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tv   Canadas New Doctors  Al Jazeera  September 17, 2018 3:00pm-4:01pm +03

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this is al jazeera. with a check on your world headlines the wind and rain have long gone but in the aftermath of typhoon there is a desperate search going on in the philippines more than fifty are now confirmed dead in the northern parts of the country but right now in the town of gone teams are digging through mud for dozens more people. a landslide swept down on homes at a former bunk house in a mining community after heavy rain on saturday. the rescue site. we were in korea and province for several days that is the place where the typhoon first made landfall we made our week here in then get province on the cordilleras this region actually bore the brunt of this typhoon we are now we need to go in
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villages took us about twelve hours to get here and along the way we saw the devastation the damage on the roads on communities and homes and power and communication lines we saw bodies being brought in from another side of the mountain now i'm just going to step aside and actually show you this is the village where the main rescue operations is actually being focused on all the late saturday that is when the landslide started it started from the top of that mountain the ground then started to fall and can stay down all the way to the bottom of the mountain the foot of the mountain where a village a community of people actually live in that area somewhere there you can see there are volunteers. conducting rescue operations for people operations by hand somewhere there is the bunk house where more than thirteen miners actually tried to take shelter only for them to end up trapped in that bunker house it is very
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difficult to bring a machine a backhoe to actually help that operation because as you can see it is just logistically very difficult there was an attempt to bring into backhoes on the other side of the hill further to backhoes were brought in there but then they both of those factors have been stuck so you can see now that is something that is going to take some time to the operation there is a list of people who have been reported missing that list keep on keeps on growing the bodies of those people who have perished are being brought here they're being processed here and families are there wilting for news from their loved ones according to local officials it is definitely a race against time because the typhoon happened late saturday and now it's been almost two days. i'm getting actually out there but they will do their very best well typhoon manga has now we can but not before making landfall in southern china for costner's are still warning that strong winds and heavy rain
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will last until tuesday at least four people were killed from falling trees and construction materials across the province cleanup efforts are underway the head of the international monetary fund says there will be significant costs to the british economy if the u.k. crashes out of the european union without a deal christine legarde has warned of a lot of negatives from bracks it overcoming differences reaching agreement and closing a deal with the e.u. will be critical to avoid the new deal breaks it which would impose very large cost on the u.k. economy syria will be the main topic of discussion when turkey's president rest of tiber two on meets russia's vladimir putin it will be their second meeting in less than two weeks the two are on opposing sides of the war has warned of a bloodbath and province and says he will not stand by and let that happen
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government forces backed by russia are fighting to retake it from rebels denuclearization is expected to dominate the agenda of tuesday's talks between the leaders of north and south korea when diane will meet kim jong il in income yang for the third time this year tropical depression florence is still lingering over the carolinas the storm may have weakened but the rain continues the city of wilmington in north carolina has been cut off by rising floodwaters officials plan to airlift food and water to the city the storm is being blamed for at least seventeen deaths in north as well as south carolina. those are the latest headlines on al-jazeera we'll have more news for you right after the people's health that's up next.
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seven billion people live on planet air. and every year and six point five trillion dollars is spent keeping them healthy in. the pursuit of good affordable health care challenges governments worldwide and. we go to six very different countries to see the constant battle to successfully deliver the people's health. each year over half a million medical students graduates around the world when you tell your parents you can get doctor this is why all of the training of young doctors is vital to us all what do you tell a mother one there's a very strong possibility that she could be burying her child within the next year for twelve months we follow young trainee doctors from one of the most pioneering
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medical schools in the world to the most exhausting thing i've ever done i think a skill which poses fundamental questions about what makes a good doctor you have to be ok with the fact that you're not going to learn it all and prepares them to make difficult decisions. he has died his brain is gone. because their decisions make the difference between life and death and how to trust to this couple just self life and. just north of my i got a phone on the bank of lake ontario in canada is the my coochie to group school of medicine at mcmaster university. for decades as forged new approaches to the training of doctors. dr simon arch kosky is a graduate. he is now in charge of the intensive care unit at hamilton
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general hospital she's doing so well actually this is doing great. we're going to get you up and moving around a bit ok we'll be careful with that leg after the surgery ok but it's good for you to get out and serving. care taker come back come back you know. nine years ago he saw his first patient as a young medical student. who was absolutely terrified you're going to walk in the room with her as can be like you're not a real physician you don't belong here you're not good enough and i distinctly remember seeing the patient talking the patient come into the room and then realize . and that was probably the truth i didn't know anything and you look at anyone at the end of their med school residency training you look at them after and you look at them before they're different people they're fundamentally different. no simon is responsible for the most vulnerable patients in the hospital. the things that go into making a good doctor you have to know your stuff you have to work hard you have to recognise you're never going to be done learning you have to be able to put the
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needs of others above yourself the last thing you need you have to have empathy. simon's transformation started at mcmaster medical school. when it opened back in one thousand nine hundred sixty five it pioneered a radical teaching philosophy which is now used widely of around the world. five thousand applied to canada's most popular medical school but only two hundred ten. this is day one for the two thousand and fifteen and take good morning. your first priority will be to learn to be great physicians your work in small groups and teams exactly the way that most of medicine is practiced. four thousand nine hundred twenty doctors have trained at mcmaster over the last forty years feeding canada state funded health care system these students all got here through
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a unique selection process called the multiple mini interview. the applicants a challenge with a series of rote place and i realize when you do your first one or two stations it's still kind of a train after your very nervous your hands are shaking you don't know what to do with your water bottle there are various you pay for and i like a lot more than traditional interview because it's fun it's fast pace it challenges you in a similar way that medical school challenge you it's quite stressful it's very high energy fast paced these scenarios test for more than just academic ability to look for empathy communication skills and moral reasoning. qualities the master's program believes will make great doctors it was two hours and we had to do twelve different stations where we go through different scenarios questions always throw at you that you've never heard of before and you just stuff to think on your feet you're getting multiple assessments or multiple. and i think that is
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a better measure of how how you would be in different situations. since the introduction of the selection process at mcmaster in two thousand and four nearly every other medical school in canada has adopted it. applicants must have an undergraduate degree but it does not need to be scientific in just three years these students will be transformed into new doctors. recognized as being from one of the most innovative made equal schools in the world. it's all begins with the pioneering approach to teaching mcmaster has virtually abolished lectures. and has introduced problem based clarinet in. jennifer key somewhere has been a mcmaster medical student for just over a year. in the sales directory glaring means she and six other students in her
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group are presented with weekly case studies to resolve under supervision. this is our problem based tutorial were given cases by the instructors we read over the cases and from there we develop learning objectives for our group that's where the bulk of our scientific learning comes physiology are pharmacology subjects that traditional medical schools would take in a class form genetics embryology all of those things come out of these cases so that we're trying to apply it to real life situations teens face having. to rebuild babies' brassard expect parents to start abnormalities of both feet and create offer sound and it's not what it's worth while playing soccer it's not going commonly any kind of an atomic bomb things that come up on the twenty we call to sound create a lot of anxiety as you can imagine in the supervisor is to guide the students so they can find the best solution themselves for this area we refer to prenatal
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genetic counselors and the phenomenal so give them all the statistics on their rates and how often it seemed in conjunction with whatever else and whatever else that is it's a great resource and open to obviously everybody and there's one in every area. by making students find their own solutions mcmasters police it trains them to cope with future changes in medical knowledge. they keep talking about the circular curriculum so things will come back and come back and come back it's a matter of teaching us where. to go for information so if they'd if we learned traditionally went out to our clerkship and looked back in our old notes and then graduated and had to sort of keep up on all the knowledge we're starting fresh what are our resources where do we go where do we check where is now you know we're sort of discovering that together and while we can sit around the table and say i found this one this was a really good resorts and we can get to know all of those resources while we're still here this kind of problem based learning is now used increasingly around the
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world. for the next stage students are taken to the center for simulated learning where they are taught to treat the patient not just the disease i'm jennifer while and i'm one of the patient partners i am going to be master a long time so i always enjoy coming back here with my three students jennifer suffers from arthritis and is one of many volunteers to help students like r.t. rana prepare for the reality of patient care no area of your life is feared when you have or you have a high surf relief for three zero. one hundred. seven start with inspection and i'm kind of looking just at. the contours of the rest and i'm making sure there's not a squaring on any side. really really helpful to be able to practice with someone who maybe has a limited range of motion or something else that we would hope to find on
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a clinical exam and unlike more traditional medical schools on the mcmaster program students meet real patients from the very beginning. these real life clinical settings intensifies their training progress is testing their medical knowledge and ability to relate to the patient. the students are also learning what sort of doctor they want to be doing their last fifteen months of training the undertake ten six week placements in different medical specialties. perry is currently in psychiatry today and i am going to be out there's a clinic with child psychiatry at the little men's club. will be soon patients all day until about five o'clock so i mr morris been approaching medicine from a top down perspective where their understanding of anatomy and physiology of the basic sciences guides or clinical encounters in psychiatry the enigma is that we
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don't know many of the physiology is about as we don't know the basics. we don't know why our drugs work we doesn't know that they work so it's been a lot more difficult for me just because i find that there's a lot more just memorizing that i have to do without actually. coming out of from like a logical puzzle in the no way. that's been challenging. dr lipman is perry supervisor but it's twelve year old noah who's about to teach perry what it's really like to have a mood disorder i mean i have two sides you have to factor in me really nice are not being nice i just don't like feeling that i have a disability tough on it makes life harder perry with two years training has to find the skills to help the young boy. to get in trouble in school today yeah. yeah you know everybody just so annoying.
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i don't listen to anyone. other than just. my last few days is having to go on is a will that is. you know his minders honest i'm going to sleep ten hours now this is only like five minutes when i was. yeah. maybe. oh thank you no that's very sweet of you i like you too i was offering to you i'll try my best like many students before him perry's preconceptions are stripped away. ok i'm like oh my god i'm going to going to talk to actually every child in a couple of broken home that i'll be miserable or that he like abuse is going to be those terrible terrible. was not the case alone that although there is a lot of family children from different families with difficulties oftentimes the
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parents are really there to help their child as much as possible by body parries used to more immediate results. so sake a tree presents a challenge. much help comes in with depression i can't just give them an antibiotic one antidepressant and expect them to get better within twenty four to forty eight hours and never to have to present again and to just be ok. it's not that i can cure their depression that's not my goal my goal is to make them feel better whatever that is my goal to improve their quality of life and then for one child that means they're able to get up in the morning and go or go to school where before they went to bed all day that is a huge success in my mind. perry is a first generation immigrants from china arrived in canada each ten his parents have clear expectations of his medical career just the other day actually i was
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talking to my parents about what special session going to and my dad hates family doctors. he's. actually be no doubt big family doctors are only stupid. specialist and. an archaeologist are so hard on. perry is a good handle because he said you know it's there and it's. become the surgeon. before i think he said harvard. medical school has been a huge investment for perry and his family. this year twenty six thousand two hundred ninety three dollars and thirty three cents for one year of tuition dollars so yeah that's about some that could be someone's yearly
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income there goes one is six thousand dollars. with the year to go perry doesn't have to decide just yet. the clinical placements test a whole range of skills medical knowledge decision making and people skills all in real environments. she found out about a second year student is on her first day on a pediatric intensive care unit petes i.c.u. none of us know what it means to be a med student we've devoted so much of our lives to this grand idea of getting in. that we never really think about what that means so i'm starting with peace i see you i anticipate that the things i like about i see you will still be there i'll be it in children now i'm a little bit anxious on how i'm going to deal with a very worried and emotionally fragile adult. hold on to share the same
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location or surgical service make sure they see the spine film person who would first see one scene to destruction. she bodies been strewn in at the deep end and asked to help in the kia over to you to show you how the women she's a girl who's fallen out of a second floor window. and hit her head i'm responsible for making sure that the imaging that's when are posted of her gets done making sure that her parents are updated with what's been happening. making sure that we update her file on our chart so that it's reflective of the progress that she's made while she's been here environment's not know it's just a little bit of trepidation when you haven't met any of the patients and you know like ok help solve problems in the middle of their care and they're like i know nothing of both. i just wanted to check in with eve so i wasn't sure how much she had been told so far were noticed a bit of
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a deviation with one of her neck bones so i want to be completely sure that there's nothing else going on so that's why they're going for the m.r.i. making sure that everything's as it should be if any questions come up at any point in time in here all day grab me and grab any of the other people as you know and i'm here for a while so if you see my face and you have something you want to know i'm always be able to answer i was right thank you gotten three patients seen all of my notes now and stuff to do right occasions so it's a fairly successful first day. don't you karyn june issue funny soon. reviser. created a city. that it's her job to check whether she has medical knowledge is up to scratch a classic or medical student question asked what's the difference kids up to the job after a girl please are going to have
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a hard facts and distinction on the border whereas your subdural ones are marked as actually appear almost. a donor through up and honestly when you get a question wrong at someone that you. literally like there's a blinding apparent because if you really get to know him there's like this love in my gosh really. i'm so sorry i'm so sorry for my stupidity. and you submission to the pediatric intensive care unit is a very sick child. his future lies precariously between life and death. facing this level of responsibility is the true purpose behind these clinical placements. and the ensure that students lay in lessons that can't be found in books we're going to have a multidisciplinary team meeting because this patient has multiple complications
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and the very poor prognosis and there's certain decisions that need to be made in his best interest so where ever best interest is being considered it's important to have a team approach so that is not unilateral decision making i think the point involved in this discussion because the communication aspect of it is difficult to teach it's vital that students like shivani attend these meetings this is where she sees just how moral and medical decisions come together to treat or not to treat to meet seeing him at this stage and seeing him in clinic you know on a month and a half or two months ago he has had. a very big deterioration you can't see because follow you can't smile is not necessarily an awareness and vironment should've seen a clinical improvement right now and i'm afraid we're added to a level where are we going to get back i. think it should be highlighted he's
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exhibiting minimal interaction despite recurrent surgeries with. with the intent to improve optimize this function he's actually minimally interactive if the prognosis is correct and this is the best cerebral function he can ever regain and a surgical decompression of brain some would not necessary improve his cortical function then improvement of the brain stem function does not necessarily improve his quality of life you may actually be prolonging is inevitable death. and so first said in a meeting like this cruel of us to even problem those discussions with that are necessary and make these conversations so hard there is no good news to be shared you know bad things are about to happen we have all of course never finished cross that it won't and that things will turn out brilliantly but what do you tell a mother there's a very strong possibility that she could be. the next year. in
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this moment that i not the one who's i mean to make this decision. the doctors decided not to appreciate and shivani takes the phonology of the decision to heart . i feel the birth of the story from a doctor that i possibly can i feel incredibly like a student and like a learner in less than a year i'm going to hold the degree that i'm directly tied to anything and everything that happened this is the patients under my purview and it's a heart flutter and makes me catch my breath sometimes people can. that there are. not very. commitments to course tries to prepare its students for the complex realities facing doctors. something that graduates dr simon. deals with every day. sometimes you have to move from one environment that's very
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emotional and you have to communicate a lot of empathy you have to go directly from that to a resuscitation or you have to go to another family and maybe that news is good news and all of a sudden you're going from a very tragic situation to one that's all a bit happier and more pleasant and you have to be able to make that transition and sometimes i mean to do that within ten minutes i think it's a skill you have to learn how to do it your own needs in your own emotions a little bit on the back burner temporarily while you deal with the issues in front of you. so mcmaster at the medical school were introduced to the clinical environment very early start with family medicine irritations the book learning and the real life learning are sort of taught at the same time with time to get more comfortable with the decision making to get workers to go with the response. in their responsibility. the ultimate goal of a medical school is to turn people into doctors able to make life and death
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decisions twenty five year old gentlemen. procedures for the city to put into. this role. we're not totally sure what the underlying causes so we've done a number on my old you get some food to make sure it's not effective make sure it's not an. easy. first time and these traumatic situations are part of everyday life as a doctor but for grain richter the patients mother it's never acking they incubated them from grimsby to hamilton and so he was pretty much in a coma. by the time he got here. and that's been used to play about it for the last four days. after talking to a doctor or even looking at a dog need to look in their eyes and see type of person they are and whether they
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really care. you know of that haven't met that man the spot i've known him for a week and i have to trust him he's kept his something slightly in the sense ready so if i do. the past past. travels the roads of mexico raising the ecological the wind. and sharing creative solution of the country's most remote. demonstrated courses of idea in the struggle for a better speech to the. past passed by a. couple of the viewfinder latin america seen on al-jazeera.
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discover the stories you didn't know about. be a witness to life changing scenes. notice the changes that affect all of us. experience our worlds and be a part of it last. a focus al-jazeera balkans international documentary film festival saturday will from twenty first to twenty fifth september. a climb to style and world of illegal trade what you have here is not just archaeological objects you're talking about a political dimension where the spoils of war are smuggled and sold to auction houses and private collectors and bearings are selling an artifact is worth finances to be headaches and muslims in the middle east don't sound don't tax one
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quick solution trafficking on al-jazeera. this is al jazeera i'm dead with a check on your world headlines the wind and rain have long gone but in the aftermath of typhoon manga there is a desperate search going on in the philippines more than fifty are confirmed dead in northern parts of the country but right now in the town of it's a gone teams are digging through mud for dozens more people thought to be breed a landslide swept down on homes in a former bunker house in a mining community after heavy rain on saturday the head of the international monetary fund says there will be significant costs to the british economy of the u.k. crashes out of the european union without a deal christine legarde has warned off a lot of negatives from. overcoming differences
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reaching agreement and closing a deal with the e.u. will be critical to avoid the new deal breaks it which would impose very large cost on the u.k. economy the leaders of russia and turkey are holding talks in the russian city of sochi over what to do about it in syria it's the second time rest of tell you. putin have met in less than two weeks has warned off a bloodbath and it led province which has been coming under recent attack by the government putin says the pair have a lot of complicated matters to review and solve. denuclearization is expected to dominate the agenda of tuesday's talks between the leaders of north and south korea and will meet kim jong un in pyongyang for the third time this year in ethiopia at least twenty three people have been killed in violence targeting minority groups in the ethnic heartland that's there the capital addis ababa the unrest follow
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a mass rally last week to mark the return of leaders in the form of the exiled or roma liberation front group the o.l.f. was kicked out of the country by the previous government for demanding more autonomy. tropical depression florence is still lingering over the carolinas the storm may have weakened but the rain does continue the city of wilmington in north carolina has been cut off by rising floodwaters officials plan to airlift food and water to the city the storm is being blamed for at least seventeen deaths in north and south carolina. those are the headlines on al jazeera it's back to the people's health next then it's the news hour at the top of the hour i'll see you then bye bye.
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the michael gita groot school of medicine at mcmaster university in ontario canada has a pioneering three year medical program. it focuses not just on strong clinical knowledge but teamwork moral thinking and putting the patient first. the test of any medical skill is how well they prepare their students for the complex challenges of their country's health care system. the rico the mit shivani and nevis medical student in the pediatric i.c.u. . no she's a qualified doctor putting all that she's learned into practice. when i compare what i knew the first day in medical school versus what i knew last in medical school versus what i know now i and myself know that those are
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exponentially different places that you know in a very short period of time i can amass huge amounts of knowledge and be able to make clinically relevant decisions based on that knowledge and that comes with time . even as a qualified doctor shivani has to continue her studies she has chosen internal medicine as her specialty which requires a compulsory postgraduate residency for a minimum of four years. the one thing but for me and a lot of people who graduate from mark is that i'm always going to have things i don't know and being ok with that and being ok with i guess the practice of researching and learning and constantly being on a track where you're educating yourself to keep yourself up to date that's something that everyone struggles with. this process of continuous study is never a major element of the. eighteen system responding to the need for doctors to keep
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up with the extraordinary speed with which care and treatments are changing. the way. to do you shivani is participating in a more code blue to suit your version of your patients unstable you want to lean towards or there's a rule plea of a cardiac arrest on a ward so that's why we had marco it's a means to really help you be able to manage critically ill patients when you don't have all the resources available the senior dr gates the scenario that's really what this court you know you're going in the same room ok when you get this call on the person for i'm just calling about mr ass he's a forty year old german air of you know he was actually made earlier today with a little bit of a commute are pneumonias been doing quite well i'm just hoping i can give him some cough syrup why does he really want cops or that there's just been a cop for the cop and so much like his family can be leaving here and i mean i don't personally i do is my belief you know from urge because you know or very few would really give me
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a good read let's go see his racing because that right now to michael it's very very helpful because it forces you to make those quick decisions and to really think on your feet serve him shot him or other incidents here a little bit concerned you can't tell me what's going on i'm having pain in your chest if you're a little tight whereabouts and that also are else you know we're in the middle it's really just physics and the city and as it radiating anywhere else. these small cool it's a here to train young doctors to make the right decision in real life and death situations including knowing when to call for more experience called leaks like t.v. i have a very old joran who came in with what this was wired money that he has been complaining of chest pain he's talking kartik at one thirty respirators forty on rebreather setting ninety percent i believe with a more senior doctor present and the medical protocol fulfilled. she valley gives the patient a shock absorption saturation
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a certain proof you know these intubated these are history we can get a little bit agitated all right very good. when we met perry give her a year ago he was undecided about his future specialty. now against his father's dream of having a surgeon in the family perry has chosen family medicine to my mom supported me very much she's there like you know what perry valley medicine is a great life you can work and just be happy. my father was very opposed to me. and the reason i think for that is mostly because he wanted me to be a specialist but the very traditional way of thinking i think of specialists are better than general as special as or better the valley doctors in family practice perry can air in about one hundred ninety thousand u.s. dollars a year this is less than half of what he could earn as
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a specialist i used to say our money doesn't matter i'm going into medicine as i love it which is still true i do love medicine even the lowest earning doctor is still a doctor you know and they're still making way very confortable wait twenty years ago the government started initiatives to promote family medicine including increasing the amount they could air in it has worked and perry's joining the most popular specialism amongst graduates. but this is not the end of the learning process for a doctor here the neonatal resuscitation program trained doctors nurses in assisting newborns that need a little bit of help in canada one of the core competencies for a family doctor is that we are able to double reviews. and we're going to part. this be we can do everything to we can be we can.
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and we can do pretty much everything y'all have to rotate and do forty five seconds one and two three one two three one and two three great and relations and three while too. such sessions not only reinforce best medical practice but remind the new doctors cure for the need to be in a society where patients have the right to question their treatment and have the power to. this is the highest risk of population if something goes wrong they have eighteen years. we have to keep our generically children are eighteen years until the research of adults i think it's. a modern dr must keep accurate well written records of their patients consultations. the fear is that in a critical case who recordkeeping can turn a peer
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a decision into a possible career ending nightmare so that's why you need to say get the baby to the resuscitation table now because it could be. very detrimental. right from the start the importance of keeping medical records is drummed into the students. and as so often at mcmaster it is the newly qualified doctors like shivani who are brought in to hammer the message home as a medical student that is the only thing that will ever be expected of you is to get as well and nurture the history from your patient and be able to relate intelligently to your supervisor your seeing your whoever it is that you're you know talking to the patient both history is our where every thing important comes from technically legal binding documents a little bit so that the note that you write in a patient's chart can be taken to court and can. be asked to be broken down so be
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very careful about the words it use be confident in the ones that use obviously you're coming from a place of skill when you write these things down but all that you have to be able to stand by. everything they say really the fear of god is put into us when it comes to like don't screw up or they're going to take your license away from you and everyone has a story of someone who's had their life this is that it or has had to go to the college because they've done not the right thing. mcmaster students are made fully aware of the disciplinary process through the provincial college of physicians and surgeons. the college oversees the practice of just over thirteen thousand five thousand physicians in ontario. and twenty fourteen there were two thousand six hundred sixty investigations and twenty seven disciplinary hearings. if for whatever reason there was the threat as me losing my license of being
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a physician like what i do with myself in the back of oliver head there is a very real threat that you know if something goes wrong everything i worked my entire life for goes away. seventy two year old margaret montfort has been admitted to the intensive care unit her husband caro believes that her life was saved by an anonymous phone call it was just one o'clock in the morning and he's received a phone call to both of us up i went to the answer phone and there was no one there . he thinks there is a good thing because it will disclose her to sleep and margaret says she needed to get out and she says she was frightened. and i'm sure there's a feeling she was truly a very needy really decided it was going to call nine hundred. fifty k.
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summary so blood clot in along as her heart stopped she got c.p.r. for that they gave her blood thinners and then unfortunately because of her broken ribs from the c.p.r. ended up bleeding requiring want to transfusions she took a very difficult to stop. was critically ill almost died simonides kosky the mcmasters graduate is in charge of the unit. no amount of training can fairly prepare him for the volume of work and the stress involved now and a little bit tired because yesterday was very busy and to stay in overnight i've now been here for thirty hours in syria but now i'm going to be here again for the rest of the afternoon before i get to go home on a busy day it can be very stressful and we're often worried that you're going to make a mistake you're going to forget something that has to be done she's doing great or big things with her really trying to get her strength out. trying to get as many
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lines into third as we can yeah. you would have caught it went into your. distress on your heart cause your heart just stopped you doing really well trust me the way you were you would. think you're going to make it. yours cross so we work together as a team lose all the bedside nurses you spray treat there because social work physiotherapist all of our pharmacy staff is a huge group of people here there is a level of responsibility i have but it's not a burden that you bear alone it has to be in the responsibility integrated where i think we're providing better care. markets and has been the karo are a testament to the training of doctors like simon. canada boasts a life expectancy of eighty one the fourth highest in the world. but it's not
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a pear shaped system the long waiting times prohibitive pharmaceutical costs and a relatively low number of doctors compared to other developed countries still causes problems. to help sort out some of these problems the medical authorities encourage doctors to get involved in designing change. it is a process that begins june in training. a second year student jennifer keitt summer is presenting her ideas on how to avoid crisis for tammy and the patients to her fellow students so i'm starting this presentation with a picture of charlie rose because she has come to symbolize for me a system gone wrong that failed someone a crisis that could have been averted so charlie rose as an eight year old cats that was owned by a woman that i met during my palliative care elective she was a woman who had absolutely no social support system no family to speak of and no
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one that she wanted notified of her death no neighbors whose name she knew no friends lived alone an apartment with a cat she truly had no one what i'd like to advocate for today is that as physicians we need to help people with end of life planning and there's a real role for physicians in this capacity to avoid crisis like like we've seen with charlie rose's mum. oh the system might need to improve meant the students are taught to always put patients first when you're taking care of a patient you know your first responsibility is towards that that patient they are taking care of not to words the health care system as a whole that's very clear at least in canada from a legal point of view you can't deny someone treatment simply because you think it's too expensive and not worth it the focus on the patient is vital because new system can provide everything all of the time. are you doing.
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good. often put into positions of limited resource and in those moments of scarcity sometimes i do have to make decisions so for instance if there's only one bed available and two sick patients upstairs i'm taking care of which patient gets that bad first and who has to wait until a second bed is available we try to minimize the resources that we waste but while at the same time trying to provide care but those costs never really interesting to. calculus of what care should we provide overall. canada the eleventh richest country in the world can afford to spend five thousand seven hundred eighteen dollars per person on health care the global average is
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barely one fifth of that. mcmaster encourages its students to go abroad and to put their knowledge to the taste and different environments. at the end difference taken dear she finally went to india for two months so i went to india and i spent seven weeks doing rural medicine and like the north east every part of that system is so different from mine i saw a doctor see fifty sixty patients and then. we had a child coming through the door who had renal failure a very very sick arrested and never actively seen someone in the process of dying before. families panicking in the background and crying we got him stable enough to be transported and the nearest hospital is like an hour away and i just remember in that moment knowing as the ambulance robot that i had just seen someone being sent
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to their death. this fifteen or fourteen year old child was going to die because the resources didn't exist to help him. and i remember going back to my room. i. i don't want that to be the type of medicine i don't force the path if only i know that these people would help but it wouldn't break me in the long term to be in a place where not every person came through my doors or someone that i could help. shivani learned the limitations of her training and also some fundamental truths i think our curriculum as designed for the setting that what end but a lot of what we learn is transferable to other places i don't think it takes
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resources or money or any kind of privilege to be able to teach someone how to speak to another person with empathy and kindness i think there's no place in the world that that would be a detriment where like shivani simon also went abroad junior his time at mcmaster. been in uganda worked there for a number of months and it's a very different kind of environment where physicians are very independent there isn't a lot of shared care and responsibility that we have here where one person is responsible for everything and there is a shared responsibility you're more likely to lead to errors you're less likely to provide coordinated care more likely to be wasteful but the basic skills and approach remain so valuable. is just so busy and so hectic there is also very little time to communicate so you had to really learn how to communicate effectively in a very short time period we didn't have the luxury of having quite as much time as
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we do here to spend talking to people physicians i was working with there did appreciate the communication skills. several of them had trained in canada as well that certain points and you could see how the training affected the way they practice of. being a good communicator is at the heart of mcmasters teaching. a doctor must be able to both relate to the patient and cure the disease. learning to be a doctor is primarily about learning to save lives and keep people healthy. but death is an ever present part of the work. you do said his forty nine he has suffered a traumatic brain injury although his heart is still beating his brain function stopped just over twenty four hours ago. the doctors have done all they can his family has been called in to witness the final tests before simon can declare him
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dead. if your brain is damaged in stops functioning all together then the body can't survive very long without support so when we do declare someone brain dead they're legally dead just as if their heart had stopped because every element that made that person they are their entire brain their brain stem everything is gone and the family often want to be present for these because it's at the time they need done all the testing declared and that is the believe the moment of death. it is a moment that puts to the test everything simon has learned since he joins mcmaster nine years ago. reasoning legal question during teamwork and above all his ability to relate to richard's family which is my second cousin. i'm fifteen and he was going to be fifty in march come and.
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sit down i love you so it was. solid. this year and a very disheartening. life but it did set him. in medical school we did a lot of our communication training things like how to break bad news when you've got a situation like this that so devastated and i think it's one of the most important things we can do is care providers is to make sure that people are getting the support they need when going through that you know traumatic injury or death. so we do a few things here so we're going to start at the top and work or way down so we're going to start with the. people's is very strict regulations around the process of declaring brain dead people's or unresponsive so we don't see
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a reaction to light the way we normally would. the corneal reflex of most of us if you touch the eyes they blink and that's a reflex you can't control that because we are. declaring someone dead everything has to be exactly perfect so it's very strictly. in ontario is supposed to tell us. to go seventy questions so far with everything make sense what we're doing. we do we look for any and he sign we can. have brain activity. so we just looking for any breathing. that her side has provided us with step by step procedures that he was going to perform on my cousin richard. he has shown us compassion if that's the direction and information we couldn't have a better position. so we would say it's time of death is seventeen
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time so five ten pm the time of the last gasp that was drawn their. eyes want to spend a bit of time hold his hand. at this point we would say that he has died his brain is gone his body is still here with us. you can never really predict the way your emotions are going to work some today when we pronounced patient i saw the mother start crying over her dead son
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it really hit home i actually became a little bit teary myself. taking care of people taking care of people's health taking care of the health of people's families it's a privilege people put a lot of trust and faith in you and you're providing them with health care i think it's important to reciprocate that trust and be worthy of that trust and provide the best care you possibly can. training doctors who can inspire such trust isn't easy it requires human skills. but it lies at the heart of what it means to be a truly good doctor. wherever you are in the world. from city hospitals to community health and change is happening across china. and for one six year old boy there is now home. the bomb just zone is from the
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countryside he came to a big hospital and experienced death since perform the operation for him. how to care for one point four billion people china is unique challenge on the people's health on al-jazeera. from the waves of the south. to the contours of the east. hello get a welcome back here in a national weather forecast for here across southern parts of america we're seeing a lot of rain and a lot of clouds incorporating a lot of countries here across as want to videos on c.n.n.
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as well as into rio de janeiro we are seeing a mixture of those clouds and rain that is really going to continue not only for today but maybe get a little bit better as we go towards tomorrow the rain is going to continue here for rio some of the showers thunderstorms could be quite intense at times associate with a cold front that is out here in the atlantic for one is out and so a little bit of a break for you at twenty one degrees but we do see some more rain down here towards the south well across the caribbean we were talking about isaac earlier this weekend and now we're going to be watching potentially for redeveloping here right now it is located over jamaica the remnants of the storm but the national hurricane center says it could have a twenty percent chance of redeveloping either way we're going to be seeing a lot of rain here across eastern portions of cuba there s. a day today and then as we go towards tomorrow have any you're going to be seeing the brain as well and across united states we're still why. watching a lot of rain falling out of trouble depression florence into the carolinas that is going to continue for today but as we go towards tomorrow things are going to get a little bit better rain continues up here towards washington at about twenty six
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degrees in new york right about twenty five degrees for you in your forecast. the weather sponsored by cattle and movies. getting to the heart of the matter the three big challenges facing human crime in the twenty first century they are nuclear war climate change and technological disruption facing realities whatever it is they have to fear is not in me it is in the people of uganda hear their story on talk to al-jazeera. al-jazeera. with every viewer.
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this is al-jazeera. you're watching the news hour live from the headquarters in doha i'm coming up in the next sixty minutes in search of agreement on how to deal with syria of lattimer putin says there are complicated matters to discuss with his turkish counterpart digging by hand through a philippines hillside dozens feared curried in the aftermath of typhoon manga it's a lot of negatives from bricks at the international monetary fund warns of major problems for the u.k. economy if there is no deal with europe. and who was behind the killing of a prominent.

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