Auto insurers face pushback over preferential deals with health care providers

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Kyle Whaley, the executive director, and a physiotherapist for Propel Physiotherapy, at the company’s Etobicoke clinic on March 6.Fred Lum/The Globe and Mail

Health care professionals are warning that auto insurers are increasingly signing preferential deals with providers that are controlling patients’ choices about how to get injuries treated after car accidents.

A proposed agreement between Manulife Financial Group MFC-T and Shoppers Drug Mart recently thrust the issue of preferred provider networks (PPNs) into the spotlight. Under that deal – which was later cancelled – chronically ill patients would have been limited to buying their medication only at pharmacies owned by Loblaw Cos. Ltd. L-T.

But similar agreements have become increasingly common across the insurance industry – including among auto insurers.

Health care professionals who work with accident victims say these deals direct more business to large physiotherapy chains, such as the Loblaw-owned Lifemark, and they can create conflicts of interest in which the terms of a contract could unfairly dictate the treatment that a patient receives.

Kyle Whaley has experienced the issue from both sides of the table. As a physiotherapist and owner of Propel Physiotherapy, he has treated many patients who were injured in auto accidents.

Last summer, he was in a collision himself and got a concussion. At first, he figured he could find his own physiotherapist. But he then decided he wanted to experience a PPN system himself. “I thought, you know what, I’m going to go through this process and see what it’s like,” he said.

He booked an appointment with one of the three clinics his insurance company recommended. On the morning of the appointment – a week and a half later – the clinic called to cancel, saying it didn’t have the right specialist available that day.

Winter Worries: Road Salts and Private Wells

It’s easy to forget about road salt. For most of the year in Connecticut, we do not see white coatings on asphalt parking lots or salt residue on our cars. However, the salt that we apply to our roads in the winter months persists in the environment, even though we can’t see it. There are stacks of scientific journal articles that document the damaging effects of road salt on aquatic life, plants, and infrastructure. It can also negatively impact us as residents. UConn Extension has worked for many years to raise awareness of this issue by convening statewide workshops and participating in workgroups with agencies in the state such as the Department of Public Health, Department of Energy and Environmental Protection, and the Department of Transportation. Despite the concern and tireless efforts of many people across Connecticut to try to address this issue, no alternative product with less environmental impact has been found.

One ray of hope is the Green Snow Pro program being run by UConn’s Training and Technical Assistance Center. Based on a program from New Hampshire, Green Snow Pro provides hands-on training for municipal public works staff. Participants learn about how salt works and how to calibrate equipment to optimize the right product, in the correct amount, given the weather conditions. Staff have been trained in most of Connecticut’s towns. Benefits include reduced salt applications, which translates to reduced costs for towns, while still maintaining safe conditions.

UConn Extension documented some of the benefits to local waters after UConn facilities received the training. What this means is less salt accumulating in local waters in the towns where this program is implemented, creating better conditions for plants and aquatic life. This also translates to less potential contamination of drinking water sources. These include surface water sources such

Medieval women used informal social networks to share health problems and medical advice – just as we do today

In the medieval period, medical science was still dominated by the ancient writings of Hippocrates from the fifth century and Galen of Pergamon from the second century. Research has shown that women were increasingly being taken seriously as healers and as bearers of wisdom about women’s bodies and health. But despite this, men were preferred while women faced restrictions.

Informal networks developed in response, as a way for women to practise medicine in secret – and pass on their medical wisdom outside the male bastions.

The Distaff Gospels, first published in France around 1480, is a collection of “gospels” around pregnancy, childbirth and health. It was created during secretive meetings of French women who had gathered with their drop spindles and distaffs to spin flax.

These women, who were mostly from the regions of Flanders and Picardy, agreed to meet over the long nights between Christmas and early February to gather the wisdom of their ancestors and pass it on to the women who came after them. The meetings are believed to have been organised by a local villager who selected six older women, each chairing one night, who would recount their advice on a range of topics such as pregnancy, childbirth and marriage.

A scribe was appointed to record the advice, which had previously only been preserved through the oral story tradition of peasant women. What is most fascinating is that although the text is mediated by a male scribe, The Distaff Gospels presents the often-silent voices of the lower working-class women. One such gospel advises:

Young women should never be given hares’ heads to eat, for fear they might think about it later, once they are married, especially while they are pregnant; in that case, for sure, their children would have split lips.

‘Deviant women’

The advice

Mango adapts as climate change makes fashion less seasonal

By Corina Pons

MADRID (Reuters) – Spanish retailer Mango is honing in on adaptable clothing to help customers adjust to wild swings in temperature as climate change makes fashion less seasonal, Chief Executive Toni Ruiz told Reuters.

The clothing industry used to work according to clearly delineated seasons, but global warming means it needs to adapt to periods that can include a mix of hot and cold temperatures and produce pieces that reflect those transitions, Ruiz said.

“Before, when you came back from summer, all the shops were full of winter clothes,” Ruiz said in an interview. “More and more the customer is going to look for what they need at that moment.”

With Spain and other countries in Europe experiencing higher temperatures during some periods of the year as well as more rain in some places, clothing trends are shifting too.

The trend among women for light trench coats is an example of seasonally-transitional clothing, Ruiz said. Mango is also offering clothes for men using “performance” fabrics that are more breathable and that better handle sweat on hot days.

In recent years, family-owned Mango has shifted to sourcing its trend-dependent items from manufacturers in Europe and its functional wardrobe pieces from manufacturers in Asia, Ruiz said.

“We have the ability to work in two parallel worlds, depending on the needs and the nature of the product,” he said. “I believe that is a necessary virtue at the moment in this disruptive world.”

At the end of 2023, Mango sourced from about 3,000 factories in China, Turkey, India, Bangladesh, Spain, Italy and Portugal. Ruiz said about 40% of Mango’s suppliers were located in Europe but that more than 80% of volumes were still manufactured in Asia.

The flexible supply chain has helped Mango navigate recent disruptions to shipments through the

Leveraging AI Applications to Overcome Linguistic Barriers in Healthcare

In the field of healthcare, the effective interpretation of health information, giving medical counseling, and achieving a shared understanding between healthcare providers and diverse populations play a key role in the performance of health programs. Nevertheless, additional challenges exist besides the actual language incompatibilities. Exploration of the complex relationships between language barriers and public health includes their effects on community resilience, healthcare outcomes, and access to care.

The intersection of language and healthcare stands out as a crucial concern, particularly in societies characterized by linguistic differences. Inconsistent health outcomes, misinformation, and poor access to health care are often experienced most severely by non-native speakers and marginalized linguistic groups. However, as artificial intelligence grows, there appear to be positive innovations and inventions that can or may aid in tackling these difficulties. This article explores the revolutionary potential of artificial intelligence in bridging language barriers to improve service delivery in healthcare delivery.

Linguistic Challenges in healthcare

As mentioned above, linguistic differences pose a challenge in healthcare delivery. This phenomenon gives rise to critical issues such as – 

1. Inadequate information – Not knowing the dominant languages may limit access to correct and prompt health information. Consequently, such a situation raises even more challenges during health outbreaks when the immediate diffusion of that information can prevent diseases or manage public health.

2. Health literacy– Approaches to a language may cause misunderstanding of medical terms and advice, leading to accepting health decisions with undesirable consequences.

3. Ineffective communication– Successful dialogue between doctors and patients is the key to a high level of health care. Linguistic conditions occasionally interfere with the inter-patient dialogue, which weakens diagnosis accuracy, treatment adherence, and general patient outcomes.

4. Cultural sensitivity– Language is tied to culture. A lack of cultural understanding can result in ineffective or inappropriate

Physician incivility in the health care workplace

Behaviour categorized as “incivility” includes aggressive or dismissive language and actions or inactions that degrade working relationships1

Prevalence varies and is likely underreported owing to nonstandardized definitions and heterogeneous behaviours.1 More than 75% of health care employees have witnessed uncivil behaviour from physicians,2 and 31% of physicians report receiving weekly or daily rude, dismissive or aggressive communication from other doctors.3 Residents report higher rates of incivility toward trainees who are younger than 30 years, shorter than 5′8″, junior trainees, females or non–native language speakers, or who belong to a nondominant ethnicity.1

Habitual incivility from specific individuals is commonly reported, but situational triggers can increase uncivil behaviour2

High workload, resource limitations, communication challenges, poor team cohesion, unfamiliarity with team members and interdisciplinary interfaces were associated with increased incivility.2 Physicians with consistent disruptive behaviours may have concurrent mental health challenges.4

Incivility by physicians is associated with poor patient outcomes, adverse effects on health care professionals and high organizational costs

Disruptive behaviour diverts attention away from patient care, diminishes team collaboration and is associated with medication errors, patient neglect, surgical complications and death.5 Health care team members experiencing incivility have decreased well-being, increased burnout, higher rates of absenteeism and premature departures.5

Accepting incivility as inevitable in a stressful environment or excusable in “high value” physicians perpetuates the behaviour

Learners exposed to incivility are more likely to exhibit it.1 Successful interventions for disruptive physicians include individual coaching and therapy.4 Structured approaches to improve emotional intelligence, introspection, conflict resolution, leadership and mindfulness have led to positive behaviour changes in the clinical environment.4

Organizational leadership is essential in successfully preventing and addressing incivility

Leadership training, role modelling, wide dissemination of institutional definitions and policies for incivility, improved reporting mechanisms and implementation of a

Province helps fund Innisfail Fire Department’s cardiac monitor

Province releases funds from its Medical First Response (MFR) program and Innisfail Fire Department will finally have its first ever LIFEPAK 15 unit

INNISFAIL – The Government of Alberta has awarded the Innisfail Fire Department almost $25,000 through its Medical First Response (MFR) program.

And with that money Innisfail medical first responders from the local fire department will have for the first time an advanced cardiac monitoring unit.

On Feb. 21,  Adriana LaGrange, provincial minister of health, announced two funding streams totalling $3.8 million for Medical First Response (MFR) agencies throughout the province.

Medical first responders (MFR) provide care to patients or assist EMS crews as needed. The majority of them that have partnered with Alberta Health Services are fire departments, and many of the responders are volunteers.

The new grant money will be distributed through two streams of the MFR Program to participating fire departments in urban, remote and rural municipalities and Indigenous communities.

One of the new funding streams, which will include medium and large-sized agencies, is $1.5 million for essential equipment, such as modern automated external defibrillators, trauma bags, CPR mannequins, instructor development and frontline response training courses.

“The MFR programs always had a grant system but generally the grants were significantly lower. They (province) increased the amount basically for that equipment grant,” said Gary Leith, the town’s fire chief for the Innisfail Fire Department. “In the past we received grants up to around $2,500.”

But this year the Innisfail Fire Department received $19,000 for the purchase of a LIFEPAK 15 monitor, which Leith says will allow his first responders to do advanced cardiac monitoring.

He added the unit also operates as a defibrillator.

“It (monitor) gives us the ability to monitor the patient more efficiently in respect of their oxygen uptake, and certainly post-fire if they

Canadians need to know how much money Big Pharma gives health-care providers, but this information is far too difficult to find

Drug companies often give payments to physicians, other health-care workers and health-care organizations for things like consulting fees, sitting on advisory boards, speaking at sponsored events or funding research, as well as meals and travel expenses. However, in Canada, it’s difficult to know how much was paid to whom.

Prominent on the website of Innovative Medicines Canada (IMC) — the organization that represents the research-based drug companies operating in Canada — is the statement:

“As part of our commitment to high ethical standards and enhancing trust, Innovative Medicines Canada has developed a Voluntary Framework on Disclosure of Payments made to health-care professionals and organizations.”

Based on that commitment, starting in 2016, 10 companies — fewer than one-quarter of IMC’s members — have been reporting how much in total they gave to doctors and organizations.

In order to maintain faith in the integrity of treatments that doctors and other health-care providers and organizations offer their patients, it’s vital that the public knows that the choice of therapy is based on the patient’s best interest and not on the interest of the company that makes the drug.

Lack of transparency

When the disclosures began, the president of IMC said the revelations were only the first step in increased transparency, and that more companies were expected to disclose payments in the coming years. However, since that time, there has not been an increase in the amount of information disclosed nor in the number of companies participating.

A person in a business suit shaking hands with someone in a white coat who is holding a box
Canada’s disclosure guidelines don’t require pharma companies to disclose which doctors and organizations have received payments, or what they have done to earn the money.
(Shutterstock)

In fact, two companies have stopped disclosing information altogether so now only eight companies out of the 48 that belong to IMC make even these minimum disclosures. Another company has

Medical society has not seen N.B.’s primary health-care transformation strategy, says president

The New Brunswick Medical Society has not seen the province’s primary health-care transformation strategy or the 18-month action plan, quietly launched about six months ago, according to the president.

“The NBMS is not aware of any comprehensive provincial strategy related to primary health care,” said Dr. Paula Keating.

The professional association, which represents more than 2,000 practising, future, and retired physicians in the province, was not involved in developing the strategy either — “beyond typical budget submissions and discussions directly related to the negotiation of recent improvements to the Family Medicine New Brunswick program,” she said.

The strategy and action plan, which the Department of Health has committed at least $10.3 million annually toward implementing, have not been made public.

Keating suggested a white paper the Department of Health hired a consultant to prepare has also been kept confidential.

A woman wearing a pink shirt
The medical society was ‘not engaged beyond typical budget submissions,’ said president Dr. Paula Keating. (CBC)

Department spokesperson Sean Hatchard declined a request by CBC News to release the strategy and action plan. The department is still reviewing a request from the legislature’s standing committee on public accounts last month, he said.

Green Party health critic Megan Mitton, who only learned of the strategy and action plan through mention in an annual report submitted to the committee, asked deputy minister Eric Beaulieu during a Feb. 21 appearance whether they could be released.

“I believe we can, but I want to check a few things first,” Beaulieu said at the time, without elaborating.

‘High level’ overview of strategy

The deputy minister did, however, provide committee members with a “high level” overview. He said the strategy includes having interdisciplinary primary care teams consisting of doctors, nurses, and other allied health professionals, working either within the same setting or having formalized agreements with each

Quitting the right way can improve mental health. Here’s when to do it.

Some months back, one of my patients — a man in his 50s — told me: “I’m burned out. I should look for a new job; I’m just there doing what I need to do to get by.”

A few weeks later, he told me he had been laid off. “How do you feel about that?” I asked.

“Surprisingly good,” he said with a sigh. “I should have quit years ago.”

Many of my patients ask me to help them quit — usually it’s something unhealthy such as smoking or gambling. But a few ask me to help them quit a job or relationship or a long-term project — things that many of us value.

Many people think — and you might, too — that quitting reflects laziness, inadequacy or failure. From the time we are children, we are taught that “nobody likes a quitter.”

My work, however, has taught me that quitting, itself, isn’t the problem. And quietly quitting — doing the bare minimum like my patient had been doing — can be a form of avoidance. But knowing how and when to quit is a superpower that can benefit your mental health.

Persevering at all costs can be harmful

Quitting is a normal — and healthy — human behavior. Thirty percent of students who entered college in 2011 changed their major at least once in their first three years, according to a survey by the National Center for Education Statistics. And in 2023, more than 3 million U.S. workers quit their jobs every month.

But while people can quit one thing, they may find it difficult to quit another thing. Also, quitting prematurely can lead to a sense of regret.

Persevering at all costs, though, can inhibit our ability to adapt, grow or explore new opportunities. And sometimes,

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