Premature Death

Doc, what are my risks of dying prematurely or getting chronically disabled? How can I change this? Dave had left my office last time with these questions in mind.

Dave is six feet tall. Weighs 210lbs. Smokes twenty cigarettes a day. As a travelling salesman he entertains his clients to lunches and dinners.

His wife Susan, always worries about his life style.

Dave rarely misses his appointments. He arrived on time. My receptionist admires his punctuality.

By the time I saw him, I was running late by fifteen minutes.

“Whats up doc?” Dave greeted me in his usual style. “Not busy today? I guess you have plenty of time to give me a pep talk.”

First, we discussed the leading causes of death in Alberta. According to Alberta Health (1994), heart diseases is the number one killer (39%), followed by cancer (25%), lung diseases (8%) and other causes (28%).

Accidents, alcoholism and suicide form major portion of “other causes”.

In U. S., it is estimated that fifty three percent of deaths are premature occurring before the age of sixty five.

“Doc, is there anything we can do about this?” Dave queried.

Yes, we can. With appropriate preventive measures, significant number of these patients could live to enjoy the next century.

“Doc, these are interesting numbers. What about me? Tell me what I need to do to improve my chances of staying healthy? I guess my life style is not ideal!”

Dave looked serious. I was glad that the questions came from him. As we know, whatever the age, people in general do not always choose habits which are good for their health.

Is it easy to change habits? No, it is not easy unless there is a desire and motivation to change. Change requires discipline, determination, devotion and dedication (the four Ds).

“Doc, you sound like my golf instructor! In any case, for the sake of my family and myself, I need to change. Give me five commandments for promoting good health.”

Five commandments? Sounds cool! Here we go:

1. Dave, quite smoking. An average smoker looses fifteen years of life from lung cancer, heart disease, emphysema, stroke and other illnesses.

2. Exercise, Dave, prolongs life, reduces fractures in old age and improves function and mood.

3. Weight, for your height and age, should be maintained. A combination of nutritious diet and exercise can do that for you, Dave. Obesity is a risk factor for many illnesses.

4. Physical check ups with your family doctor are worthwhile. They remind you to stay in good health. If a condition is detected early then it can be cured or controlled.

5. Alcohol drinkers, Dave, compared to non-drinkers, have increased injury and death. Death is from cirrhosis of liver, alcoholism and cancer of various organs.

Dave was speechless. He wiped his forehead. Glanced at his watch and said: “Doc, aren’t you running late?”

Indeed, I was.

Dave got ready to leave. He looked serious. Did I upset him? Should I remind him about the four Ds?

No. He needs time to digest. I will wait for his call. He will probably need more help to follow the “five commandments”.

“Susan wants to know about the screening tests you had mentioned last time. Would you mind discussing with her?”

“Dave, it would be my pleasure,” I said as I watched him slowly shuffle his way out of my office.

(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems)

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Graduates of foreign medical schools: false hope.

Canadian Medical Association J, Vol. 132, May 15, 1985

Letter to the Editor

Graduates of foreign medical schools: false hope

I read Chouinard’s article on foreign-trained physicians with interest (Can. Med. Assoc J 1985; 132: 231).

Most graduates of foreign medical schools who come to North America have no illusions about the problems facing them. The fact that they have to take a number of “knowledge” – testing examinations and the experience of dealing with several licensing bodies in one country prepare them for the worst, unlike in the United Kingdom, where there is one licensing body for four countries.

What upsets foreign-trained physicians is the deliberate coolness or harassment of some of the licensing bodies. The physicians are kept running from pillar to post to fulfil the requirements in a frustrating vicious circle consisting of the evaluating examination, rotating internship, licensing by the Medical Council of Canada and postgraduate training for certification.

Most foreign-trained physicians suffer in silence, afraid of offending those in authority. There is no organization sympathetic to their plight, and their point of view is rarely heard.

I have experienced such obstruction twice. In 1979 I was told by the College of Physicians and Surgeons of Alberta (CPSA) that to practise as a surgeon in Alberta I had to be a licentiate of the Medical Council of Canada and a fellow of the Royal College of Physicians and Surgeons of Canada. After I had fulfilled these criteria, I was told that I should be a Canadian citizen or landed immigrant (which I am) and that the CPSA was “reluctant to register anyone who is outside the province unless they are actually going to start working in this province”. When I protested this new requirement, I was told that it had been laid down in the Medical Profession Act and its bylaws since 1975. Why did the CPSA not tell me at the start what the act required?

The second experience occurred when I was offered a fellowship in surgical oncology by the M.D. Anderson Hospital and Tumor Institute in Houston. I had been working towards this goal during my research and residency years, and when I received the offer I was ecstatic. I was eligible for a licence in Texas, but when it came to obtaining a non-immigrant visa for 1 year of training in the United States, the Education Commission for Foreign Medical Graduates refused to approve my application because I had not passed the basic science portion of the Visa Qualifying Examination. Anyone who has taken this test knows how difficult it is to pass a pure basic science examination after being qualified for 5 to 10 years. I had to have up-to-date knowledge in basic medical science to obtain a temporary visa.

Graduates of foreign medical schools are ready to take up any challenge to make themselves acceptable and useful in Canadian society once they are allowed to enter the country. The ultimate effects of obstruction on their personal and professional lives are largely unknown. It is time someone looked at this problem.

Noorali Bharwani, MB, BS, FRCS (Edin), FRCS (Glasg), FRCSC
North Battleford Medical Clinic
North Battleford, Sask.

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