Category: Medicine Hat News

Posted on

Doctors acting as Good Samaritans – are they liable for the care they provide?

Water fountain at Strathcona Island Park in Medicine Hat, Alberta, Canada. (Dr. Noorali Bharwani)
Water fountain at Strathcona Island Park in Medicine Hat, Alberta, Canada. (Dr. Noorali Bharwani)

A Good Samaritan is one who helps a stranger. Is there anything like a bad Samaritan? I don’t know.

“The parable of the Good Samaritan is a parable told by Jesus and is mentioned in only one of the gospels of the New Testament”, says an article in Wikipedia. So the concept of a Good Samaritan is not new. But in the present era of litigation, some people are reluctant to help a stranger in an emergency situation. For some, including physicians, nurses and paramedics, it is second nature to help strangers in physical danger.

“When an individual suddenly becomes ill or injured, doctors instinctively stop in the midst of their vacation, their business trip, or their work and offer assistance as good Samaritans, often under trying conditions”, says an article in the Canadian Medical Protective Association Bulletin (CMPA). The CMPA’s job is to provide legal assistance to doctors.

What are the physician’s ethical obligations?

  1. The College of Physicians and Surgeons of Alberta view physicians as having an ethical duty to do their best to attend to individuals in need of urgent care.
  2. The Canadian Medical Association’s Code of Ethics states that physicians should: “Provide whatever appropriate assistance you can to any person with an urgent need for medical care.”
  3. Quebec has its own code of ethics for physicians, which is enshrined in law, with similar requirements.

Are there legal obligations and risks?

The article in the CMPA bulletin says that legal obligations and risks can be more difficult to determine. Because emergencies can happen anywhere, at any time, physicians may find themselves being asked to provide emergency care in a variety of legal jurisdictions – within Canada or in another country, or in international airspace or waters if on an aircraft or ship. Different locations can mean different legal obligations.

Three things to remember about legal obligations:

  1. In Canada, most jurisdictions do not impose a legal duty or obligation on physicians to provide emergency medical services.
  2. All jurisdictions, however, have legislation that protects physicians who voluntarily provide emergency assistance at the scene of an accident or in an emergency.
  3. Quebec is the only province in Canada that imposes a legal duty on physicians to come to the aid of a person in a life-threatening emergency. Quebec’s Civil Code protects physicians from liability for that care.

CMPA does not think courts anywhere would criticize the conduct of a physician who in good faith treated a person in need of urgent medical attention. The CMPA does not know of any proceedings commenced against Canadian physicians in Canadian courts or in foreign courts alleging negligence in providing emergency medical attention as a good Samaritan.

CMPA says that when its members provide care in an emergency as good Samaritans they are generally eligible for CMPA assistance regardless of where the emergency care was delivered – anywhere in the world. Former CMPA members who act as good Samaritans are also eligible for CMPA assistance; they do not have to retain membership solely for this possibility.

With that in mind, the CMPA encourages its members to consider assisting when confronted with an accident or with sick or injured individuals in urgent or emergent circumstances.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Posted on

Some Drivers Continue to Ignore Distracted Driving Law.

Tomb of Camões in the Jerónimos Monastery, Belém, Lisbon. (Dr. Noorali Bharwani)
Tomb of Camões in the Jerónimos Monastery, Belém, Lisbon. (Dr. Noorali Bharwani)

In September, it will be four years since the distracted driving became a ticketable offence. But some drivers continue to ignore the law.

As of May 1 2015 the fine for breaking the distracted driving law is $287. If a driver is exhibiting more risky behaviour, they can be charged with driving carelessly and receive a fine of $402 and six demerit points.

Is that going to prevent people talking on the phone, drinking coffee and smoking a cigarette, sometimes all at the same time?

From my casual observation, I would say no because it is hard to enforce the law.

My impression is there are too many other things going on in the city to keep the law enforcement people busy. Distracted driving offence may not be high on the priority list. I may be wrong on this. It would be nice to see some statistics.

As we know, while driving, it is illegal to:

  1. Use a hand-held phone while talking, texting and/or e-mailing
  2. Operate electronic devices like video players and laptops
  3. Manually program GPS units or portable audio players
  4. Read or write
  5. Engage in personal grooming

Drivers are allowed to use hands-free mobile devices that are activated by a single touch or are voice activated, eat a snack, or drink a beverage while driving.

The law also says that members of the public can report a distracted driver to their local community station. The complainant must be able to identify the driver, vehicle and be willing to testify as a witness in court. I wonder how many people would have time to do that.

It is important to know there are some exceptions to this law:

  1. Emergency personnel such as fire rescue, EMS and police are exempt from using hand-held radio communications and electronic devices while performing their duties.
  2. Calling 911 in an emergency, or to report an impaired driver as part of the Curb the Danger program, is permitted while driving under the distracted driving law.

According CAA/AAA most drivers are distracted by outside object/person/event (29.9 per cent), adjusting radio/CD (11.4 per cent), other vehicle occupants (10.9 per cent), and something moving in the car (4.3 per cent). Other distractions are using another object/device, adjusting car’s climate controls, eating/drinking and using cell phones.

Statistics show that drivers engaged in text messaging on cellular phone are 23 times more likely to be involved in a crash. Driver distraction is a factor in about four million motor vehicle crashes in North America each year.

According to Alberta Transportation, international research shows that 20 to 30 per cent of all collisions involve driver distraction.

These indeed are grim statistics. There is more information on this subject on the internet and Alberta Government website. The question remains – is the law meant to be self-regulated or do we have enough manpower to enforce it? Have we made a dent in the tragic consequences of distracted driving?

We are into a holiday season and the weather is conducive and enticing to people who want to speed and break the law. Can we prevent that?

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Posted on

Should You be Worried About Nipple Discharge?

To drink or not to drink - Cordoba, Spain. (Dr. Noorali Bharwani)
To drink or not to drink - Cordoba, Spain. (Dr. Noorali Bharwani)

“Nipple discharge is benign in most instances and is the third most common breast-related complaint, after breast pain and breast mass,” says an article in the Canadian Medical Association Journal (CMAJ May 19, 2015).

About 50 per cent of women in their reproductive years have nipple discharge, which are physiological. This kind of discharge is usually from both breasts, milky, green or yellow fluid expressed from multiple nipple duct openings and often associated with nipple stimulation. Usually these patients do not require surgery if the ultrasound and mammogram is normal. Discharge may spontaneously disappear.

Nipple discharge you should be worried about are spontaneous and often from one breast. It may arise from a single duct or be associated with a breast lump or new skin changes. It can be bloody, serous (clear thin plasma fluid), green or black.

About 15 per cent of these patients will have breast cancer. About 50 per cent of these patients will have benign intraductal papilloma (benign growth in the duct), and 20 per cent will have ductal ectasia.

Ductal ectasia of the breast (also known as mammary duct ectasia or plasma cell mastitis) is a condition in which the lactiferous breast duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal women.

Intraductal papillomas are benign growths of the nipples in women close to menopause. They are usually single. Generally they are not seen on mammography. Surgical excision is indicated to rule out malignancy. These papillomas are the most common cause of bloody nipple discharge.

What can be done for women with nipple discharge?

Women with nipple discharge should be investigated. Mammography (sensitivity may be decreased in younger patients) and retroareolar ultrasonography should be performed in all cases of pathologic nipple discharge. Galactography, and more recently, magnetic resonance imaging, can be helpful in identifying an involved duct or papilloma. Patients with a palpable mass or a mass identified on imaging should undergo needle biopsy to exclude carcinoma, says the CMAJ article.

Milky discharge in patients who are not pregnant or lactating (galactorrhea) is often due to medications. Milky nipple discharge from both breasts is appropriate during pregnancy and lactation, and it can last up to one year after delivery or after breast-feeding has stopped.

In patients who are not pregnant but are lactating should have prolactin levels checked to exclude endocrine disorder (> 20 ng/mL). Medications such as:

  • Psychotropics, antihypertensives (e.g., reserpine, methyldopa, verapamil),
  • Opiates, prokinetics (e.g., metoclopramide) and
  • H2-blockers (e.g., cimetidine) can cause galactorrhea.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Posted on

How Schools Teach our Children to be Fat

A beautiful view of the mountains in Canmore, Alberta. (Dr. Noorali Bharwani)
A beautiful view of the mountains in Canmore, Alberta. (Dr. Noorali Bharwani)

“Our children are getting fatter. They eat more and move less,” says Diane Kelsall, MD, deputy editor, Canadian Medical Association Journal (CMAJ April 7, 2015), in an editorial titled, “How schools teach our children to be fat.”

The editorial goes on to say that nearly 85 per cent of children aged three to four years meet activity levels recommended in Canadian guidelines, but this falls to only four per cent in teens.

Unfortunately, most of our overweight or obese children will not outgrow their weight problem. That means they develop adult diseases like hypertension and diabetes. And our schools hinder the fight against obesity in our youth, says the editorial.

If you look at a typical day for our children when they are at school then you will understand why Dr. Kelsall feels our schools are doing a poor job of preventing obesity. She makes the following points:

  • Our children’s school day starts early, often well before 9 am.
  • They are likely driven or take the bus to school.
  • They are tired when they arrive and sit for most of the day.
  • Physical education classes are usually not required after grade nine.
  • Lunch may be rushed, and food options available in the school may be high in fat or sugar.
  • At lunch or after classes, some students may participate in sports, but most don’t.
  • Students have hours of homework resulting in extended screen time.
  • They go to bed late, and the cycle starts all over again.

No wonder nearly one-third of our school-aged children are overweight or obese. Our schools should be helping our children to be healthy and that should lead to healthy adulthood. How can schools do that? Dr. Kelsall suggests the following:

  • Daily exercise should be mandatory for all school children. It should become part of daily life. Classes should include enough sustained, vigorous exercise to help students meet recommended activity levels, rather than the 20-minute requirement in some jurisdictions.
  • Walking or cycling to school is a good start.
  • Taking public transportation affords more opportunity for exercise than being driven by parents.

Lengthy sitting time has been shown to be a risk factor for early death in adults. The editorial says that a peek into most high school classrooms will show rows of students sitting for classes that are often 75 minutes in length, among the longest in the world. This sends the message that being sedentary is acceptable. Beyond physical education classes, getting students moving during school hours takes creativity.

We should do what Japan does. Make food education a part of the compulsory curriculum. We should encourage our kids to sleep early and get up early. Like adults, tired adolescents are at increased risk of obesity.

“Obesity is a complex disease and prevention requires multilevel intervention,” says Dr. Kelsall. It starts with the individual and family making good choices around exercise and food intake, but broader societal support is necessary. Our battle against smoking is slowly winning and message to people is clear – if you smoke then you kill yourself and hurt others. The message for obesity and overeating is the same – stop hurting yourself and the people you love.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!