Kevin Mcleod
@dockevinmcleod
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Father. Teacher. Internal Med Specialist for the North Shore of Vancouver and Whitehorse. Loving life. Married to the love of my life. Proud dad.🇨🇦
Vancouver
Joined October 2010
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Two guys come in to an ER. One has COVID. He’s sicker than he thought this would make him. Crashes pretty quickly. Docs and nurses do everything to help him. He needs ICU. Wasn’t vaccinated. Not a hard core anti vaxer. Just didn’t think he’d really need it, COVID not so bad.
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The ICU is full and after this surgery he’s going to need some time in there. BUT hey? He’s not as critical as the person who had the respiratory collapse with COVID. We have to triage. It’s just that the guy with covid could have really helped the guy with cancer. Big time.
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The other guy has belly pain. It’s been a month. Can’t find a GP. Waiting for a scan a walk in clinic ordered. Gets a CT in ER and shit it’s pancreatic cancer. Docs and nurses explain it’s early. They can still treat this. He needs a big surgery but we have to delay it.
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The hospital I work at had the very first case of covid in Canada in January of 2020. Today we have…wait for it… zero covid cases in the hospital. First time since that first case! Very optimistic. Vaccines are working!
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You know what makes me angry?
When I admit a patient with metastatic cancer who’s unlikely to survive… and if that patient had been able to access a family doctor and simple routine screening tests they would have been most likely cured months ago. Now it’s too late.
This
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BC we have a problem. The hospitals are much busier last 72 hours. Significant increase in COVID cases especially in younger people who are coming in around day 10 from initial disease onset. Presenting really sick. Needing 100% oxygen to stay alive teetering on intubation sick.
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I do not want to discourage anyone who needs care from coming to hospital. I’ve been in the ER much of the day and will be here this weekend. I’ve done this job 17 years. I’ve NEVER seen it like this. It is beyond busy. Patients and staff are struggling. Be kind. Have patience.
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Interesting stat released yesterday. Currently in BC every single patient in ICU is unvaccinated. 100%. Get vaccinated.
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A family doctor gets about $35 for seeing a patient in their office. As a specialist I get about $80. When so many of my patients don’t have family doctors and I have to follow them instead it costs you more in taxes. I don’t want more. I need less volume and more family doctors.
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On my way to the airport. The rumor of docs driving Ubers was true today. My driver did his medical training in Italy. Highly regarded medical school. Can’t get licensed in Canada. He’s trying to do residency training here but hugely complicated process and moving back to Europe.
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It’s many patients in that 20 to 50 year old group. Most do not seem to have co morbidities. This will go very badly if people don’t wise up. Don’t travel right now. At this pace of admissions our covid unit will be over capacity before Tuesday.
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The BA.5 variant is ramping up. It is seeming to make people feel sicker - fevers, chills, stuck in bed a few days - than some of the other recent variants. You can get it even if you’ve recently had Covid or are vaccinated and boosted. Do things to decrease exposure risk.
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Henry and Dix are bang on. If you are a health care worker and you aren’t vaccinated pack your stuff. You aren’t the right person for the job. The 98% of us doing everything we can to protect patients don’t want to be working beside you. Ignore the noise. This policy is correct.
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There are currently 32 people under the age of 50 in ICUs in BC with severe COVID infections. All, 100% are not vaccinated. Those are 32 beds we could desperately use for other patients.
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There is a significant uptick in COVID right now. It’s really important if you are sick not to pretend you aren’t. You should avoid others and not spread it around. When it gets in to high risk groups, hospitals, and long term care vulnerable patients have high morbidity and many
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There are hundreds of Canadians who have completed medical school in countries like Australia, the UK, Ireland. They can’t practice medicine until they complete a residency. While training as a resident they work in our health care system. The value they add is high. The cost is
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We were scheduled to go to Hawaii Dec 18th. I’ve been working non stop for 18 months and was really looking forward to good family time away. We just canceled the trip. It is the right decision. With numbers expected to rapidly rise the risk of getting stuck abroad is real.
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So many of my patients can not find a family doctor. I’ve seen 218 patients this week so far. 65 more scheduled for Friday. None of these visits are superfluous. This isn’t sustainable or safe. If only they could find a GP. We have a huge crisis in family medicine in BC.
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We have about 2,900 well qualified applicants to UBC medical school yearly. We have 288 positions. About 10% of those who apply are accepted.
Many kids go abroad to train in excellent programs in Australia, the UK, Ireland. Why do we make it so difficult to come back to Canada?
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ICUs are being filled with unvaccinated. Should we delay care for that patient with cancer or that person waiting for their surgery because someone took that away from them by choosing not to get vaccinated? Right now unvaccinated are bumping other patients. Fair?
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Do you know what a CODE blue is? It’s a medical emergency where a patient is in imminent danger.
Our health system is at the CODE blue stage. It’s not a left or right government problem. It’s happening across the country.
Rural ER closures. Delays in cancer care. Patients in
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Big shout out to all the essential workers who aren’t having a long weekend off. I’m at the hospital and it’s full of dedicated hard working nurses, cleaning staff, docs, and allied health staff.
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If you didn’t get vaccinated and have COVID and are having trouble moving around you’re so short of breath you should come to hospital. We have treatments that work better if we start them early. Don’t delay. We’re still going to help you. Don’t let more misinformation hurt you.
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Just left the hospital. COVID numbers are looking excellent. Dramatic improvement. Things are looking up. Very optimistic.
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@ridge_line1
Team based care. Pay me less but have a larger team. Don’t spend more $ but use them way more effectively than we are now. Less management and more front line care.
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The fire in Fort Nelson has cut off a fibre line connecting Yukon to the rest of Canada. This is a big deal because cell service goes down. 911 goes down. Internet goes down.
Ambulances are stationed at major public areas (see below from CBC) so if someone needs help you can
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I had a brutal day. I’m not a complainer but I think it’s important for people to understand the volumes of patients being thrust on to specialists. I started at 6am. Just home now. Saw 54 patients. Is that ok? No way but they have no other option. These are complex patients.
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Gyms should be reopened. I run the Cardiac Rehab program for the North Shore (large gym space) and we’ve stayed open (essential service) with mitigation protocols to keep a very high risk group safe. It can be done. Fitness is essential for health. Don’t tell me Costco is safer.
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IDEA. We need more GPs practicing full service family medicine. Let’s incentivize that. Not in a year. Not in a month. Today. Any GP who is truly providing full service family medicine will have their overhead covered at $10k monthly. Remove the overhead burden. Get it done.
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Using kids as shields, flooding 911 and risking lives, trying to take weapons from police, and public mischief. Freedom? Nope. Asshole behavior that drowned out any message you thought was important.
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Why do patients wait 6 months to now even a year plus for a CT scan?
Do we not have enough scanners? No
Do we not have enough radiologists? No
Do we not have enough electricity? No. Come on.
We do not have enough techs to run the equipment.
Grow the training programs to keep
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Paying me more will not help patients. It won’t make me more efficient. It won’t make me work harder. I’m working as hard as I can. Letting me hire a physician assistant or other helpers will make me more efficient. It will help patients. It will shorten my waiting list. Help me.
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Could it get anymore frustrating? Patient presents in respiratory distress, sick, and clearly asking for help by coming in. CT suggests COVID. Refuses COVID testing because “it’s a hoax” and PCR testing is scam. Why ask for help but then make it so hard for us to help?
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To buy a home in Vancouver you now need a minimum income of $231,950 per year and a 20% down payment. Looks like attracting teachers, nurses, fire fighters, heck almost everyone just got easier. In other news CEOs launch a program to learn to self nurse, teach, fight fires, etc…
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The bank of Canada should have 2 interest rates. One for a primary residence mortgage (not an investment property but your home) and one for every thing else. We want to curb inflation which is mostly from discretionary spending. Housing isn’t discretionary. It’s kinda essential.
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There seems to be a few people out there who think our current health care crunch is because our hospitals are overwhelmed with Covid. That just isn’t the case. We have around 400 patients in BC admitted with Covid. That makes up about 4% of total capacity.
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The health system is really struggling. I’m really struggling. The patient volumes are like nothing I have seen in almost 20 years of practice. We are burning out and the quality of care is suffering. It is not sustainable or safe.
Empower physicians to hire teams. Not complex
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About 25,000 of us will be diagnosed with colon cancer in Canada this year. If it’s caught early with a simple safe cheap screening test (we look at your poo in a lab) we can cure it 90% of the time. You know what though?
In BC you can only access this colon cancer screening if
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A few weeks back I had a brutal headache. I never get headaches. I’d exercise and have to stop. I’d bend over and it was intense. It would wake me from sleep. Being an internist I was worried I had a tumor or possibly aneurysm. The worrisome history was there. I thought I was in
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We have 10,000 people moving to BC every 37 days. 100,000 people a year. We need ten more family doctors every 37 days or 100 more per year to keep up with population growth. We have about 120 family doctors retire per year. So 220 per year needed just to keep status quo. We have
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Waiting lists are killing people. Patient I met in his early 50’s with aortic stenosis (sticky valve in your heart that obstructs blood flow) who was waiting for urgent cardiac surgery. He died waiting for a procedure that would have given him a normal life expectancy. Waiting
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Long day in Whitehorse clinic. It’s always crazy busy. 50 plus patients. One lovely lady I’ve known for many years painted this for me. In her 80’s and still paints like this. Absolutely love my patients! How cool is this?!
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If you have cancer and you’ve lost your GP or just can’t find one the BC cancer agency has set up a primary care program with nurse practitioners to help make sure you don’t fall through the cracks. Kudos to government for creating this.
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The longer you run a health system severely understaffed the more existing staff burn out. That makes the crisis worse. We need more people today. Not years from now. We need to get those with the skills from other countries who now live here credentialed asap. Get it done.
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I see a lot of misinformation for BC residents around specialist referrals. If you have lost your family doctor it does not mean you are cut off from your specialist. Remind your specialist that they can use referral billing number 99957 which is for - no GP, retired, or deceased
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I’m proud to be Canadian. Really proud. It bugs me that when I saw a Canadian flag on a truck today my son said it felt weird. I admit it felt weird to me too. No more. I’m saying this publicly because I’m going back right now to feeling pride when I see the flag. Join me I hope.
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IDEA. Pharmacists should be able to renew chronic medications (think blood pressure pills). You still need a doctor to check you are on the right meds but let’s make renewals easier. And things like antibiotics for someone with recurring bladder infections. Why make it hard?
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This is quite possibly my last tweet. I’m not leaving twitter. I am going to attempt to install a high voltage power line to a hot tub. I’ve watched the YouTube. I figure it’s 50-50 odds. To my colleagues in ER… I’ll see you soon. My wishes are stretcher 14 in the waiting room.
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My amazing office staff has all agreed to work a normal Monday Sept 19th. They will struggle to find child care. I can’t see how we could just cancel patients who’ve been waiting for ages with no space to rebook them. Do we rebook them for months from now? Every day is full.
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My tweets were not an attempt to make people feel pessimistic. Yes it is going to get worse but if we can stick to our bubbles, follow advice, don’t travel, and really ramp up the vaccine roll out we are going to get through this. Let’s just not blow it at the 11th hour.
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Younger people think they are invincible. That feeling quickly fades when we are blasting you with 100% oxygen and your saturation’s are sitting high 80’s and all you really hear is a team debating pros and cons of intubating you and hooking you up to a ventilator.
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He came here to be with family. We absolutely have to ensure the highest standards and competence for physicians but the process needs to be streamlined with a dash of common sense and a side of urgency. Why are we so slow to fix this?
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I’m typically a cautious physician. I weigh risk benefit all day long every day. Nothing is a zero risk. Nothing is a perfect benefit. My kids are all going to school today. I believe strongly it’s the right risk benefit balance.
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Can’t access a doctor? Waiting 10 hours in ER? On a many month waiting list for a specialist?
It’s a solvable problem.
1. Expand medical school positions by 10% per year for the next 5 years.
2. Expand residency positions by 15% per year for the next 5 years. The extra 5%
Part 1 of Episode 1 on the Doctor Crisis with
@dockevinmcleod
. Watch the full length episode on our YouTube.
#vancouverbc
#vancouver
#britishcolumbia
#healthcare
#canadianhealthcare
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We are really only a few short weeks away from having oral medication you can take for 5 days that reduces risk of death, severe disease, and hospitalization from Covid by 89%. Effective antivirals are almost here. They will be a game changer. Hang in there. 2022 will get better.
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It’s well past time the BC government get a group of experienced experts together to figure out the best way to redevelop and reopen a modern day version of Riverview hospital. Creating a safe supply of drugs without proper longer term inpatient treatment can not work on its own.
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Last week I was away on vacation. First one in a long time. Came back to 105 new patient referrals from a single week all added to a waiting list. Until we have access to teams and physician assistants that sort of volume isn’t manageable.
I keep saying it and I’m sure many are
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Come 2035 - 100% of vehicles sold in Canada must be zero emission or electric. We’ve hit a tipping point. In less than 13 years you will not be able to buy a gas powered car. Gas prices won’t be the issue. Gas stations will disappear. Huge change is coming. Resistance is futile.
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If you get covid you get 100% of the RNA. If you get the vaccine you get 20% of the same RNA (just the spike protein part). Getting COVID has a much higher risk of a bad inflammatory reaction than does the vaccine. It makes no sense to say you’d rather get covid than vaccination.
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We turn good qualified kids away from nursing schools because there are not enough training spaces. We then pay companies huge sums of money to float nurses in to our hospitals because we can’t staff them. We burn out existing staff because they are over worked.
Health
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This is the challenge. The 10% unvaccinated group are using 70% of the resource (and 90% of the ICU cases). Their decision directly impacts every other person who needs access to care. That is the epitome of selfishness.
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The 10% of BC that is unvaccinated is making up 75% of hospitalizations and 90% of those in ICU. Yes some vaccinated patients are landing in hospital but they typically have many other medical challenges at baseline. It’s those choosing not to help us that are hurting so many.
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Beyond proud dad here. My son got accepted to medical school today. Smart hard working kid. I’m biased but just the type of young person we need in the system…granted he’s got 11 years of schooling now to go but then I’m cutting back! What an awesome day.
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Message left on my phone this AM “this is … I’m the nurse assigned to ER hallway. Your patient …”
Hallway care is just normal now.
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Health care is in crisis and we need urgent change. There are simple things we can do to improve access and care. Below are ten things I would like to see implemented. I’m so frustrated with how much patients are suffering. Every single day it gets worse. It doesn’t have to.
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It is insanity that a kid has to wait 3 years to see a gastroenterologist. That is harmful and unacceptable.
If you asked me how many pediatric gastroenterologists we need in BC I’d have no idea. Government wouldn’t either. The universities wouldn’t. It’s not straightforward.
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Is it just me or are groceries even more expensive this week? Maybe a holiday thing? The eggs I usually get used to be about $6. They are $10.45 today. Milk is about $2 more. Anyone else notice a recent jump in addition to what we’ve seen this year?
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I’m so frustrated. I supervised a doc from the US. He did part of his training at the Mayo Clinic. He’s excellent. Can’t get in to a program/licensed in BC after 3 years of trying. His wife is a busy family doc with a huge practice here. Now they are both leaving back to the US.
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I think we’ve hit the peak and things will improve significantly and quickly over the next couple of weeks. Very optimistic that the worst is behind us. Confident enough that I’ve rebooked family travel for March spring break. First time in over two years.
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There will be lots of “noise” soon about the very small numbers of health care workers who loose their jobs because they are not vaccinated. These weren’t umm … the sharpest tools in the health system shed. The remaining 99% of us will make sure you get better safer care.
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I understand the desire to have a national holiday for the Queens passing. I urge the province not to have a stat day Sept 19th. Patients are fully booked that day. I have 61 people scheduled on the 19th. Where should they go if services close? It would be harmful.
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“Hello. Is this the Dean of UBC medicine?”
“Yes it is. How can I help you?”
“This is the minister of health. I know for 30 plus years under multiple governments as a province we haven’t been training enough doctors given our population growth. It’s become particularly bad the
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Vaccine mandates initially made sense. I supported them. At this stage of the pandemic they do not make sense. They shouldn’t be political. It’s time they are removed. That’s coming from a physician who’s seen a lot of harm from Covid. Get vaccinated. Drop mandates. Move forward.
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BC we all make mistakes. If you messed up, felt that understandable COVID fatigue, or just said @$&$ it and gathered or travelled this weekend not all is lost. You can now do the right thing and stay home and not spread these variants further. Stay home if you’re sick. Please.
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I’m triaging referrals right now and it’s so apparent we have huge challenges in our health system. Most of these referrals are urgent. Blood counts in the 80’s. Worsening ischemic chest pain. 40 lbs of weight loss from a suspected cancer. The list goes on.
There are over 60 of
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“I don’t want mRNA injected in me”. Ok but you’re gonna get Covid and what do you think the virus is filled with inside? mRNA. So you don’t want the 10% in the vaccine but you’re good with the 100% in the virus. Plus it kinda helps us A LOT with hospital capacity and delays.
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Nurses are hugely underpaid for the work they are expected to do. We need to fix this. It’s crushing us not having enough nurses. If nurses can’t afford to live here they aren’t going to work here.
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The health system is faltering not for lack of money but lack of staff. It is causing harm and death. Government should tell the licensing bodies for nurses, doctors, allied health that they have 14 days to come up with a list of countries that have similar health care to us with
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Drug addiction is a medical problem. It should be treated with compassion. That does not mean drug use in hospitals around other patients, nurses, and other staff is at all reasonable. It puts others at risk and just further stigmatizes the patient with addiction.
The minister
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It’s almost as if it would have been better to train enough doctors, get on with licensing those Canadians who trained in places like Ireland and Australia, expand residency positions, allow physician assistants, and a host of other policy ideas instead of burning out our current
Health authority offers $4,100 for doctors to work in B.C. emergency department
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My favorite comment I’ve seen so far “Zelensky was a comedian who became a leader in a time when so many leaders have become clowns.”
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If you have TikTok on your phone you have consented to let a Chinese company look at every keystroke you make, text you send, photo, location even when you aren’t using the TikTok app. Delete it. It’s not worth it. Good on the privacy commissioner looking in to this.
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Well done
@adriandix
and
@DoctorsOfBC
for fixing the specialist re-referral process. As of July 1st patients will no longer need to get a repeat referral to see their specialist after 6 months. This cuts down paperwork and time for the patient going back and forth. Excellent.
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Many of those admitted with Covid are primarily there for other reasons. This idea that if we eliminate Covid we solve the health care crisis is ridiculously naive. We don’t even run a Covid unit anymore as not enough patients to need it.
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It’s been an exceedingly busy last few weeks in hospital and with complex outpatients. I worked non stop through weekends often 15 plus hour days. I’m going away this coming week with my family. Much needed. My wife is doing a super cool high endurance race. I could not get
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A crisis in family medicine isn’t brewing or around the corner. It’s here now. Family practice is collapsing in BC. We are understandably focused on the Covid tree but we are forgetting the health care forest. We need to see the larger picture and see it quickly.
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If you are a health care worker there is no reasonable medical reason to not get vaccinated. You are in a high risk setting. You are putting others at risk. Honestly get vaccinated or get lost. We will cope without you. Altruism not narcissism in health care please.
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If emergency room doctors are speaking up about unsafe patient conditions the solution isn’t to shut the doctors up.
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Anti vaccination protests at hospitals today. Really? Come on. Nurses and staff are exhausted and to do this. In other news we will be releasing mRNA vaccine in to the air around all hospitals today. If you haven’t been vaccinated gather around a hospital today.
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Seriously?! Deface the Terry Fox memorial. That’s not being patriotic. That’s being an asshole.
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“Your CT scan is delayed. Sorry we do not have enough radiology technologists working in the system. We know this isn’t great for your health care.”
“I’d like to change careers. Do something different. I’m looking at the radiology technologist program but I can’t do it. How
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Canadian border services called me. I’m in trouble for contraband in a delivery. The only way I won’t go to jail is to pay the federal government in iTunes gift cards. Why can’t this be stopped?! Can you imagine if this was your job making these calls? What a waste of a life.
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Medical education is expensive. Taxpayers (society) hugely subsidize the cost. We have 3,000 qualified applicants for about 300 medical school spaces in BC. Demand is dramatically higher than training positions.
It is not unreasonable for society to ask for a return of service
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In Canada our population has grown by 5 million and we’ve gotten older the last 10 years. We as a country (not province) have increased medical residency training spaces by 167. For the whole country. A residency training space is required to become a practicing physician.
We
Canada's population is booming — access to family doctors hasn't kept pace
Canada added just 167 medical residencies in 10 years, while the population has grown by 5 million
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Be outside. Avoid huge crowds indoors. Mask in high risk settings. It’s a good time to be responsible because the next few weeks will have the potential to mess up your summer plans and also possibly really hurt someone else if you don’t.
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Really?? Vaccinated people getting omicron. Why did I get $&@! vaccinated then?? Because it makes it REALLY unlikely you will need hospitalization, ICU, or a morgue. We will all over time get Covid. Vaccination is still the most effective tool to prevent severe illness.
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In BC we post ER wait times. We should do more.
I challenge government and opposition parties to commit to posting wait times to see specialists, get imaging, and time to surgeries. It’s not to criticize but information is important for those needing and those paying for the
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British Columbia had an operating surplus of 5.7 billion dollars last year. But we are told we have all these health care problems because the federal government needs to send us 3 billion more a year for health care. Hmmm. That seems plausible. Maybe money isn’t the problem.
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I admitted multiple patients with covid this weekend. All will be home by tomorrow. This is not the same as previous waves. Patients are recovering quickly especially if vaccinated. Don’t look at hospitalizations out of context. It’s more nuanced than reported numbers.
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I don’t think most of us realize that Nurse Practitioners are not under the same financial rules as physicians and can charge patients private fees. It’s problematic because if you can’t access a publicly funded family doctor you can pay an NP for private care. Heck you can even
Nurse practitioners are able to open full private practices as they are not subject to the Health Canada Act. User fees could have saved many GP clinics, but it is illegal
@timthielmann
@CCurrieadvocate
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