Evidence of meeting #7 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was prescribing.
A recording is available from Parliament.
President-Elect, Canadian Medical Association
I don't have that sense. I think what I'm hearing from my colleagues, and I think most other associations would likely take the same tack, is that we value information. Information gives us more ability to make the appropriate decisions for the patients.
Dr. Meuser said we're used to working in information vacuums. We use our judgment all the time, and I don't see more information as derogating the value of that judgment. It would inform our judgment and make us better physicians.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
Okay. It seems like there's a training deficiency somewhere and maybe that's just because of the advances in medicines available and being pushed by pharmaceuticals, and so on. But is there something missing?
Maybe Dr. Meuser could comment on this from a family doctor perspective. Is there anything missing from medical school training in respect of this, because it seems like a lot of the training is on the job?
Associate Executive Director, College of Family Physicians of Canada
A lot of the training is on the job and part of it is that every patient is different and every situation is different, so, in fact, it's certainly hard to train for every situation you're going to encounter in a brief period of medical school.
Having said that, we certainly have come to believe that, for instance, having a better understanding of pain, what contributes to pain, and how it can be analyzed and treated is a more important aspect of medical training than we had realized, perhaps, in the past.
The problem is you can say that about 20 things that we now know that we didn't know five years ago. The medical school curriculum is only so long. What we're doing about that is being very active on the level of continuing professional development, continuing education for physicians, and increasingly...for teams in family medicine, to help us stay on top of the ways medicine and patient problem-solving are changing.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
Thank you.
Dr. Simpson, are there any territoriality challenges with the various colleges of physicians and surgeons across the country? Or are they pretty united and uniform in supporting the initiatives in this area?
President-Elect, Canadian Medical Association
I think there's quite a bit of unanimity around this issue. We're all motivated by doing the maximum good for the patient and minimizing the harm. I think on the principles you've heard here today and the intent, there would be widespread unanimity in the profession and in all health care professions, I would venture to say.
Director, Policy and Research, Canadian Medical Association
Thank you very much for the opportunity.
When you asked the question about whether physicians are concerned that they're just being policed about these matters, I want to take it in a different direction. What we're keen on is patient-oriented care, and you can design your surveillance system to prove whether or not you're interested in patient-oriented care or policing.
Patient-oriented care means your surveillance system provides the information to the provider at the point of care. Policing systems gather up all the information for use later, and then reach out and punish. It's too late; the harm's done. That's something I want to emphasize.
Conservative
Laurie Hawn Conservative Edmonton Centre, AB
No, I agree. I'm not suggesting a policing system. I'm suggesting an education system with the focus on patient care; it was just whether there was any fear that it might be used in that way.
Director, Policy and Research, Canadian Medical Association
Yes, exactly.
And I'm sorry, I didn't mean to imply that you'd made that suggestion.
Director, Policy and Research, Canadian Medical Association
With the continuing professional development point, it is a part of all licensed health care providers. Once again, the issue of the evolving information base and the need for clinically oriented guidance that you can use in the health care setting means that an individual person actually cannot keep up with everything.
To support the practitioners, you need to have all of these systems that the others in the room have already described. I just wanted to support those statements.
Conservative
Conservative
The Chair Conservative Ben Lobb
We're now heading into our five-minute rounds.
I'd just like to mention to the Institute for Safe Medication Practices that if at any time you want to get in on a point, don't be shy. We want to make sure you're heard during the meeting as well. That's just an open invitation from me.
Mr. Morin, five minutes, sir.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Thank you very much, Mr. Chair.
Ms. Bard, thank you for your testimony. I particularly appreciated the fact that you reminded us of the importance of the fourth pillar in Canada's National Anti-Drug Strategy: harm reduction.
As my colleague Libby Davies pointed out, before 2007, this was part of the Canadian anti-drug policy. But, as priorities change when a new government arrives, in 2007, one year after the Conservative government took power, the fourth pillar disappeared. I already know your position on harm reduction and its importance in Canada, and I would like to know the position of the other witnesses.
Should harm reduction be reinstated in the Canadian anti-drug strategy?
Chief Executive Officer, Canadian Nurses Association
Let me make a comment while my colleagues prepare their answers.
We feel that it is of critical importance to provide prevention and to reduce the risks. It is the basis of all prevention. People have to be educated and provided with a safe environment so that we can identify and provide the care they need.
Associate Executive Director, College of Family Physicians of Canada
I'll just say that the College of Family Physicians of Canada endorses the report from the National Advisory Council on Prescription Drug Misuse, which validated harm reduction as one of the important strategies in dealing with drug misuse.
Director, Policy and Research, Canadian Medical Association
To add to my colleagues' words on this, I think there is an essential misunderstanding of what's meant by the words “harm reduction”. I think most of medicine is harm reduction. A person with diabetes who receives treatment for diabetes is in the throes of harm reduction interventions. When you educate people about diabetes, about heart disease, this is harm reduction being done.
I almost wish we had a new phrase for it, because it's just so core to the practice of medicine, it just doesn't quite....
It isn't easy to understand how it became such a political item.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
But I'm not clear on the answer from the CMA. When we look at the strategy itself, the wording, it talks about three pillars, so the fourth pillar, named harm reduction, which was in it before, was reduced.
What is your position on this? Does the CMA believe that harm reduction should be put again in the strategy—yes or no?
President-Elect, Canadian Medical Association
We believe it should be in the strategy.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Thank you very much.
How about the Institute for Safe Medication Practices?
Donna Walsh Educator, Institute for Safe Medication Practices Canada
I'd say that ISMP Canada doesn't have an official position on this, but I would put forward the notion that we do value patient safety and would very much value the input from clients and families in their treatment and their care.
So if it were something that included them and included families, it might be something for consideration.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Ms. Bard, harm reduction was removed in 2007. In the opinion of the Canadian Nurses Association, what effects, positive or negative, has that had? What have been the consequences for Canadians, both on patients who use medications and the “junkies”, the people who, unfortunately, are seriously addicted to the medications?
Chief Executive Officer, Canadian Nurses Association
We need supervised injection sites. We need to reduce the risks and the complications that arise from poor practices such as the use of dirty needles. That is one way to reduce risks. If we do not have sites of that kind, we are making a mistake. It is a way of helping people with their addiction problems. Sites like that can be a way into the ability to develop a relationship with them, to guide them as they search for rehabilitation services, and so on. For us, they are part of the solution. They must not be looked on negatively, but proactively.
Conservative
Conservative
Earl Dreeshen Conservative Red Deer, AB
Thank you very much, Mr. Chair.
Thank you to our witnesses today.
I want to talk about some of the best practices and the safety initiatives we have. According to reports from IMS and some of the figures we've been given here today, 453 million prescriptions were filled in 2008. We're talking about 14 prescriptions per Canadian. You mentioned 898 opiate prescriptions per 1,000 for first nations and even though that wasn't 898 people, that is a lot of opiates being given to any population.
Then you also talked about medication among seniors and the concerns and issues that are associated with that. I'll mention one anecdote. I have an aunt who celebrated her 100th birthday two years ago and had never taken a prescription drug. She'll be celebrating her 102nd very soon.
I take a look at that and I try to look at all the different abuse. When I think about that.... You also mentioned something about the caregiver intervention. The first thing that came to my mind was when someone has come home, who is looking after the individual there? I also recognize there's another way of looking at it, which is of course the physicians and the nurses and so on.
If it goes beyond the mother-in-law's thoughts of what is taking place, when you have a prescription drug being used by a member, when he comes back from hospital and is being taken care of, how do you determine where the adverse effects of that drug come in? Half the time I hear people say they tried this drug and it gave this side effect, so they had to get a different drug. They would check to see what those side effects were going to be. I'm wondering how we are able to keep track of that and if there's a way in which, as we try to do the advocacy, as Ms. Ma was saying, people could find out what the adverse reactions are going to be, or if they start to see them, whom they should be talking to.