement and the fact that they might have personal experience that leads them to make the choices they do. If I do not trust them to make the best choices on my behalf, I can decline to engage their services and go elsewhere.

            Medicine is exactly the same thing. The physician has the expertise. You are hiring and paying for that expertise. If you trust the physician, accept the advice. If you don’t, hire a different physician. Meanwhile, that physician has a waiting room full of people who do trust their advice. You want them to tap dance for you and explain why one antibiotic is preferable over another….sometimes it just comes down to cost….the drug plans won’t pay for something that is very expensive. Sometimes it comes down to the fact that the physician has always had good luck using one particular broad-spectrum antibiotic. If you don’t trust the physician, get someone else. If you don’t trust ANY physician, ask yourself why not.

          • Healthcare, you write elaborate, and, i must say, very convoluted parables to illustrate the innate virtues of medical doctors, who, let it be mentioned, seem perfectly attuned to the Physical Universe. But your prescriptions are extra-planetary.

            Example: “If you don’t trust the physician, get someone else.”
            Reality: Millions of Canadians do not have one physician but are bounced arbitrarily from one clinic practitioner to another. You do not have the right to “ask” for a doctor — new, old, whatever– in the 3 Canadian provinces I’ve lived in. In my current province, there is a mandatory exclusion period of two years, minimum, from the privilege of “booking an app. with a doctor.” You’re not allowed to have one. If your feet still work and you can make it in, you take a # at a walk-in clinic and see a stranger 6 hours later. Guess how eager the stranger is to chat about your ongoing health options or even to read your chart, assuming you have a chart. The whole idea of controlling your medical care with some sort of personal intervention is a fanstasy.
            The idea of “getting a second opinion” is something hatched by a neurotic who surfs from clinic to clinic, and it wouldn’t even work because someone will end up asking why 2 sets off tests were asked for, not one.

          • I am sorry. I should not have assumed that all provinces had the same attitude as Alberta which according to some is living in the dinosaur ages but for all that does not limit who its citizens can see in terms of physicians. Also, there is no “arbitrary bouncing patients from one clinic to another”. Perhaps my parables are convoluted and extra-planetary to you but in the reality that is my home province, they are legitimate. If you don’t like and trust your doctor, you can move on and hire yourself a new one.
            Furthermore, a wait at a walk-in clinic here is 3 hours at the outside and the clinics are open until late in the evening. I guess whether this “stranger” you are seeing at the walk-in clinic wants to discuss your “ongoing health options” would depend on how many other people have also waited 3 hours to see the doctor and how serious your health issues are (ie: are your health issues chronic and should you be under the care of a specialist). As for your belief that someone would “ask” why two sets of tests are being ordered…I am baffled. Who is this someone? In the US, they have HMO’s that monitor the costs. Who in your province is keeping track of and limiting the number of lab tests a physician orders for you?

          • See fabuloso….it all comes down to yet another Alberta blowhard session, not healthcare at all.

            Even though HI has been told it’s ALL provinces and for years.

          • Oh Emily….I am just relating what I am familiar with. I didn’t realize you guys didn’t get to fire your doctor if you weren’t happy with their performance. Look on the bright side, I have given you yet another opportunity to spew out some bigoted hatred toward Alberta. Have at it and enjoy yourself doing it. What was it you said…”haters got to hate” and you Emily, hate Alberta and Albertans.

          • ???

            We simply find another doctor here HI.

            And as I’ve told you before, I was married and had a child in Alberta.

            I find it sad that Albertans have ruined what they’ve got.

          • Well perhaps you could pass along your info to fabuloso. Apparently where he lives, you aren’t allowed to “simply find another doctor”.

          • We have 10 provinces….and so there are 10 ways of doing things. Another problem we need to fix.

          • Unfortunately for you, hospitals (healthcare) is a matter exclusive to the Provinces under the Constitution. Subsection 92(7)

            The good old Constitution, you should read it sometime.

          • That child, did you support it or did you do a run out?

          • I’d admonish you for your cruelty toward Emily IF I could stop laughing.

          • Yeah, I feel like I should admonish myself, but that one is so flaked with nonsense, it can’t keep itself out of trouble. Cheers.

          • Are you writing from the Usa? Or is your reference to HMOs just a comparison?
            To answer your question, it’s all random. It certainly won’t be the lab who refuses to re-test; however, in my experience, it’s the doctor who refuses to do so; I get the impression that there is a backcheck by the povincial health authoriity to see whether dr’s are doing the job ‘cost-effectively’; naturally, I’m a patient, and can only report through a patient’s eyes.

            The emergency rooms in my current province reported waits of between 30 and 50 hours for exams for those not deemed ‘emergency’ over the holiday period. The normal wait is 15 to 20 hours. The walk-in clinics everywhere in large cities, have 6 hour waits, standard procedure. I’ve not heard of any exceptions, but perhps there are.

            I have been to hospitals in Alberta. Are you claiming wait times are shorter?? What about the dead body they discovered a few years back, of a man left to die for 24 hours on a chair in the waiting room? In fact, Alberta health is execrable, including much doctoring and certainly, diagnosing..

            I recently had a fairly serious accident with severe contusions all over my body, possible bone breaks, and bloody scrapes, plus an infected knee. I deliberately avoided the Hell called Hospital, and visited a clinic The wait to see the doctor was 8 hours; another 3 were spent waiting to get xrays. The exam, although attentive and professional, did not last longer than the mandated 7 min. dwell time. Although the doctor could see the I could barely walk or even move, there was no added empathy. In all, the clinic did the job of treating me very well. However, I am over 65, and certain added precautions, e.g., checking my consciousness (had hit my head) might have been indicated – in a parallel universe.

          • I am a nurse in Alberta. Of course the hospital wait times are long and can be VERY long at times like this….flu season… as can clinic wait times.
            I am glad that you were treated “well” in the clinic. I am not sure what your complaints are….is it that they don’t spend enough time with you?

          • H.I., at what time do you report for duty?

          • It depends. Like most hospital nurses, I work shift work and I work weekends and holidays so my work rotation constantly changes.

          • Obviously, I’m not working in the Health system.

          • They shouldn’t be looking in ANY book….and they certainly shouldn’t be giving penicillin to a heart patient whose had previous problems with it.

          • Emily…have you ever even seen the CPS? It is the Canadian “bible” of pharmaceuticals and ALL physicians and pharmacists refer to it. A new one is published every year. Perhaps you have a photographic memory Emily but given that medical research is ALWAYS evolving, the information in the CPS changes and physicians must always be looking at the book to make sure that something new hasn’t been discovered.
            As I pointed out, sometimes a physician has NO CHOICE but to give a patient an antibiotic that they have had a reaction to in the past…it is a risk/benefit issue. As you might have learned from this article, we don’t have all that many viable antibiotics so we have to use the ones we have. Would it be better for a person to die from Sepsis than be treated with an antibiotic they had a reaction to in the past? You are hardly an expert…so why am I asking you for an opinion…..just know this person is in a FULL service hospital so if they suffer from anaphylaxis, the code team will be on their way.

          • Online…upgradeable instantly. Worldwide.

            A code team shouldn’t be necessary.

          • Not every physicians office has the computer version but they ALL get the book sent to them automatically as well as the upgrades….as does every hospital unit.
            As for a code team being unnecessary…..hmmm….nice fantasy.

          • It should be mandatory.

            And a code team wouldn’t be necessary if doctors stopped the poor judgement.

          • No…the code team wouldn’t be necessary if the human body didn’t decide to stop functioning despite all the interventions…..we in the medical profession are not God and sometimes the body just stops working. That is when the code team steps in…when there is no pulse

            Despite what you might believe Emily, nature often takes its course and it has nothing to do with anything a doctor does or says….it might actually be as result of YOUR treatment or mistreatment of that body YOU have had in YOUR possession for the past 66 years. Physicians aren’t miracle workers. They can’t always reverse your poor judgement or the the course of illness.

            I am shocked that you would suggest that every code is a result of a doctor’s poor judgement. That is patently ridiculous. How many codes result from car accidents, etc. etc.

          • ‘sometimes the body just stops working.’

            Why?

            ‘when there is no pulse’

            Why?

            ‘nature often takes its course’

            Why?

            ‘it has nothing to do with anything a doctor does or says’

            Why?

            It’s the 21st century, chickie….you SHOULD know.

          • You truly can’t be this misinformed. Why does the body stop working? Have you ever heard of a stroke? a heart attack? severe case of asthma; pneumonia; sepsis; kidney failure; cancer; anueryism…..none of these have anything to do with a physician’s interventions…..you’re right I do know.

          • Focus HI…we should be further ahead than this by now. Why are these things still problems? We should be beyond the Dark Ages.

        • I shocked at how many people like you think so little of their doctor. Too bad. Maybe you should find another doctor. Mine always takes the time to discuss my health as a whole, and treatment possibilties. He always looks for the least evasive way to deal with a medical issue. From the sounds of it I’m lucky to have the doctor I do.

  3. what’s with the emily and bram love hate thing?

    • Emily has several stalkers….some of whom are, um, ‘overly refreshed’….others are just plain obsessives or crackpots.

      bram and Sot are two of them….you decide their category.

      • Ah Emily, referring to yourself in the third person isn’t good, it’s a psychological disorder. I can’t recall the name of it as we speak but you can look it up in Wikipedia.

        Richard Nixon talked like that and so does Elmo; it’s a big thing with little kids.

        http://www.youtube.com/watch?v=vSYadh2xmcI

    • Now my side…

      As I noted in my exchange with her, and as she herself has noted, Emily does not come on here to discuss, but to pontificate and harass. Most long-time posters just ignore her.

      She and I got along alright at first, as we do agree on many issues (she would likely be shocked if she knew how many “up” votes she gets from me). But then one day, I dared to disagree with her, and it got ugly.

      Over the years she has repeatedly misquoted, misinterpreted and outright lied about things I have said while trying to have a reasoned discussion. It has gotten to the point where she attacks me even if I post to agree with her.

      Since she thinks she “wins” if people don’t respond, and since she has libeled me many times, I refuse to knowingly let her have the last word if it is a comment that misrepresents what I said.

      I can have quite reasonable discussions with most of the posters on here – see e.g. the exchange between Healthcare Insider and me on this thread. HI and I don’t always agree but we actually have conversations rather than pissing matches.

      So why do I bother to reply to Emily’s posts? I sometimes try to ignore her blathering, but occasionally she says something that I think is too stupid to leave unchallenged, so… Other times, it starts when she replies to something I said.

      Frankly, when we get going, you may want to ignore our whole exchange. :-)

      • LOL another comedy routine!

        • La la La la
          La la La la
          Emily’s song

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