It is far easier to bring large numbers of unskilled immigrants to Canada than to produce a qualified, educated doctor to treat them. Myabe this issue is telling us that we don't have a shortage of doctors, we have an excess number of immigrants in Canada seeking medical care.

The article states immigrants come in healthy, and then worsen. No evidence is provided here for that assertion. Considering that most immigrants now come from Asia and Africa, where medical care is substandard, this does not make sense.

Provincial budgets are bursting because, in isolation, the federal govt sets immigration policy and numbers, while the provinces pay for their health and education. While there is only one taxpayer, federal and provincial policy is not coordinated here. So while we complain of gas taxes going up to pay for more transportation infrastructure and hospitals in Vancouver, the federal govt is indifferent because they don't set aside the funds for the additional population they bring in.

Doctors treating immigrants get new guide (external - login to view)

Doctors treating immigrants get new guide

CMAJ publication spells out what to look for, when to screen and what risk factors are relevant

By Louisa Taylor, Postmedia News July 26, 2011

After years of treating Canadians born in faraway lands, Dr. Kevin Pottie is reasonably confident he knows the right questions to ask when it comes to assessing the health of his patients, no matter where they're from.

Experience tells the Ottawa physician to be on the lookout for certain intestinal parasites when treating newcomers from parts of Africa, to watch for symptoms of diabetes in middle-aged men born in South Asia and signs of depression or post-traumatic stress in a refugee arriving from a war zone.

But that's because Pottie has made migration health - the treatment of an increasingly mobile global population - his professional passion.

What happens when a young woman recently arrived from the Congo enters the examining room of a family doctor in small-town Alberta or a nurse practitioner in downtown Montreal?

They're trying to get through a busy day and a full patient load, but do they know what this new patient needs from her doctor, where she has been and what her life is like now and how that will affect her health?

The answer most often is no, but a national team of medical experts and researchers are hoping that after Tuesday, Canadian practitioners will know exactly where to look for advice.

The Canadian Medical Association Journal published Tuesday the first Canadian guidelines to immigrant and refugee health, a detailed resource for primary care providers serving patients not born in Canada, whether they arrived last week or decades ago. Guidelines spell out what to look for, when to screen, when not to screen, what risk factors are relevant and more.

Led by Pottie, the Canadian Collaboration for Immigrant and Refugee Health spent six years developing the innovative guidelines with input from more than 150 family doctors, researchers, nurse practitioners and specialists.

Some of the guidelines were published in CMAJ last year, but this is the first time the full package is available.

The CMAJ's online resource includes a summary of the guidelines along with case studies covering the four main themes: infectious diseases, mental health, chronic diseases and women's health.

The underlying motivation, says Pottie, was the belief that Canada's increasing diversity is changing medicine, and practitioners need to adjust their knowledge and skills to meet the needs of their patients.

Most immigrants arrive in Canada healthier than the native-born population, but that "healthy immigrant effect" declines over time.

"A significant part of our population have not been wellserved by our current Canadian-oriented guidelines," says Pottie, a clinician and researcher with Bruyere Continuing Care and an associate professor at the University of Ottawa's Institute of Population Health.
"The changing diversity of our patients has led to the realization that we have to be much broader in our consideration of the diseases or illnesses we're routinely looking for.

A sense of fear or uncertainty about what to do can lead to overtesting or overtreating" newcomers.

Dr. Lanice Jones, a family medicine specialist practising at the Calgary Refugee Health Program, says the new guidelines will be a "reassurance" that her team is practising the best standard of medicine, but also a valuable tool she can share with family physicians who lack the specialized training she has.