CBC’s “Dr C” and the problem of doctor-centred care

A CBC-hosted blog has been following the story of “Dr C.” CBC describes him as “a St. John’s physician training in internal medicine. He’s also a writer, and he’s documenting his life since being diagnosed with cancer.” His blog posts show up on the CBC Health twitter account periodically, and they pass through my newsreader on a fairly regular basis.

For the last few months, I felt uncomfortable every time I saw one of his blog posts go by, and I couldn’t put my finger on why that might be. I think today I can finally articulate my misgivings.

A doctor’s privilege

I feel like the underlying assumption for CBC’s intense coverage, and the voice that “Dr C” has in expressing his experience with cancer is that when it’s a doctor who is diagnosed with cancer, he will have some interesting insights on the matter. In fact that’s the whole premiss of the “Dr C” blog. This makes me uncomfortable because in the modern medical system, a doctor’s voice is always the most important.

Fortunately, this is less the case than it used to be, to be sure. It used to be that nurses were trained to stand up out of respect when a doctor entered a hospital room, for example. But even today in 2014, the opinion of a doctor is, on the last analysis, the only one that really matters in the healthcare system, and in a lot of ways, that shouldn’t be the case.

What is patient-centred care?

Before a conspiracy theorist mistakes what I’m writing about, I want to clarify that I’m not saying that an untrained quack should be given the same voice as a medical doctor on issues like vaccine safety, or the efficacy of “alternative” medical therapies. I’m not advocating for that at all. I’m fully on the side of medical science, and I have rather mainstream views on that matter, even though I work in the Medical Ethics Unit. (It turns out that the real evils of drug development and medical practice are rather mundane things, mostly done under the light of peer-reviewed scrutiny. Go figure.)

What I’m talking about is patient-centred healthcare, a concept that most medical professionals agree on, or at least pay lip-service to. It is a somewhat nebulous umbrella concept, and it is aspirational in nature—a healthcare worker can always try to be more patient-centred.

The idea itself is not controversial. Every healthcare worker would likely say that she wants to be patient-centred, and this includes things like catering her care toward the patient’s own idiosyncratic values, taking into account the patient’s strengths, and seeing the patient’s family as the unit of care, rather than maintaining the fiction that it is possible to treat a disease process in an individual without regard for the rest of the patient’s life.

So what’s the problem with Dr C’s blog?

I have nothing against “Dr C” from the CBC. I think it’s terrible that he (or anyone) has cancer, and I wish him the best in his treatment and recovery. I’m even glad that his blog has given him a place to work through his thoughts. I hope that he’s a more sympathetic physician as a result, and that his insights have helped other people to deal with their own cancer diagnoses.

That said, I feel like the way in which a doctor’s opinions are privileged in any discussion on healthcare is very troubling, and I can’t shake the feeling that this blog pushes it even one step further. It’s as if they’re saying that privileging a doctor’s voice when he’s the one treating the cancer isn’t enough. We also have to get a doctor to tell us what it’s like to be a patient as well, because then it will be something worth listening to.

Puns are truly the highest form of humour

Shortly after my little sister moved to Montréal, she was asking about how to use the word “celui” in French.

Alain gave her an example. “You can say, ‘celui-là,’ which means ‘that one there,'” he told her.

Caitlin asked, “Can you use ‘celui’ anywhere else?”

To which I replied, “You can put celui in … a sawad.”

Super creepy Ananas

Creepy Ananas
Creepy Ananas

Since my sister’s move to Montréal, she watched a lot of Téléfrançais. In an effort to keep up with her level of French, I have been watching it as well. Téléfrançais is an educational TV show designed to teach French to elementary school students. It stars a talking pineapple named “Ananas.”

Inspired by Téléfrançais, I have been working on a digitally remastered version of Ananas in Blender. Tonight I did a little camera tracking test and put Ananas on the kitchen table with my sister and boyfriend. It turned out okay. Click the thumbnail of the image attached to this post to see an animated GIF of Ananas waving at you creepily.

I feel like this creepiness is definitely in keeping with the spirit of Téléfrançais. Next up, time to do some writing. I’m not planning a feature-length film, but perhaps a (series of) short film(s)?

New house

Sesame Street Colour Collection
Sesame Street Colour Collection

In December of 2012, Alain and I became home-owners for the first time ever. Montreal is one of the few big cities left with reasonably affordable housing.

The house has everything we wanted, and even a few things we didn’t know that we would want. It has a garage, which is great for snowy Montréal winters. It also has a big beautiful back yard with gardens all around. The house is 4 minutes by foot from the métro, and it’s sort of near the Olympic Stadium.

There are two things that we really plan to change about the house: The tile floors in the front hallway and the kitchen need to go, and we’d like to renovate the bathroom. It’s fine, but it isn’t beautiful. Also, the bathtub is kinda shallow.

Cookie Monster paint colours
Cookie Monster paint colours

The previous owner of the house had made some questionable decorating choices, and so when we moved in, painting was in order. When we went to the hardware store to find books of paint samples, one in particular caught our eye: The Sesame Street Colour Collection (see the first image attached to this post). My little sister wanted her room to be coloured “Cookie Monster,” so we painted her room a nice calm light blue with a cream-coloured stripe along the middle. She has darker blue curtains for her window, and we plan to find some pots to paint dark blue and put googly eyes on.

Ernie and Bert paint colours
Ernie and Bert paint colours

As for me and Alain, we really didn’t have a choice when we saw that there was a “Bert and Ernie” theme. This turned out to be a lot of work, although the official story is that the whole paint-job took 20 minutes. When it was half-way done, I was a little worried about how it would look when it was finished, but then by the end, it  turned out much better than I had anticipated. The doors to the bedroom have orange translucent glass panels in them, which happened to work with the orange lines in the paint—not by design, but purely by accident. You can see in the video below the way that the paint looked when the green masking tape was still on the walls.

Catch-22 in mental health: An open letter to Andrew Williams, CEO of Stratford General Hospital and Randy Pettapiece, MPP

Dear Andrew Williams and Randy Pettapiece,

Recently, my father was hospitalised for schizophrenia in the psychiatric ward at the Stratford General Hospital. This was good news. It was a welcome change after months of increasingly abusive and dangerous behaviour on his part that affected the entire family. Not only was he suffering from disordered thoughts and paranoid delusions, he lost his impulse control with regard to money (and some other things as well). Due to his condition he lacks the ability to deal with his own finances. He was admitted to the Stratford General Hospital and shortly thereafter, a medical tribunal determined that he was not competent to make his own medical decisions. My mother was assigned to be his medical decision-maker and power of attorney.

Yesterday, we found out that some unscrupulous lawyer visited the Stratford General Hospital to arrange the papers so that my dad could transfer his medical decision-making and power of attorney away from my mother, and give it to another patient on the psychiatric ward. As far as we know, this other patient is just some guy that my dad met less than two weeks ago when he was admitted. The name sounds made-up, though, so for all we know, it’s not his real name. This “other patient” could even be a delusion of my dad’s.

Needless to say, we were upset.

We contacted the lawyer to ask him what he thought he was doing. He said he didn’t do anything—that it was my dad who made it happen, and that he had training to determine when someone was competent to make such decisions. We will be inquiring about what legal options we have against this individual.

When we told our own lawyer about the problem, his administrative assistant broke out laughing, because it was such a ridiculous turn of affairs. He advised us to get a letter from dad’s psychiatrist, and on the basis of such a letter, it would be possible to have this transfer of power of attorney reversed. This seemed reasonable. On contacting the doctor, we were told that he could not release such a letter, since my dad has requested that his medical information not be shared with us (one of his paranoid delusions is that we’re out to get him), and my mother no longer had her status as his medical decision-maker and power of attorney.

In the face of this Catch-22, we’re not sure what to do next. As of today, the doctors at the Stratford General are still refusing to provide a letter indicating my dad’s condition, because they are afraid of being sued.

I’d like to emphasise at this point that the unscrupulous lawyer got paid for what he did. Paid with money. He came in to the locked ward of the Stratford General and walked out substantially richer, thanks to money he took from a person who was determined by a medical tribunal to be incapable of making his own medical decisions.

If someone walked into a hospital and found an old woman with dementia and exploited her condition for his own financial gain and gave her nothing in return, that conduct would be reprehensible, but it still wouldn’t be as bad as what this lawyer did to my dad yesterday. Not only did he take money from someone whose mental condition renders him incompetent to handle his own financial affairs, but he made it a thousand times harder for us to get my dad back on his meds to stop the paranoia and abuse.

So, Andrew Williams: When do your doctors plan on doing the right thing for their patient and his family?

Yours angrily,

Benjamin Carlisle

(Edit 21h00—the original version had more cursing, but as my friend advised, “Try not to swear so that your interlocutor doesn’t have an excuse to dismiss you.”)

The luge

What's the luge?
What’s the luge?

Every once in a while I have an idea for something that I think would be fun on a t-shirt or on your iPhone wallpaper. This one is not original. It’s something of a running joke in my family.

A few years ago, listening to CBC’s coverage of the Winter Olympics, my older sister asked, “What’s the luge?”

She had never heard of it before.

Not missing a beat, my mother answered her, “It’s when you don’t winge!”

My sister was not impressed. As far as I know, she still hates that joke. My mother, on the other hand, thinks it’s hysterical, and she will explain in detail why it is such a good joke to you if you don’t laugh the first time you hear it.

Offensive message at Stratford’s Canada Day ceremony

Last week I went to Stratford, Ontario to celebrate Canada Day with my family in my hometown. The weather was beautiful and I got to see a bunch of old friends.

Behind City Hall, there were food vendors, booths from various organisations around Stratford, and live music and dancing. Some were done by actors from the Festival, and other acts were done by fiddlers and tap-dancers from around Perth County. I understand that they were recruited from a festival that was going on nearby.

Partway through the event, one of the groups of dancers came on stage, and there were two boys in the dancing troupe. After they finished, the person who was emceeing the dancers made a comment that still bothers me. She said in a very tongue-in-cheek way, “Look at that—those two boys are pretty smart, aren’t they? Learning to dance with all those girls.”

The audience laughed, while I looked around in horror.

What’s offensive about this comment is the suggestion that it’s not okay for boys to learn to dance because they like dancing. That would be beneath a man’s pride. That would be womanly. There are some things that men don’t do, and dancing is one of them, and if a boy enjoys that, he should be ashamed of himself.

But learning to dance in order to pursue sexual congress—that’s another story. You can still be a man if you’re dancing in order to get in a woman’s pants. It just means you’re really shrewd about it, that’s all.

Two things immediately come to mind that are really problematic about this:

  1. This sort of thinking is fantastically demeaning to women. It puts women in the place of being a sexual object to be pursued by men. Not only that, but these girls were about ten years old! Why on earth is this even being hinted at?
  2. Having attitudes like the one I outlined puts boys in a position where they have to rationalise all their actions, preferences and their own identity through the lens of manhood. Not only that, but it emphasises how fragile someone’s manhood actually is: If just the act of dancing publicly is enough to threaten it so much that it needs to be rationalised by appeal to the subjugation of women, then you are sending the message that a person’s manhood is a very fragile thing indeed, and that it’s okay to turn a few ten-year-old girls into sex objects in order to preserve it.

I would actually be interested in knowing if there’s a way to quantify how much violence can be shown to be directly causally related in a non-controversial way to some guy trying to defend his own manhood. These comments are not benign.

A bacon-related death

I used to have the phone number for my little sister’s landlord programmed into my phone. I forget why, exactly, but one day, a couple years ago, I accidentally sent the following text to the landlord’s number rather than my little sister’s:

“I am about to die a bacon-related death.”

My little sister’s landlord replied, “I don’t know who you are, but whoever you are, stop eating bacon!”