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January 8, 2017

District of North Vancouver Garbage

The District of North Vancouver is implementing a new garbage collection scheme in 2017. Single family homes will be given two 240 litre wheeled carts, one for household waste, the other for organics. By comparison, the large Schaefer cart now in use is 360 litres but a extra garbage fee is charged if it is more than half full.

For most people, for most of the year, the new system will have advantages. Hopefully it will reduce back injuries for District workers. For gardeners and those "blessed" with large maples or chestnut trees on the District's boulevard, parts of the scheme looks like it was designed by a condo dweller who has never raked leaves. The District's website says: "You can use your old containers to store leaves or extra yard waste in the spring and fall, and continue to fill your cart each week with the stored organics (but remember you can't put your old containers out for collection)." They’ve got to be kidding; I expect to see many people simply rake their leaves into the street.

A sensible policy would supplement the cart pickup with the pickup of paper garden bags when the leaves drop in the fall, and perhaps during spring garden cleanup. The volume of organic material in those seasons vastly exceeds the home composting capacity of most people.

March 16, 2016

Click here to see the response from Dr Wilson to my letter copied below.

One Issue per Visit

March 5, 2016

Dr. Galt Wilson
Senior Deputy Registrar
College of Physicians and Surgeons
of British Columbia
300 -669 Howe Street
Vancouver BC V6C 0B4

Dear Dr. Wilson:

Your presentation at the Walk-in-Clinic conference was the highlight of the day. Thank you for being so clear. I am writing to verify what I heard and to ask that the College’s position be posted as a standard or guideline.

When you took questions, a clinic manger from Kamloops asked if she could ask physicians at her clinics to restrict office visits to one issue per visit. You said no and went on to describe how physicians could find themselves in trouble if they did that and in particular trouble if they had signs in their office notifying patients that they had a policy of one issue per visit.

Following the conference, I searched the College's website to see if I could find anything that offered the caution you gave. Not finding anything, I broadened my search and on the Doctors of BC website (at I found:
"Some patients in BC may notice a sign at their doctor's office that limits the amount of questions they can ask in a medical visit to one. These signs are generally an office-byoffice, clinic-by-clinic decision that the doctor has made in order to reduce backlog and decrease waiting times."

"The College of Physicians and Surgeons of British Columbia, the regulatory body for medical practice in BC, says that many doctors have established a "one issue per visit" policy in order to assist them with time management and patient scheduling due to a heavy roster of patients."

"Dr Bill Cavers, past president of Doctors of BC, explains that while he doesn't like to use a sign, he does tell his patients that there is a time limit and they will have to focus on the most urgent problems for that day."

"He recommends to all patients that they be aware of time and present the doctor a written list of all health issues before the visit. The doctor can then read over them and decide if the issues are related or if some of them should be examined during the visit."
That statement on the Doctors of BC website verifies my sense that the practice of "one issue per visit" signage is common. The likelihood that all, or even most, patients are capable of presenting a physician "a written list of all health issues before the visit" is slim, and it is my opinion, those words weakly attempt to avoid the legal and ethical issues involved in "one issue" policies.

Last fall I phoned a clinic to book an appointment for my annual flu shot and requisition for blood work to monitor my cholesterol, something that usually takes about 5 minutes. I was told that two appointments would be required. I havent been to the clinic since and I sent a complaint to the Medical Services Commission asking them to investigate billing practices at the clinic. While my issue was one of cost and convenience, as you noted, there can be serious health consequences if the one visit policy results in some patients not reporting symptoms or in symptoms being ignored.

Please confirm what you told that clinic manager at the March 4th conference regarding "one issue policies" and signage. I believe as a matter of public interest and protection, those words should be added to either a standard or guideline on the College's website.


David D. Schreck