Author Archives: John Sloan

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 40 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.

Pandemic

NB: this note was posted and updated March 20-26 2020. Big changes will no doubt occur to make much of what I’m saying simply wrong in the near future. Sounds like the title of ER doctor Dan Kalla’s thriller published … Continue reading

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Careful What You Wish For (or, Creating a Monster)

About four years ago I had a meeting with a dear and trusted colleague and a bunch of Vancouver Coastal Health administrators. The chief executive officer and her group said “We have a culture of admission here”. Too many elderly … Continue reading

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I’ve moved

For over 10 years my wife and I have lived in two places. We’ve travelled back and forth each week between our home in Roberts Creek on BC’s Sunshine Coast and an apartment in Vancouver, where I’ve conducted my part-time practice looking after homebound frail old people … Continue reading

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FMF Award Acceptance Speech

A couple of very good friends in Vancouver somehow convinced the Canadian College of Family Physicians and Canadian Geriatrics Society to give me an award for innovation in geriatrics. I don’t deserve it. Here is my acceptance speech at the … Continue reading

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A Very Interesting Medical Book

I post this here having already put it in my “Reviews” website because I think it’s well worth reading and I take a slightly different message than most reviewers from it. Kalanithi, Paul. When Breath Becomes Air. Random House, New … Continue reading

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Healthcare Mismanagement

April 2017 I’ve been working in Canadian primary health care now for almost 40 years, and it seems to me that while in many ways we’re making progress, in others we keep making the same mistakes. At the moment our … Continue reading

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A Fool and His Money

I work with a multidisciplinary emergency room team that tries to stop unnecessary hospital admission of frail old people. Again and again at the busy Vancouver General emerg family doctors who go on holiday without replacement, won’t make house calls, or … Continue reading

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Policy and People

I ran across a recent review in the New Yorker by Canadian journalist Malcolm Gladwell, commenting on The Death of Cancer, a book by Dr. Vincent DeVita. Dr. DeVita is a leading cancer specialist in the United States who has … Continue reading

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Type-Casting

A few weeks ago our team, normally focusing in the emergency room on avoiding unnecessary hospital admission in over-70s, was asked to see a 45-year-old lady who had come to the ER for the second time in four days. The … Continue reading

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WHEN NOTHING WORKS

Working in a big emergency room as part of a team that tries to intercept unnecessary hospital admissions of frail elderly people, I seem to find there are fewer elderly people who call an ambulance themselves and are brought to … Continue reading

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Final Adventure of the Geriatric Doctor-In-Law (6)

You can follow the string of my “Geriatric Doctor-In-Law” stories by searching through the posts here. Basically my wife Robin’s mum Liz and dad Nigel became quite frail over the last several years, at roughly the same time, with all … Continue reading

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Dr. Sloan on local radio, again.

CKNW radio reporter Jessica Gares interviewed me a few months ago. You can hear the content here.

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Lost Sheep

Well it’s Christmas. And I the sorry lapsed and sentimental secular Christian can’t resist childhood-retrospective feelings. But although I know the suicide rate probably doesn’t really increase much at Christmas, still from my adolescence I am no stranger to Christmas … Continue reading

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Bringing Family Practice Training Up to Date

I’m very lucky to be part of several groups of committed and capable family physicians doing care of the frail elderly. One of these is our (University of British Columbia) Family Practice community geriatrics program, led by my colleague and … Continue reading

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Airline-Industry Healthcare

Such outrage about awful healthcare! Too many mistakes, too many adverse drug reactions, hospitals making people sick, accidents in the operating room, arrogant doctors, costs going through the roof. What’s the matter? Everyone wants answers. Why, when competitive business and … Continue reading

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Another Jailbreak!

GM “Gord” is 87. He is a proud and accomplished man who was born in the 1920s in small-town Saskatchewan with birth injury to his arms and legs. As a child he could walk and move his arms but wasn’t … Continue reading

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Housecalls 10: It’s Never Too Late for a Hospital Jailbreak

Mrs. N. will be 107 at the end of the year. She has lived for over 60 years in the same rented apartment, initially with her husband but for the past several decades on her own. She is an absolutely … Continue reading

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Robert Munsch and Putting Sentimentality to Work

Munsch was popular when my kids were young and I read them his books. It’s just been announced that the original illustrations from Love You Forever are about to go on sale, and I’m reminded of my inescapable emotional response … Continue reading

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HOUSECALLS 9: An End-Run Around the Rules.

Are there times when rules should be broken, or just ignored? This can be hard to decide, rules being rules and presumably set for everybody and for good reason. But one of rules’ limitations is that there may be exceptions. … Continue reading

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SECOND op-ed on diet hits the (Toronto) big time.

The online Globe and Mail picked up my short article on salt. Andre Picard kindly tweeted it which resulted in a near-record number of hits here on Sunshiners. As I said before I have mixed feelings about notoriety on this … Continue reading

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Op-ed on diet hits the local media

I was surprised at having my op-ed article on dietary sugar “Sweet Nothing” promptly picked up by the Vancouver Sun. I’m sure it will generate a fair bit of controversy recognizing as I do that anti-sugar ideology is everywhere.  Feel free to … Continue reading

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House Calls 8: More on Home Support

Bearing in mind the story of Mrs. Forsyth which seems to keep repeating itself, I have been meeting for about a year now with the generous and hard-working administrative people at Vancouver Coastal Health (VCH), our local health authority. In the … Continue reading

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House Calls 7: Supporting Home Support

Here’s a fictitious story of a problem with home support. Mrs. Forsyth age 92, mildly memory-impaired, under treatment for heart failure and dependent for mobility on a walker because of arthritis, was in the hospital three months ago because of … Continue reading

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DIET: A New Direction

Somebody said we change jobs every five years whether we know it or not. You may be a high school math teacher for four decades but in reality you do eight fundamentally different things during that time: teach trigonometry, coach … Continue reading

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Putting Out Fires

I’ve worked in a few provincial and federal government healthcare agencies: a pharmacy plan and veterans’ services for example. I understand how difficult it must be to allocate public funds in a rational useful way, keep constituents satisfied and higher-ups … Continue reading

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“JAILBREAK” post picked up

Writers and administrators at the US health policy organization Altarum Institute kindly took notice of my recent post on getting an elderly patient out of the hospital. It’s live on their website. I’m grateful for the added visibility and look forward to … Continue reading

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Housecalls 6: JAILBREAK!

Gertrude (not her real name of course) is a just-about-90-year-old lady with red hair living alone in a small one-bedroom apartment overlooking the beach. The place is… not cluttered exactly, but packed with mementos: photographs and paintings on the walls, … Continue reading

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FP RES

Welcome, Family Practice residents. This post provides access to materials for our upcoming session. Viewing them may work better if you save them to your machine rather than running them on the site. Other visitors, welcome as well. These PowerPoints … Continue reading

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Further Adventures of the Geriatric Doctor-in-Law 5: The Trial of Therapy

Here’s an anecdote to illustrate one of my favorite principles: trial of therapy, not high-tech investigation leading to cookbook care. Mother-in-law Liz has not been that great lately. Quite confused with no obvious cause, but also complaining of pain. Pain … Continue reading

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New website

I’m branching out. I’ve had a book-reviews page on my Sunshiners website for a long time, but I wanted to separate health care of the elderly from other interests, so there’s a new site for book reviews and also comments … Continue reading

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Dr Sloan Speaking 2

I’ve found another video on YouTube of me addressing a small audience about care of frailty. Click here .

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Permission Not To

Getting on in a medical career, especially caring for elderly people whose priorities don’t tend to be technically-based or even specific, I sometimes suspect that my value to people if any is sort of symbolic. Not the white coat exactly … Continue reading

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HOUSE CALLS 5: Cross-Cultural Crossed Wires

Mrs. Hii is an 85-year-old Chinese lady who speaks Mandarin when she speaks at all. She lives in a big condominium apartment with her husband who is a long-retired health professional. Poor Mrs. Hii has an incurable and advanced relentlessly … Continue reading

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Further Adventures of the Geriatric Doctor-in-law 4: Is This Reality?

It’s been awhile since I’ve posted about my in-laws, Liz and Nigel (awhile since I’ve posted on anything…). They’re doing fine, in some ways. But having them close to us and being our responsibility worries me a bit, and not … Continue reading

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Tired Eyes: Why High-tech Medicine Doesn’t Work

There are a lot of wonderful things about general medical practice, but like anything else it occasionally gets, well, tiring. A fourth worried-well general physical exam at the end of a long afternoon is not something most doctors look forward … Continue reading

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New England Programs II: Slow Medicine and Dr Dennis McCullough

I’ve held off posting about Dr. Dennis McCullough, whom I visited back in September, because I wanted to finish his book and also hear him speak. He visited us in Vancouver this past weekend and gave two impressive presentations, so … Continue reading

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New England Programs I: Full Circle America

In September I did another holiday-cum-healthcare-research road trip, this time to those northeastern US states referred to as New England: Massachusetts, Rhode Island, New Hampshire, Maine, Vermont. I was privileged to visit and meet with the leaders of two programs … Continue reading

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The Missing Ingredient in Medicine: TRUST

A friend of mine is interested in trust. Not the kind that lawyers and bankers deal with, but the strong intermolecular force that makes human interaction possible. If you catch a lawyer or banker at the end of the day … Continue reading

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Further Adventures of the Geriatric-Doctor-in-Law 3

We are now many months into the bold experiment of looking after Robin’s frail parents in their Roberts Creek home. Avid readers will recall our success at getting Nigel out of a nursing home and Liz out of the acute … Continue reading

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Human Health Science

My campaign to encourage what I see as common sense in care of frail people gets tangled up with another interesting controversy.  It’s got several names: patient-centered care, patients’ rights, shared care, and others. The idea is that whereas traditional … Continue reading

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HOUSE CALLS 4

Nothing’s perfect. But I don’t think it’s too much to expect for things to work out acceptably, at least some of the time. There follows a sad story with only an ambiguous and implied moral. Dusan Havel (not his real … Continue reading

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Bad Hospital Care: Fragmentation Equals Trouble

When I was working in a small hospital in the city many years ago, nursing administration decided that all nurses were to rotate through all the services. Operating room nurses had to do a shift in emerg and on a … Continue reading

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House Calls 3: When the Doctor Makes a Mistake

I’ve been impressed by (and I’m envious of) some physician authors I’ve read lately, including Abraham Verghese and Nortin Hadler. But I was particularly dazzled by Harvard surgeon Atul Gawande’s book Complications . This was not a confessional about a … Continue reading

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Dr. Sloan is on Twitter

Whatever the social and psychological consequences may be, I’ve signed up for Twitter today. It’s taken me a while to decide to do this because somehow I associate the facility with kids trying to keep track of one another on … Continue reading

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Further Adventures of the Geriatric Doctor-in-Law 2

Readers of my website will understand that over the last couple of years I’ve had a dose of care of frailty from the consumer’s side, once removed. My wife’s parents, Liz and Nigel (both in their 80s) have become more … Continue reading

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House Calls 2

For a several years I was family doctor to a lady I’ll call June Cunningham, who lived in an expensive private assisted living facility. June was an American Pollyanna of the frontier persuasion who would usually say something like, “Doctor, … Continue reading

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I’m Blogging for the Vancouver Province

Thanks to the kindness of Vancouver Province editors Ros Guggi and Erik Rolfsen, I’ve been invited to provide posts for the Province blog on my favorite topic of home care for the elderly. I plan to continue to post right … Continue reading

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The REAL Reason Agitation is a Problem in Dementia

Further to the fuss in my last post over Global TV, here’s my loonie’s worth of opinion on what we in healthcare call “Agitation in Dementia”. What would having severe dementia feel like? Well we understand that for demented people … Continue reading

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Globaloney

It has a new meaning! Global TV’s “15 x 9” revealed to me last week a spectacular level of journalism nonsense and dishonesty. Here’s what happened. A producer called and asked if I would appear on TV giving my opinions … Continue reading

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House Calls 1

Under this heading, I’m going to post a few anecdotes of my home-care practice experience. I hope these will be taken in the spirit in which they are intended. That is a window on a peculiar kind of practice which … Continue reading

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